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
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Management of manifestations of psychotic disorders; control of manic phase of manic-depressive illness; treatment of schizophrenia
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Relief of preoperative restlessness and apprehension
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Adjunct in treatment of tetanus
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Acute intermittent porphyria therapy
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Severe behavioral problems in children
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Therapy for combativeness, hyperactivity
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Control of nausea and vomiting, intractable hiccups
Contraindications and Cautions
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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.
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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
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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.
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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).
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Acute intermittent porphyria: 25–50 mg PO or 25 mg IM tid–qid until patient can take oral therapy.
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Tetanus: 25–50 mg IM tid–qid, usually with barbiturates, or 25–50 mg IV diluted and infused at rate of 1 mg/min.
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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.
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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.
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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).
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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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