Chlorpromazine

 

Ingredients

Active ingredients: Thorazine (chlorpromazine) is 10-(3-dimethylaminopropyl)-2-chlorphenothiazine, a dimethylamine derivative of phenothiazine

 

Non-active: Benzoic acid, croscarmellose, lactose, magnesium stearate, methylparaben, polyethylene glycol, propylparaben, talc, titanium dioxide and trace amounts of other inactive ingredients.

 

Indications

Thorazine is used in the treatment of schizophrenia. In addition it can be used to treat nausea and vomiting, restlessness and apprehension before surgery, acute porphyria, relief of intractable hiccups, treatment of manic-depressive illness and it can also be used for treatment of children with severe behavior problems. 

 

How It Works

The exact mechanism where by the therapeutic effects of chlorpromazine are produced is not known. The principal pharmacological actions are psychotropic. It exerts sedative and antiemetic activity. Chlorpromazine has actions at all levels of the central nervous system as well.

 

Dosage

Oral tablet (25 mg, 50 mg, 100 mg)

Adult dosage is depending on condition.

The 100 mg and 200 mg tablets are for use in severe cases.

 

Acute schizophrenia and manic states: 25 mg (1 ml).

If necessary, give additional 25 to 50 mg injection in 1 hour. Increase subsequent I.M. doses gradually over several days— up to 400 mg every 4 to 6hrs in exceptionally severe cases— until patient is controlled. Usually patient becomes quiet and cooperative within 24 to 48 hours and oral doses may be substituted and increased until the patient is calm. 500 mg a day is generally sufficient. While gradual increases to 2,000 mg a day or more may be necessary, there is usually little therapeutic gain to be achieved by exceeding 1,000 mg a day for extended periods.

 

Less acutely disturbed:

25 mg three times a day. Increase gradually until effective dose is reached –usually at 400 mg.

Out Patients: 10 mg three times a day or 25 mg twice or three times a day.

Severe cases: 25 mg three times a day. After 1 or 2 days, daily dosage may be increased by 50 mg at semiweekly intervals until patient becomes calm.

 

In the elderly patients: since they are more susceptible to hypo-tension and neuromuscular reactions, these patients should be observed carefully. Dosage should be tailored to individual based on response and dosage adjusted accordingly. 

 

Psychotic disorders: daily dosage of 200 mg is not unusual. Increase dosage gradually until symptoms are under control. Maximum improvement may not be seen for weeks of months. Continue optimum dosage for 2 weeks. Some patients requiring higher dosages of up to 800 mg is not uncommon in discharged mental patients.

 

Nausea and Vomiting: 10 to 25 mg use as needed every 4 to six hours, increasing only if absolutely necessary.

 

Presurgical apprehension: ¼ mg/lb 2 to 3 hours before operation.

 

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Precautions

Contraindications: Do not use in patients with known hypersensitivity to phenothiazines.

Do not use in comatose states or in the presence of large amounts of central nervous system depressants (alcohol, barbiturates, narcotics, etc.).

The extra pyramidal symptoms which can occur secondary to Thorazine (chlorpromazine) may be confused with the central nervous system signs of an undiagnosed primary disease responsible for vomiting. (Reye’s syndrome or other encephalopathy). The use of Thorazine and other potential hepatotoxins should be avoided in children and adolescents whose signs and symptoms suggest Reye’s syndrome.

 

Possibility of acquiring Tardive dyskinesia, a syndrome consisting of potentially irreversible, involuntary sykinetoc movements. It can develop in patients treated with antipsychotic drugs. If signs and symptoms of tardive dyskinesia appear in a patient on anti psychotics, drug discontinuation should be considered.  Neuroleptics Malignant Syndrome is a potentially fatal symptom complex which has been reported in association with antipsychotic drugs. Clinical manifestations are hyperpyrexia, muscle rigidity, altered mental status and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis and cardiac dysrhythmias). The management of NMS should include 1) the immediate discontinuation of antipsychotic drugs and other drugs not essential to concurrent therapy, 2) intensive symptomatic treatment and medical monitoring 3) treatment, however there is no general agreement about specific pharmacological treatment regimes for uncomplicated NMS.

 

An encephalopathic syndrome is usually characterized by weakness, lethargy, fever, tremulosness and confusion, extra pyramidal symptoms, leukocytosis, elevated serum enzymes, BUN and FBS has occurred with patients treated with lithium and antipsycotics. Patients on such therapy should be monitored closely for evidence of neurologic toxicity.

Thorazine capsules and multi-dose vials contain sodium bisulfite and sodium sulfite. Sulfite may cause allergic-type reactions.

 

The use of drugs and alcohol should be absolutely avoided if possible. Do to the effects of hypotension.

 

Throazine may counteract the antihypertensive effect of guanethidine and related compounds.

 

Safety has not been established during pregnancy. Consult a physician if you are pregnant or thinking about becoming pregnant while on this medication.

 

Antipsychotic drugs elevate prolactin levels. Although disturbances such as galactorrhea, amenorrhea, gynescomastia and impotence have been reported, the clinical significance of elevated serum prolactin levels is unknown for most patients.

 

An increase in mammary neoplasms has been found in rodents after chronic administration of antipsychotic drugs. Chromosomal aberrations inspermatocytes and abnormal sperm have been demonstrated in rodents treated with certain antipsychotics. 

 

Drug Interactions

Thorazine (chlorpromazine hydrochloride) can potentially interact with a number of other medicines. Some of these medicines that may leadtonegative side effects. Thorazine interactions include:  Alcohol, Barbiturates, Amobarbital (Amytal), Butalbital (Fioricet, Fiorinal), Pentobarbital (Nembutal), Phenobarbital (Luminal), Secobarbital (Seconal), Divalproex sodium (Depakote, Depakote ER), Fosphenytoin (Cerebyx), Phenytoin (Dilantin, Phenytek),Valproic acid (Depakene)

 

Certain SSRI antidepressantsmay react with Thorzaine, such as: Fluvoxamine (Luvox), Fluoxetine (Prozac, Sarafem, Symbyax), Paroxetine (Paxil, Paxil CR) Sertraline (Zoloft) Narcotics or opiates, such as morphine or oxycodone (OxyContin), Pindolol, Propranolol (Inderal, Inderal LA,InnoPran XL), Rifamycin antibiotics, including rifabutin (Mycobutin), rifampin (Rifadin), and rifapentine (Priftin).

 

Tricyclic antidepressants, including: Amoxapine (Asendin), ,Clomipramine (Anafranil), Desipramine (Norpramin), Doxepin (Sinequan, Silenor), Imipramine (Tofranil, Tofranil PM) Maprotiline (Ludiomil), Nortriptyline (Pamelor), Protriptyline (Vivactil), Trimipramine (Surmontil).

 

This list may grow and may not include all medications. Check with a physician if you are on any medication. 

 

Adverse/Side Effects

Please note that some adverse effects of Thorazine are more likely to occur, or occur with greater intensity.

 

Constipation, drowsiness, vision changes or dry mouth may occur. If any of these effects persist or worsen, notify your doctor. Unlikely to occur but report promptly: restlessness, muscle stiffness, weakness, difficulty speaking, loss of balance, mask- like facial expression, trembling or shaking, dizziness, lip smacking or other uncontrollable movements, difficulty urinating, skin rash/discoloration.

 

Very unlikely to occur but report promptly: sore throat, unusual bleeding or bruising, stomach pain, yellowing of eyes or skin, dark urine, hot dry skin, vomiting.

 

Though very unlikely to occur, notify your doctor immediately if you experience any of the following effects: severe muscle stiffness, confusion, fever, seizures, irregular/fast heartbeat, increased sweating, prolonged/painful erection.

 

Allergic reaction adverse effects: rash, itching, swelling, severe dizziness, trouble breathing. 

 

Overdose

Symptoms of a Thorazine overdose are: Fever, irregular heart rhythms, or unusual body or facial movements. Treatment for a Thorazine overdose may include certain medications to pump the stomach or supportive care.

In case of overdose call your local emergency room or poison control. 

 

Storage Instructions

Store at room temperature away from sunlight and moisture. Do not store in the bathroom. Do not freeze. Keep out of the reach of children and pets.

 

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