ChlorproMAZINE Hydrochloride(klor proe’ ma zeen)
Novo-Chlorpromazine (CAN)
PREGNANCY CATEGORY C
Drug Classes
Antiemetic
Antipsychotic
Anxiolytic
Dopaminergic blocker
Phenothiazine
Therapeutic Actions
Mechanism not fully understood; antipsychotic drugs block postsynaptic dopamine receptors in the brain; depress those parts of the brain involved with wakefulness and emesis; anticholinergic, antihistaminic (H1), and alpha-adrenergic blocking.
Indications
Management of manifestations of psychotic disorders; control of manic phase of manic-depressive illness; treatment of schizophrenia
Relief of preoperative restlessness and apprehension
Adjunct in treatment of tetanus
Acute intermittent porphyria therapy
Severe behavioral problems in children
Therapy for combativeness, hyperactivity
Control of nausea and vomiting, intractable hiccups
Contraindications and Cautions
Contraindicated with allergy to chlorpromazine, comatose or severely depressed states, bone marrow depression, circulatory collapse, subcortical brain damage, Parkinson disease, liver damage, cerebral or coronary arteriosclerosis, severe hypotension or hypertension.
Use cautiously with respiratory disorders; glaucoma; epilepsy or history of epilepsy; peptic ulcer or history of peptic ulcer; decreased renal function; prostate hypertrophy; breast cancer; thyrotoxicosis; myelography within 24 hr or scheduled within 48 hr, lactation; exposure to heat, phosphorous insecticides; children with chickenpox, CNS infections (makes children more susceptible to dystonias, confounding the diagnosis of Reye syndrome or other encephalopathy; antiemetic effects of drug may mask symptoms of Reye syndrome, encephalopathies); pregnancy, lactation.
Available Forms
Tablets—10, 25, 50, 100, 200 mg; injection—25 mg/mL
Dosages
Full clinical antipsychotic effects may require 6 wk to 6 mo of therapy.
Adults
Excessive anxiety, agitation in psychiatric patients, schizophrenia: 25 mg IM; may repeat in 1 hr with 25–50 mg IM. Increase dosage gradually in inpatients, up to 400 mg every 4–6 hr. Switch to oral dosage as soon as possible, 25–50 mg PO tid for outpatients; up to 2,000 mg/day PO for inpatients. Initial oral dosage, 10 mg tid–qid PO or 25 mg PO bid–tid; increase daily dosage by 20–50 mg semiweekly until optimum dosage is reached (maximum response may require months); doses of 200–800 mg/day PO are not uncommon in discharged mental patients.
Surgery: Preoperatively, 25–50 mg PO 2–3 hr before surgery or 12.5–25 mg IM 1–2 hr before surgery; intraoperatively, 12.5 mg IM, repeated in 30 min or 2 mg IV repeated every 2 min up to 25 mg total to control vomiting (if no hypotension occurs); postoperatively,
10–25 mg PO every 4–6 hr or 12.5–25 mg IM repeated in 1 hr (if no hypotension occurs).
Acute intermittent porphyria: 25–50 mg PO or 25 mg IM tid–qid until patient can take oral therapy.
Tetanus: 25–50 mg IM tid–qid, usually with barbiturates, or 25–50 mg IV diluted and infused at rate of 1 mg/min.
Antiemetic: 10–25 mg PO every 4–6 hr; 25 mg IM as a single dose. If no hypotension, give 25–50 mg every 3–4 hr. Switch to oral dose when vomiting ends.
Intractable hiccups: 25–50 mg PO tid–qid. If symptoms persist for 2–3 days, give 25–50 mg IM; if inadequate response, give 25–50 mg IV in 500–1,000 mL of saline with BP monitoring and administer to patient flat in bed.
Pediatric patients 6 mo–12 yr
Generally not used in children younger than 6 mo.
Psychiatric outpatients: 0.55 mg/kg PO every 4–6 hr; 0.55 mg/kg IM every 6–8 hr, not to exceed 40 mg/day (up to 5 yr) or 75 mg/day (5–12 yr).
Surgery: Preoperatively, 0.55 mg/kg PO 2–3 hr before surgery or 0.55 mg/kg IM 1–2 hr before surgery; intraoperatively, 0.25 mg/kg IM or 1 mg (diluted) IV, repeated at 2-min intervals up to total IM dose; postoperatively, 0.55 mg/kg PO every 4–6 hr or 0.55 mg/kg IM, repeated in 1 hr if no hypotension.
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