Chlorpromazine

Registered South African indications:

• Psychotic conditions
• Hyperkinetic states
• Anxiety
• Schizophrenia
• Hiccups
• Mania

Contraindications

• Hypersensitivity to the active ingredient or any of its excipients
• Breastfeeding
• Bone marrow depression
• Agranulocytosis
• Closed angle glaucoma
• Risk of urinary retention related to urethroprostatic disorders
• Hypothyroidism
• Cardiac failure
• Pheochromocytoma
• Myasthenia gravis
• Central nervous system depression
• Coma
• Gluten allergy or intolerance (tab)
• Galactose intolerance (tab)
• Lapp lactase deficiency (tab)
• Glucose-galactose malabsorption (tab)
• Coadministration with dopaminergic antiparkinsonism agents
• Coadministration with citalopram
• Coadministration with escitalopram

Cautions

• Pregnancy
• Renal impairment
• Hepatic impairment
• Elderly
• Blood dyscrasias
• Bradycardia
• Electrolyte imbalance
• Congenital or acquired QT prolongation
• Cardiovascular disease
• Parkinson's disease
• Risk factors for venous thromboembolism
• Risk factors for stroke
• Elderly
• Dementia-related psychosis
• Excessive exposure to sun
• Impaired body temperature regulation
• Diabetes mellitus
• Seizure disorders
• Prolonged treatment 
• Avoid abrupt withdrawal  
• Monotherapy where depression is predominant
• Sulphite allergy (inj)  
• Children

Forms avail. in SA and covered in this monograph: tab, inj

Chronic psychosis
Schizophrenia
Anxiety
Agitation
Mania

• Oral (tab): Initial: 25mg, 8hrly OR 75mg, dly at night; Titrate by 25mg, dly until effective maintenance dose reached; Usual range: 75-300mg, dly; Max: 1g/24hrly
• IM: 25-50mg; May be repeated 6-8hrly

Hiccups

• Oral (tab): 25-50mg, 6-8hrly
• IM/IV: 25-50mg

Nausea and vomiting in terminal illness

• Oral (tab): 10-25mg, 4-6hrly
• IM: 25-50mg; May be repeated 3-4hrly until vomiting stops, then change to oral

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Oral route should be used when possible

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Deep IM injection is the route of choice in most severe cases₅

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IM admin: Inject slowly and deeply into upper outer quadrant of the buttock. Patient should remain lying down for at least 30min after injection to avoid possible hypotensive effects

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IV admin: Add 24ml sodium chloride to 25mg (1ml) chlorpromazine OR 500-1000ml sodium chloride to 25-50mg chlorpromazine 

Paed. forms avail. in SA and covered in this monograph: inj, tab

Neonatal tetanus-sedation of non-ventilated patients

• Oral (tab): 1mg/kg, 8hrly via nasogastric tube

Schizophrenia
Psychoses
Anxiety
Agitation
Mania

Younger than 1 year

• Not established for use

Between 1-5 years

• Oral (tab): 0.5mg/kg, 4-6hrly; Max: 40mg/24hrs
• IM/IV: 0.5mg/kg, 6-8hrly; Max: 40mg/24hrs

Between 6-12 years

• IM/IV/Oral (tab):1/3-1/2 adult dose; Max: 75mg/24hrs

Older than 12 years

• See adult dosage

Nausea and vomiting in terminal illness

Younger than 1 year

• Not established for use 

Between 1-5 years

• Oral (tab): 0.5mg/kg, 4-6hrly; Max: 40mg/24hrs
• IM/IV: 0.5mg/kg, 6-12hrly; Max: 40mg/24hrs

Between 6-12 years

• Oral (tab): 0.5mg/kg, 4-6hrly; Max: 75mg/24hrs
• IM/IV: 0.5mg/kg, 6-12hrly; Max: 75mg/24hrs

Older than 12 years

• See adult dosage

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Oral route should be used when possible

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Deep IM injection is the route of choice in most severe cases₅

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IM admin: Inject slowly and deeply into upper outer quadrant of the buttock. Patient should remain lying down for at least 30min after injection to avoid possible hypotensive effects

Pregnancy

• Caution
• A large amount of exposure to chlorpromazine during pregnancy did not reveal any teratogenic effect. However, there is evidence of harmful effects in animals, so like other drugs, it should be avoided during pregnancy unless essential. It may occasionally prolong labour and at such a time should be withheld until the cervix is dilated 3-4cm
• It is advised to keep an adequate maternal psychic balance during pregnancy in order to avoid decompensation. If a treatment is necessary to ensure this balance, the treatment should be started or continued at effective dose all through the pregnancy
• Neonates exposed to antipsychotics (including chlorpromazine) during the third trimester of pregnancy are at risk of adverse reactions including extrapyramidal and/or withdrawal symptoms that may vary in severity and duration following delivery. There have been reports of agitation, hypertonia, hypotonia, tremor, somnolence, respiratory distress, or feeding disorder. Consequently, newborns should be monitored carefully

Breastfeeding

• Contraindicated
• Chlorpromazine is excreted in milk, breastfeeding is not recommended during treatment

Renal Impairment

• Caution; no dose adjustment recommended

Hepatic Impairment

• Caution; no dose adjustment recommended

Elderly

• Caution; dose adjustment recommended
  Initial: 33-50% of usual dose; Titrate gradually to achieve therapeutic effect

Porphyria Information

• Not porphyrinogenic (NP)

Drugs in Sport

• Permitted - No warnings

Central Nervous System Disorders

• Anxiety
• Lethargy
• Altered mood 
• Sedation
• Somnolence
• Extrapyramidal movement disorders
• Hypertonia
• Seizures 
• Hyperkinesia
• Neuroleptic malignant syndrome 
• Parkinsonism 
• Insomnia
• Neonatal drug withdrawal syndrome

Cardiovascular Disorders

• ECG changes 
• Cardiac arrhythmias
• Ventricular fibrillation
• Ventricular tachycardia
• Torsade de pointes
• Cardiac arrest
• Sudden cardiac death 
• Orthostatic hypotension 
• Venous embolism
• Pulmonary embolism
• Deep vein thrombosis 
• Postural hypotension

Respiratory Disorders

• Respiratory depression
• Nasal congestion 

Gastrointestinal Disorders

• Dry mouth
• Constipation 
• Colitis ischaemic
• Paralytic ileus
• Intestinal perforation 
• Gastrointestinal necrosis 
• Necrotising colitis 
• Intestinal obstruction

Hepatobiliary Disorders

• Jaundice cholestatic
• Cholestatic hepatic injury

Genitourinary Disorders

• Urinary retention
• Priapism

Endocrine and Metabolic Disorders

• Hyperprolactinaemia
• Amenorrhoea
• Galactorrhoea
• Gynaecomastia
• Erectile dysfunction
• Impotence
• Female sexual arousal disorder
• Increased weight 
• Glucose tolerance impaired 
• Hyperglycaemia 
• Hypertriglyceridaemia
• Hyponatraemia
• Inappropriate antidiuretic hormone secretion
• Temperature regulation disorder

Musculoskeletal Disorders

• Torticollis
• Trismus

 Skin and Subcutaneous Tissue Disorders

• Allergic dermatitis 
• Angioedema
• Contact skin sensitisation 
• Skin rashes
• Urticaria
• Photosensitivity reaction

Immune, Blood and Lymphatic System Disorders

• Agranulocytosis
• Leucopenia
• Systemic lupus erythematosus
• Antinuclear antibody positive
• Bronchospasm
• Anaphylactic reactions

Sensory Disorders

• Accommodation disorder
• Eye deposits
• Ocular changes
• Oculogyric crisis

• Dopaminergics
• Citalopram 
• Escitalopram
• Adrenaline
• Anticholinergics
• Amphetamine
• Clonidine
• Antihypertensives
• Propranolol
• Myelosuppressive agents
• Guanethidine
• Deferoxamine
• Carbamazepine 
• Cytotoxics
• QT prolonging agents
• Alcohol
• Lithium
• Anti-diabetic agents
• Antacids
• Antiparkinsonism agents
• Central nervous system depressants

• ECG

Specific cases may require

• Full blood count
• Blood glucose
• Vital signs
• Ophthalmic examination

Chlorpromazine Tablet - EML (Primary)

Chlorpromazine acts as an antagonist on postsynaptic dopaminergic receptors. It also acts as an antagonist on serotonergic receptors, histaminergic receptors, muscarinic receptors, alpha-1 and alpha2 receptors.

Tablet 25mg

• Largactil (Sanofi)

Tablet 50mg

• Largactil (Sanofi)

Tablet 100mg

• Largactil (Sanofi)

Injection (per 1ml) 25mg

• Chlorpromazine Hcl Fresenius (Fresenius)

Injection (per 2ml) 50mg

• Chlorpromazine Hcl Fresenius (Fresenius)