A Cochrane review [Abstract] 1 included 55 studies with 5506 patients with schizophrenia. The mean chlorpromazine dose was 574 mg/day. The most common study length was 6 to 12 weeks, most studies were undertaken in hospital. Chlorpromazine reduced the number of participants experiencing a relapse compared with placebo during 6 months to 2 years follow-up (RR 0.65, CI 0.47 to 0.90; 3 RCTs, n = 512). No difference was found in relapse rates in the short, medium or long term over two years. We found chlorpromazine provided a global improvement in a person's symptoms and functioning (RR 0.71, CI 0.58 to 0.86; 14 RCTs, n = 1164). Fewer people allocated to chlorpromazine left trials early compared with placebo (RR 0.64, CI 0.53 to 0.78; 27 RCTs, n = 1831). However, there are many adverse effects. Chlorpromazine is clearly sedating (RR 2.79, CI 2.25 to 3.45; 23 RCTs, n = 1627), it increases a person's chances of experiencing acute movement disorders (RR 3.47, CI 1.50 to 8.03; 5 RCTs, n = 942) and parkinsonism (RR 2.11, CI 1.59 to 2.80; 15 RCTs, n = 1468). Akathisia did not occur more often in the chlorpromazine group than placebo. Chlorpromazine clearly causes a lowering of blood pressure with accompanying dizziness (RR 2.38, CI 1.74 to 3.25; 18 RCTs, n = 1488) and considerable weight gain (RR 4.92, CI 2.32 to 10.43; 5 RCTs, n = 165).
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment) and indirectness (short follow-up time, mostly in-patients involved, the majority of trials are old)
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