Chlorpromazine (Thorazine)

Category:

  • Miscellaneous

Description:

  • Antipsychotic, antiemetic

Indications:

  • Psychotic disorders, mania, schizophrenia, anxiety, intractable hiccups

  • Nausea, vomiting, preoperative relaxation, acute intermittent porphyria

  • Behavioral problems in children, adjunct in treatment of tetanus

Contraindications:

  • Circulatory collapse, liver damage, cerebral arteriosclerosis, coronary disease

  • Severe hypertension/hypotension, alcohol and barbiturate withdrawal, blood dyscrasias

Precautions:

  • Pregnancy category C; enters breast milk

  • Seizure disorders, hepatic disease, cardiac disease, elderly (orthostatic hypotension)

  • Hypertension

  • Use sunscreen and sunglasses

  • Urine may turn pink or red

  • Avoid hot showers, hot tubs, tub baths

Adverse Reactions (Side Effects):

  • CNS: EPS, headache, seizures, tardive dyskinesia

  • CV: cardiac arrest, ECG changes, orthostatic hypotension, tachycardia, hypertension

  • HEME: agranulocytosis, anemia, leukocytosis, leukopenia

  • RESP: dyspnea, laryngospasm, respiratory depression

  • MISC: neuroleptic malignant syndrome

  • GU: amenorrhea, breast engorgement, enuresis, gynecomastia, impotence, urinary frequency, urinary retention

  • GI: anorexia, constipation, diarrhea, weight gain

Dosage:

Administered orally (tablet, suspension), intravenously, intramuscularly, rectally

  • Adult:            

    • Psychosis: 

      • PO 10mg 3-4 times daily or 25mg 2-3 times daily. Increase by 25-50mg semiweekly. Maintenance 200-800mg daily

      • IM 25mg. May repeat dose in 1 hour as needed.  Increase gradually over several days up to 400mg every 4-6 hours in severe cases.Substitute PO when possible.

    • Nausea and vomiting: 

      • PO 10-25mg every 4-6 hours as needed

      • IM 25-50mg every 3 hours as needed

      • RECT 50-100mg every 6-8 hours as neede, not to exceed 400mg daily; 

      • IV 25-50mg 1-4 times daily

    • Intractable hiccups: 

      • PO 25-50mg 3-4 times daily; 

      • IM 25-50mg (use only if PO does not work.)

      •  IV 25-50mg in 500-1000 ml saline (only for severe hiccups.)

    • Intermittent porphyria

      • PO 25-50mg 3-4 times daily

      • IM 25mg 3-4 times daily

    • Tetanus: 

      • IM 25-50mg 3-4 times daily

      • IV 25-50mg

  • Child:   not to exceed 40 mg/day (<5 years) or 75 mg/day (5-12 years)

    • Psychosis: 

      • PO 0.5 mg/kg every 4-6 hours as needed

      • IM 0.5 mg/kg every 6-8 hours as needed

      • RECT 1 mg/kg every 6-8 hours

    • Nausea and vomiting: 

    • PO 0.55 mg/kg every 4-6 hours as needed

    • IM 0.55 mg/kg every 6-8 hours as needed

    • RECT 1.1 mg/kg every 6-8 hours as needed

    • IV 0.55 mg/kg every 6-8 hours

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