Chlorpromazine 25mg

Antimanic Agent, Antipsychotic (First-Generation)

“Alert: Black Box Warning

Increased mortality in elderly patients with dementia-related psychosis:

Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death.  Although the causes of death were varied, most of the deaths appeared to be either cardiovascular (i.e. heart failure, sudden death) or infectious (i.e. pneumonia) in nature.  Chlorpromazine is not approved for the treatment of patients with dementia-related psychosis.”

CSA NA – FDA Approved – REMS (N) – Can Ship

Chlorpromazine is an aliphatic phenothiazine antipsychotic which blocks postsynaptic mesolimbic dopaminergic receptors in the brain; exhibits a strong alpha-adrenergic blocking effect and depresses the release of hypothalamic and hypophyseal hormones; believed to depress the reticular activating system, thus affecting basal metabolism, body temperature, wakefulness, vasomotor tone, and emesis.

Agitation/Aggression associated with Psychiatric Disorders, Bipolar Disorder, Hyperactivity, Nausea and Vomiting, Schizophrenia

Before starting Chlorpromazine make sure your physician is aware of any allergies or medications you currently take.  Chlorpromazine can cause changes in cardiac conduction resulting in life-threatening arrhythmias, anticholinergic effects (i.e. constipation, dry mouth and eyes, urinary retention, blurred vision), blood dyscrasias (i.e. leukopenia, neutropenia and agranulocytosis), central nervous system depression, esophageal dysmotility, extrapyramidal symptoms (i.e acute dystonic reactions, akathisia, tardive dyskinesia), hyperprolactinemia, hypotension, neuroleptic malignant syndrome, photosensitivity, temperature dysregulation.

Oral: 75mg to 800mg daily.

Intramuscular: 25mg as a single dose; may repeat based on tolerability every 4 to 6 hours as needed up to 200 mg daily.

Intravenous: 25mg to 50 mg single dose as a slow IV infusion (maximum rate: 1 mg/minute).

How to Take:

Intramuscular: Inject slowly into the deep outer quadrant of the buttock. 

Intravenous: Administer using a diluted solution at a rate not to exceed 1 mg/minute. To reduce the risk of hypotension, patients receiving intravenous chlorpromazine must remain lying down during and for 30 minutes after the injection.

ECG abnormality (non-specific QT changes), orthostatic hypotension, syncope, tachycardia, brain edema, catatonic-like state, dizziness, drowsiness, dystonia, extrapyramidal reaction, hyperpyrexia, neuroleptic malignant syndrome, parkinsonism, psychotic symptoms, restlessness, tardive dyskinesia, tardive dystonia, contact dermatitis, cutaneous lupus erythematosus, skin photosensitivity, skin pigmentation (slate gray), weight gain, constipation, increased appetite, nausea, obstipation, paralytic ileus, xerostomia, breast engorgement, ejaculatory disorder, false positive pregnancy test, impotence, lactation, priapism, urinary retention, jaundice, lupus-like syndrome, corneal deposits, lens disease, miosis, mydriasis, visual impairment, nasal congestion, low fever.

1. What can I do if this medication sedates me too much?
   It is a common side effect but in most cases the tablet can be split for smaller dosages to alleviate fatigue.  Discuss with your pharmacist or physician a plan to manage this or potential alternative medications.
2. This medication has a lot of scary side effects, is it safe?
   All medications have side effects however this medication works on a lot of different neurotransmitter receptors in the brain which can lead to a variety of intentional and unintentional effects.  These are mostly dosage dependant and in lower doses the risk is minimal.  In all cases regular lab work will allow your physician to see if your blood sugar, cholesterol etc. start to move in the wrong direction so action can be taken before they become a problem.
3. What are extra-pyramidal reactions?
   Blocking dopamine in the extra-pyramidal system in the central nervous system that regulates posture and skeletal muscle tone may cause a variety of movement disorders.  This can include dystonic reactions (muscular spasms, usually repetitive), akathisia (motor restlessness/uneasiness), pseudoparkinsonism (drug induced Parkinsonism – tremor, rigidity, bradykinesia, etc.), tardive dyskinesia (involuntary complex muscle movements in lower face and extremities).  These side effects are generally dose dependant and generally occur with long term use of medications that block dopamine.  If any of these effects may be occurring, speak to your physician as soon as possible to discuss your options.
4. Why would my doctor give me an antipsychotic? Does this mean I am psychotic?
   This medication can be used for many conditions outside of its original classification.  It commonly is also used for nonpsychotic mood disorders, but this class of medication was given its name back when we knew a lot less about their capabilities.
5. What is Neuroleptic Malignant Syndrome?
   NMS is a rare but serious reaction from significant blockade of dopamine which can occur from antipsychotic medications or from being on high dosages of levodopa (dopamine analogue) and stopping suddenly.  Presents initially as muscle cramps, tremors, fever, unstable blood pressure, and sudden changes in mental status.  As it progresses over 8-40 hours it can lead to complications of rhabdomyolysis, hyperkalemia, kidney failure, or seizures.  Seek medical attention immediately if this reaction is suspected