chlorpromazine

BEERS REMS

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.

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

Therapeutic Effects:

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)

ROUTE	ONSET	PEAK	DURATION
PO	30–60 min	unknown	4–6 hr
IM	unknown	unknown	4–8 hr
IV	rapid	unknown	unknown

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.
Rep: 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.

NDC Code^*

0641- West-Ward Pharmaceuticals Corp.
0641-1397- Chlorpromazine hydrochloride 0641-1397-35- 25 AMPULE in 1 CARTON (0641-1397-35) > 1 mL in 1 AMPULE (0641-1397-31)

0641- West-Ward Pharmaceuticals Corp.
0641-1398- Chlorpromazine hydrochloride 0641-1398-35- 25 AMPULE in 1 CARTON (0641-1398-35) > 2 mL in 1 AMPULE (0641-1398-31)

0781- Sandoz Inc
0781-5913- Chlorpromazine Hydrochloride 0781-5913-01- 100 TABLET, SUGAR COATED in 1 BOTTLE (0781-5913-01)

0781- Sandoz Inc
0781-5914- Chlorpromazine Hydrochloride 0781-5914-01- 100 TABLET, SUGAR COATED in 1 BOTTLE (0781-5914-01)

0781- Sandoz Inc
0781-5915- Chlorpromazine Hydrochloride 0781-5915-01- 100 TABLET, SUGAR COATED in 1 BOTTLE (0781-5915-01)

0781- Sandoz Inc
0781-5916- Chlorpromazine Hydrochloride 0781-5916-01- 100 TABLET, SUGAR COATED in 1 BOTTLE (0781-5916-01)

0781- Sandoz Inc
0781-5917- Chlorpromazine Hydrochloride 0781-5917-01- 100 TABLET, SUGAR COATED in 1 BOTTLE (0781-5917-01)

0832- Upsher-Smith Laboratories, Inc.
0832-0300- Chlorpromazine Hydrochloride 0832-0300-00- 100 TABLET, SUGAR COATED in 1 BOTTLE (0832-0300-00)

0832- Upsher-Smith Laboratories, Inc.
0832-0300- Chlorpromazine Hydrochloride 0832-0300-10- 1000 TABLET, SUGAR COATED in 1 BOTTLE (0832-0300-10)

0832- Upsher-Smith Laboratories, Inc.
0832-0301- Chlorpromazine Hydrochloride 0832-0301-00- 100 TABLET, SUGAR COATED in 1 BOTTLE (0832-0301-00)

0832- Upsher-Smith Laboratories, Inc.
0832-0301- Chlorpromazine Hydrochloride 0832-0301-01- 100 BLISTER PACK in 1 CARTON (0832-0301-01) > 1 TABLET, SUGAR COATED in 1 BLISTER PACK (0832-0301-89)

0832- Upsher-Smith Laboratories, Inc.
0832-0301- Chlorpromazine Hydrochloride 0832-0301-10- 1000 TABLET, SUGAR COATED in 1 BOTTLE (0832-0301-10)

0832- Upsher-Smith Laboratories, Inc.
0832-0302- Chlorpromazine Hydrochloride 0832-0302-00- 100 TABLET, SUGAR COATED in 1 BOTTLE (0832-0302-00)

0832- Upsher-Smith Laboratories, Inc.
0832-0302- Chlorpromazine Hydrochloride 0832-0302-01- 100 BLISTER PACK in 1 CARTON (0832-0302-01) > 1 TABLET, SUGAR COATED in 1 BLISTER PACK (0832-0302-89)

0832- Upsher-Smith Laboratories, Inc.
0832-0302- Chlorpromazine Hydrochloride 0832-0302-10- 1000 TABLET, SUGAR COATED in 1 BOTTLE (0832-0302-10)

0832- Upsher-Smith Laboratories, Inc.
0832-0303- Chlorpromazine Hydrochloride 0832-0303-00- 100 TABLET, SUGAR COATED in 1 BOTTLE (0832-0303-00)

0832- Upsher-Smith Laboratories, Inc.
0832-0303- Chlorpromazine Hydrochloride 0832-0303-01- 100 BLISTER PACK in 1 CARTON (0832-0303-01) > 1 TABLET, SUGAR COATED in 1 BLISTER PACK (0832-0303-89)

0832- Upsher-Smith Laboratories, Inc.
0832-0303- Chlorpromazine Hydrochloride 0832-0303-10- 1000 TABLET, SUGAR COATED in 1 BOTTLE (0832-0303-10)

0832- Upsher-Smith Laboratories, Inc.
0832-0304- Chlorpromazine Hydrochloride 0832-0304-00- 100 TABLET, SUGAR COATED in 1 BOTTLE (0832-0304-00)

0832- Upsher-Smith Laboratories, Inc.
0832-0304- Chlorpromazine Hydrochloride 0832-0304-01- 100 BLISTER PACK in 1 CARTON (0832-0304-01) > 1 TABLET, SUGAR COATED in 1 BLISTER PACK (0832-0304-89)

0832- Upsher-Smith Laboratories, Inc.
0832-0304- Chlorpromazine Hydrochloride 0832-0304-10- 1000 TABLET, SUGAR COATED in 1 BOTTLE (0832-0304-10)

0904- Major Pharmaceuticals
0904-6892- CHLORPROMAZINE HYDROCHLORIDE 0904-6892-61- 100 BLISTER PACK in 1 CARTON (0904-6892-61) > 1 TABLET, FILM COATED in 1 BLISTER PACK

0904- Major Pharmaceuticals
0904-6893- CHLORPROMAZINE HYDROCHLORIDE 0904-6893-61- 100 BLISTER PACK in 1 CARTON (0904-6893-61) > 1 TABLET, FILM COATED in 1 BLISTER PACK

0904- Major Pharmaceuticals
0904-6894- CHLORPROMAZINE HYDROCHLORIDE 0904-6894-61- 100 BLISTER PACK in 1 CARTON (0904-6894-61) > 1 TABLET, FILM COATED in 1 BLISTER PACK

0904- Major Pharmaceuticals
0904-6895- CHLORPROMAZINE HYDROCHLORIDE 0904-6895-61- 100 BLISTER PACK in 1 CARTON (0904-6895-61) > 1 TABLET, FILM COATED in 1 BLISTER PACK

0904- Major Pharmaceuticals
0904-6896- CHLORPROMAZINE HYDROCHLORIDE 0904-6896-61- 100 BLISTER PACK in 1 CARTON (0904-6896-61) > 1 TABLET, FILM COATED in 1 BLISTER PACK

50090- A-S Medication Solutions
50090-2865- Chlorpromazine Hydrochloride 50090-2865-0- 32 TABLET, SUGAR COATED in 1 BOTTLE, UNIT-DOSE (50090-2865-0)

51079- Mylan Institutional Inc.
51079-130- Chlorpromazine Hydrochloride 51079-130-20- 100 BLISTER PACK in 1 CARTON (51079-130-20) > 1 TABLET, SUGAR COATED in 1 BLISTER PACK (51079-130-01)

51079- Mylan Institutional Inc.
51079-516- Chlorpromazine Hydrochloride 51079-516-20- 100 BLISTER PACK in 1 CARTON (51079-516-20) > 1 TABLET, SUGAR COATED in 1 BLISTER PACK (51079-516-01)

51079- Mylan Institutional Inc.
51079-517- Chlorpromazine Hydrochloride 51079-517-20- 100 BLISTER PACK in 1 CARTON (51079-517-20) > 1 TABLET, SUGAR COATED in 1 BLISTER PACK (51079-517-01)

51079- Mylan Institutional Inc.
51079-518- Chlorpromazine Hydrochloride 51079-518-20- 100 BLISTER PACK in 1 CARTON (51079-518-20) > 1 TABLET, SUGAR COATED in 1 BLISTER PACK (51079-518-01)

51079- Mylan Institutional Inc.
51079-519- Chlorpromazine Hydrochloride 51079-519-20- 100 BLISTER PACK in 1 CARTON (51079-519-20) > 1 TABLET, SUGAR COATED in 1 BLISTER PACK (51079-519-01)

52584- General Injectables and Vaccines, Inc.
52584-397- CHLORPROMAZINE HYDROCHLORIDE 52584-397-31- 1 AMPULE in 1 BAG (52584-397-31) > 1 mL in 1 AMPULE

53808- DOH CENTRAL PHARMACY
53808-1104- Chlorpromazine Hydrochloride 53808-1104-1- 30 TABLET, SUGAR COATED in 1 BLISTER PACK (53808-1104-1)

60687- American Health Packaging
60687-419- CHLORPROMAZINE HYDROCHLORIDE 60687-419-01- 100 BLISTER PACK in 1 BOX, UNIT-DOSE (60687-419-01) > 1 TABLET, FILM COATED in 1 BLISTER PACK (60687-419-11)

60687- American Health Packaging
60687-430- CHLORPROMAZINE HYDROCHLORIDE 60687-430-01- 100 BLISTER PACK in 1 BOX, UNIT-DOSE (60687-430-01) > 1 TABLET, FILM COATED in 1 BLISTER PACK (60687-430-11)

60687- American Health Packaging
60687-441- CHLORPROMAZINE HYDROCHLORIDE 60687-441-01- 100 BLISTER PACK in 1 BOX, UNIT-DOSE (60687-441-01) > 1 TABLET, FILM COATED in 1 BLISTER PACK (60687-441-11)

60687- American Health Packaging
60687-452- CHLORPROMAZINE HYDROCHLORIDE 60687-452-01- 100 BLISTER PACK in 1 BOX, UNIT-DOSE (60687-452-01) > 1 TABLET, FILM COATED in 1 BLISTER PACK (60687-452-11)

60687- American Health Packaging
60687-463- CHLORPROMAZINE HYDROCHLORIDE 60687-463-01- 100 BLISTER PACK in 1 BOX, UNIT-DOSE (60687-463-01) > 1 TABLET, FILM COATED in 1 BLISTER PACK (60687-463-11)

68151- Carilion Materials Management
68151-2479- Chlorpromazine Hydrochloride 68151-2479-1- 1 TABLET, SUGAR COATED in 1 BLISTER PACK (68151-2479-1)

68428- Washington Homeopathic Products
68428-314- Chlorpromazinum 68428-314-03- 75 PELLET in 1 VIAL, GLASS (68428-314-03)

68428- Washington Homeopathic Products
68428-314- Chlorpromazinum 68428-314-05- 150 PELLET in 1 VIAL, GLASS (68428-314-05)

68428- Washington Homeopathic Products
68428-314- Chlorpromazinum 68428-314-06- 1200 PELLET in 1 BOTTLE, GLASS (68428-314-06)

68428- Washington Homeopathic Products
68428-314- Chlorpromazinum 68428-314-11- 300 PELLET in 1 BOTTLE, GLASS (68428-314-11)

68428- Washington Homeopathic Products
68428-314- Chlorpromazinum 68428-314-12- 600 PELLET in 1 BOTTLE, GLASS (68428-314-12)

69238- Amneal Pharmaceuticals NY LLC
69238-1054- CHLORPROMAZINE HYDROCHLORIDE 69238-1054-1- 100 TABLET, FILM COATED in 1 BOTTLE (69238-1054-1)

69238- Amneal Pharmaceuticals NY LLC
69238-1056- CHLORPROMAZINE HYDROCHLORIDE 69238-1056-1- 100 TABLET, FILM COATED in 1 BOTTLE (69238-1056-1)

69238- Amneal Pharmaceuticals NY LLC
69238-1058- CHLORPROMAZINE HYDROCHLORIDE 69238-1058-1- 100 TABLET, FILM COATED in 1 BOTTLE (69238-1058-1)

69238- Amneal Pharmaceuticals NY LLC
69238-1060- CHLORPROMAZINE HYDROCHLORIDE 69238-1060-1- 100 TABLET, FILM COATED in 1 BOTTLE (69238-1060-1)

69238- Amneal Pharmaceuticals NY LLC
69238-1062- CHLORPROMAZINE HYDROCHLORIDE 69238-1062-1- 100 TABLET, FILM COATED in 1 BOTTLE (69238-1062-1)

70518- REMEDYREPACK INC.
70518-0016- Chlorpromazine Hydrochloride 70518-0016-0- 30 TABLET, SUGAR COATED in 1 BLISTER PACK (70518-0016-0)

70518- REMEDYREPACK INC.
70518-0016- Chlorpromazine Hydrochloride 70518-0016-1- 100 POUCH in 1 BOX (70518-0016-1) > 1 TABLET, SUGAR COATED in 1 POUCH (70518-0016-2)

70518- REMEDYREPACK INC.
70518-1440- Chlorpromazine Hydrochloride 70518-1440-0- 30 TABLET, SUGAR COATED in 1 BLISTER PACK (70518-1440-0)

70518- REMEDYREPACK INC.
70518-1608- Chlorpromazine Hydrochloride 70518-1608-0- 30 TABLET, SUGAR COATED in 1 BLISTER PACK (70518-1608-0)

70518- REMEDYREPACK INC.
70518-1671- Chlorpromazine Hydrochloride 70518-1671-0- 30 TABLET, SUGAR COATED in 1 BLISTER PACK (70518-1671-0)

70518- REMEDYREPACK INC.
70518-1995- Chlorpromazine Hydrochloride 70518-1995-0- 30 TABLET, SUGAR COATED in 1 BLISTER PACK (70518-1995-0)

70518- REMEDYREPACK INC.
70518-1996- Chlorpromazine Hydrochloride 70518-1996-0- 30 TABLET, SUGAR COATED in 1 BLISTER PACK (70518-1996-0)

70518- REMEDYREPACK INC.
70518-2035- Chlorpromazine Hydrochloride 70518-2035-0- 100 POUCH in 1 BOX (70518-2035-0) > 1 TABLET, SUGAR COATED in 1 POUCH (70518-2035-1)

70518- REMEDYREPACK INC.
70518-2035- Chlorpromazine Hydrochloride 70518-2035-2- 30 TABLET, SUGAR COATED in 1 BLISTER PACK (70518-2035-2)

71919- Washington Homeopathic Products
71919-193- Chlorpromazinum 71919-193-07- 15 mL in 1 VIAL, GLASS (71919-193-07)

71919- Washington Homeopathic Products
71919-193- Chlorpromazinum 71919-193-08- 30 mL in 1 VIAL, GLASS (71919-193-08)

71919- Washington Homeopathic Products
71919-193- Chlorpromazinum 71919-193-09- 50 mL in 1 BOTTLE, GLASS (71919-193-09)

71919- Washington Homeopathic Products
71919-193- Chlorpromazinum 71919-193-10- 100 mL in 1 BOTTLE, GLASS (71919-193-10)

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Indications ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Availability ⬆ ⬇

Route/Dosage ⬆ ⬇

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Classifications ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Pronunciation ⬆ ⬇

Code ⬆