Adult Dosing
Psychotic Disorders
- 200 mg PO qd, gradually increase the dosage until symptoms are controlled [Max: 800 mg/day]
- Continue optimum dosage for 2 wks; then gradually reduce dosage to the lowest effective maintenance level
Acute Schizophrenic or Manic States
Hospitalized Patients
- Chlorpromazine injection until patient is controlled; usually patient becomes quiet and cooperative within 24-48 hrs and then substitute with oral doses
- 500 mg PO qd, may gradually increase the dose [Max: 2000 mg/day]
Less Acutely Disturbed
- 25 mg PO tid, increase gradually until effective dose is reached [Max: 400 mg/day]
Outpatients
- 10 mg PO tid-qid or 25 PO mg bid-tid
More Severe Cases
- 25 mg PO tid. After 1-2 days, increase dose by 20-50 mg at semi-weekly intervals until patient becomes calm and cooperative
Prompt Control of Severe Symptoms
- Initially give chlorpromazine intramuscular and then give subsequent oral dose of 25-50 mg tid
Nausea and Vomiting
- 10-25 mg PO q4-6 hrs PRN, increase if necessary
Presurgical Apprehension
- 25-50 mg PO, 2-3 hrs before the operation
Intractable Hiccups
- 25-50 mg PO tid-qid. If symptoms persist for 2-3 days, parenteral therapy is indicated
Acute Intermittent Porphyria
- 25-50 mg PO tid-qid, can be discontinued after several wks, but maintenance therapy may be necessary for some patients
Pediatric Dosing
- Chlorpromazine should not be used in pediatric patients <6 months of age except where potentially life saving
Severe Behavioral Problems
- Outpatients: 0.25 mg/lb body weight PO q4-6 hrs, PRN
- Hospitalized Patients: Start with lower dose and increase gradually; 50-100 mg PO qd and 200 mg PO qd in older children: [Max: 500 mg/day]
Nausea and Vomiting
- 0.25 mg/lb body weight PO q4-6 hrs, PRN
Presurgical Apprehension
- 0.25 mg/lb body weight PO 2-3 hrs before operation
[Outline]
See Supplemental Patient Information
- Increased mortality in elderly patients with dementia-related psychosis, hence not approved for the treatment of patients with dementia-related psychosis [US Black Box Warning]
- Chlorpromazine can cause extrapyramidal symptoms which may be confused with the central nervous system signs of an undiagnosed primary disease responsible for the vomiting; e.g., Reye's syndrome or other encephalopathy
- Avoid use of chlorpromazine and other potential hepatotoxins in children and adolescents whose signs and symptoms suggest Reye's syndrome
- Tardive dyskinesia, characterized by irreversible, involuntary, dyskinetic movements, may develop with antipsychotic drugs more likely in elderly female patients; discontinue the drug on appearance of signs and symptoms of tardive dyskinesia
- Antipsychotic drugs may cause neuroleptic malignant syndrome (NMS), which is clinically manifested as hyperpyrexia, muscle rigidity, altered mental status, and autonomic instability; immediately discontinue the drug and provide intensive symptomatic treatment and medical monitoring
- If a patient requires antipsychotic drug treatment after recovery from NMS, reintroduction of drug therapy should be carefully considered and carefully monitor the patient as NMS can recur
- Leukopenia, neutropenia and agranulocytosis may occur with antipsychotic agents. Monitor CBC frequently during the first few months of therapy and discontinue the drug at the first sign of reduced WBC
- As chlorpromazine is a CNS depressant, use cautiously in patients with chronic respiratory disorders such as severe asthma, emphysema and acute respiratory infections, particularly in children (1 to 12 years of age)
- Because chlorpromazine can suppress the cough reflex, aspiration of vomitus is possible
- As chlorpromazine prolongs and intensifies the action of CNS depressants such as anesthetics, barbiturates and narcotics, administer 1/4-1/2 the usual dosage of chlorpromazine when used concomitantly with these drugs or stop such depressants before starting chlorpromazine treatment
- Chlorpromazine diminishes the effect of oral anticoagulants
- Do not give chlorpromazine in patients with bone marrow depression or who have previously demonstrated a hypersensitivity reaction (e.g., blood dyscrasias, jaundice) unless the potential benefits of treatment outweigh the possible hazard
- May impair judgment, thinking or motor skills; caution patients against the use of hazardous machinery, automobiles
- To lessen the likelihood of adverse reactions, patients on long-term therapy with chlorpromazine and/or other antipsychotics should be evaluated periodically to decide whether the maintenance dosage could be lowered or drug therapy discontinued
- Because of the anti-emetic action of chlorpromazine, it may mask the signs and symptoms of overdosage of other drugs and may obscure the diagnosis and treatment of other conditions such as intestinal obstruction, brain tumor and Reye's syndrome
- Advise patients to avoid alcohol as it can cause additive effects and hypotension
- Abrupt withdrawal of high-dose therapy can cause symptoms resembling those of physical dependence such as gastritis, nausea and vomiting, dizziness and tremulousness; gradually withdraw the drug by reducing the dosage
- Use cautiously in patients exposed to organophosphorus insecticides and in those receiving atropine or related drugs
Cautions: use cautiously in
- Liver diseases
- Renal diseases
- Cardiovascular diseases
- Glaucoma
- History of low WBC
- History of drug-induced leukopenia/neutropenia
- High environmental temperature
Supplemental Patient Information
- Chlorpromazine impairs judgement, thinking, or motor skills; advise patients not to drive automobiles or operate hazardous machinery
- Advise patients to avoid alcohol during therapy
Pregnancy Category:C
Breastfeeding: Chlorpromazine is detectable in the milk of some mothers during therapy; drowsiness was seen in some breastfed infants during maternal chlorpromazine therapy. Very limited long-term data on chlorpromazine indicate no adverse effects on development of infants when the drug is used alone; however, using in combination with haloperidol can negatively affect development. Monitor the infant for excessive drowsiness during breastfeeding and for developmental milestones, especially if other antipsychotics are used concurrently. This data is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 31 Jan 2011). As per the manufacturer's data, because of the potential for serious adverse reactions in nursing infants from chlorpromazine, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
Pricing data from www.DrugStore.com in U.S.A.
- ChlorproMAZINE HCl 25 MG TABS [Bottle] (UPSHER-SMITH)
60 mg = $79.36
180 mg = $183.12 - ChlorproMAZINE HCl 100 MG TABS [Bottle] (UPSHER-SMITH)
60 mg = $182.99
180 mg = $424.95 - ChlorproMAZINE HCl 10 MG TABS [Bottle] (UPSHER-SMITH)
60 mg = $52.99
120 mg = $94.48 - ChlorproMAZINE HCl 200 MG TABS [Bottle] (UPSHER-SMITH)
60 mg = $114.08
180 mg = $295.86
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
