• Second-line treatment for schizophrenia and psychoses after failure with atypical antipsychotics.
• Hyperexcitable, combative behavior in children.
• Bipolar disorder.
• Nausea and vomiting.
• Intractable hiccups.
• Preoperative sedation.
• Acute intermittent porphyria.

Contraindicated in:

• Hypersensitivity
• Hypersensitivity to sulfites (injectable)
• Cross-sensitivity with other phenothiazines may occur
• Angle-closure glaucoma
• Bone marrow depression
• Severe liver/cardiovascular disease
• Concurrent pimozide use
• Lactation: Lactation.

Use Cautiously in:

• Diabetes
• Respiratory disease
• Prostatic hyperplasia
• CNS tumors
• Epilepsy
• Intestinal obstruction
• OB: Neonates at ↑ risk for extrapyramidal symptoms and withdrawal after delivery when exposed during the 3rd trimester; use during pregnancy only if potential maternal benefit outweighs potential fetal risk
• Pedi: Children with acute illnesses, infections, gastroenteritis, or dehydration (↑ risk of extrapyramidal reactions)
• Geri: Appears on Beers list. ↑ risk of stroke, cognitive decline, and mortality in older adults with dementia. Avoid use in older adults, except for schizophrenia, bipolar disorder, or for short-term use as an antiemetic.

CV: hypotension (↑ with IM, IV), tachycardia.

Derm: photosensitivity, pigment changes, rash.

EENT: blurred vision, dry eyes, lens opacities.

Endo: amenorrhea, galactorrhea.

GI: constipation, dry mouth, anorexia, hepatitis, ileus, priapism.

GU: urinary retention.

Hemat: AGRANULOCYTOSIS, leukopenia.

Metab: hyperthermia.

Neuro: sedation, extrapyramidal reactions, NEUROLEPTIC MALIGNANT SYNDROME, tardive dyskinesia.
Misc: allergic reactions.

Drug-Drug:

• Pimozide ↑ the risk of potentially serious cardiovascular reactions; concurrent use contraindicated.
• May alter serum phenytoin levels.
• ↓ pressor effect of norepinephrine and eliminates bradycardia.
• Antagonizes peripheral vasoconstriction from epinephrine and may reverse some of its actions.
• May ↓ elimination and ↑ effects of valproic acid.
• May ↓ the pharmacologic effects of amphetamine and related compounds.
• May ↓ the effectiveness of bromocriptine.
• May ↑ blood levels and effects of tricyclic antidepressants.
• Antacids or adsorbent antidiarrheals may ↓ adsorption; administer 1 hr before or 2 hr after chlorpromazine.
• ↑ risk of anticholinergic effects with antihistamines, tricyclic antidepressants, quinidine, or disopyramide.
• Premedication with chlorpromazine ↑ the risk of neuromuscular excitation and hypotension when followed by barbiturate anesthesia.
• Barbiturates may ↑ metabolism and ↓ effectiveness.
• Chlorpromazine may ↓ barbiturate levels.
• Additive hypotension with antihypertensives.
• Additive CNS depression with alcohol, antidepressants, antihistamines, MAO inhibitors, opioid analgesics, sedative/hypnotics, or general anesthetics.
• Concurrent use with lithium may produce disorientation, unconsciousness, or extrapyramidal symptoms.
• Concurrent use with meperidine may produce excessive sedation and hypotension.
• Concurrent use with propranolol ↑ blood levels of both drugs.

Drug-Natural Products:

• Concomitant use of kava-kava, valerian, chamomile, or hops can ↑ CNS depression.
• ↑ anticholinergic effects with angel’s trumpet, jimson weed, and scopolia.

(Generic available)

• Tablets: 10 mg; 25 mg; 50 mg; 100 mg; 200 mg;
• Oral solution: 30 mg/mL; 100 mg/mL;
• Solution for injection: 25 mg/mL;

• PO (Adults): Psychoses: 10–25 mg 2–4 times daily; may ↑ by 20–50 mg every 3–4 days (usual dose is 200 mg/day; up to 1 g/day). Bipolar disorder: 10–25 mg 2–4 times daily; may ↑ by 20–50 mg every 3–4 days (usual dose range is 400–800 mg/day). Nausea and vomiting: 10–25 mg every 4 hr as needed. Preoperative sedation: 25–50 mg 2–3 hr before surgery. Hiccups/porphyria: 25–50 mg 3–4 times daily.
• PO (Children): Psychoses/nausea and vomiting: 0.55 mg/kg (15 mg/m²) every 4–6 hr as needed. Preoperative sedation: 0.55 mg/kg (15 mg/m²) 2–3 hr before surgery.
• IV (Adults): Nausea/vomiting during surgery: up to 25 mg. Hiccups/tetanus: 25–50 mg. Porphyria: 25 mg every 8 hr.
• IV (Children): Nausea/vomiting during surgery: 0.275 mg/kg. Tetanus: 0.55 mg/kg.
• IM (Adults): Severe psychoses: 25–50 mg initially, may be repeated in 1 hr; ↑ to maximum of 400 mg every 3–12 hr if needed (up to 1 g/day). Nausea/vomiting: 25 mg initially, may repeat with 25–50 mg every 3–4 hr as needed. Nausea/vomiting during surgery: 12.5 mg, may be repeated in 30 min as needed. Preoperative sedation: 12.5–25 mg 1–2 hr prior to surgery. Hiccups/tetanus: 25–50 mg 3–4 times daily. Porphyria: 25 mg every 6–8 hr until patient can take PO.
• IM (Children 6 mo): Psychoses/nausea and vomiting: 0.55 mg/kg (15 mg/m²) every 6–8 hr (not to exceed 40 mg/day in children 6 mo–5 yr, or 75 mg/day in children 5–12 yr). Nausea/vomiting during surgery: 0.275 mg/kg, may repeat in 30 min as needed. Preoperative sedation: 0.55 mg/kg 1–2 hr prior to surgery. Tetanus: 0.55 mg/kg every 6–8 hr.

Thorazine

• Alters the effects of dopamine in the CNS.
• Has significant anticholinergic/alpha-adrenergic blocking activity.

• Diminished signs/symptoms of psychosis and bipolar disorder.
• Relief of nausea/vomiting/intractable hiccups.
• Decreased symptoms of porphyria.

Therapeutic Classification: antiemetics, antipsychotics

Pharmacologic Classification: phenothiazines

Absorption: Variable absorption from tablets. Well absorbed following IM administration.

Distribution: Widely distributed; high CNS concentrations.

Protein Binding: ≥90%.

Metabolism/Excretion: Highly metabolized by the liver and GI mucosa. Some metabolites are active.

Half-life: 30 hr.

(antipsychotic activity, antiemetic activity, sedation)

• Advise patient to take medication as directed and not to skip doses or double up on missed doses. If a dose is missed, take within 1 hr or omit dose and return to regular schedule. Abrupt withdrawal may lead to gastritis, nausea, vomiting, dizziness, headache, tachycardia, and insomnia.
• Inform patient of possibility of extrapyramidal symptoms and tardive dyskinesia. Instruct patient to report these symptoms immediately to health care professional.
• Advise patient to change positions slowly to minimize orthostatic hypotension. Protect from falls.
• May cause drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to the medication is known.
• Caution patient to avoid taking alcohol or other CNS depressants concurrently with this medication.
• Advise patient to use sunscreen and protective clothing when exposed to the sun. Exposed surfaces may develop a temporary pigment change (ranging from yellow-brown to grayish purple). Extremes of temperature (exercise, hot weather, hot baths or showers) should also be avoided, because this drug impairs body temperature regulation.
• Instruct patient to use frequent mouth rinses, good oral hygiene, and sugarless gum or candy to minimize dry mouth. Consult health care professional if dry mouth continues for 2 wk.
• Advise patient not to take chlorpromazine within 2 hr of antacids or antidiarrheal medication.
• Inform patient that this medication may turn urine a pink-to-reddish-brown color.
• Advise patient to notify health care professional of medication regimen prior to treatment or surgery.
• Instruct patient to notify health care professional promptly if sore throat, fever, unusual bleeding or bruising, rash, weakness, tremors, visual disturbances, dark-colored urine, or clay-colored stools occur.
• Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.
• Emphasize the importance of routine follow-up exams to monitor response to medication and detect side effects. Encourage continued participation in psychotherapy as indicated.
• Treatment is not a cure; symptoms may recur after discontinuation of medication.

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