Intramuscular Acute manic episodes of bipolar disorder, Psychoses, Schizophrenia
Adult: 25-50 mg 6-8 hourly. Substitute with oral therapy as soon as possible. Dose must be adjusted according to individual response, using the lowest possible effective dose. Dosage and treatment recommendations may vary between countries (refer to local product guidelines). Elderly: Use the lowest dosage range. Child: 1-5 years 0.5 mg/kg 6-8 hourly. Max: 40 mg daily; 6-12 years 0.5 mg/kg 6-8 hourly. Max: 75 mg daily. Dose must be adjusted according to individual response, using the lowest possible effective dose.
Intramuscular, Intravenous Intractable hiccup
Adult: If symptoms persist for 2-3 days after oral therapy: 25-50 mg via IM inj, if symptoms still persist, may administer 25-50 mg in 500-1,000 mL saline solution given via slow IV infusion. Dose must be adjusted according to individual response, using the lowest possible effective dose.
Intramuscular Nausea and vomiting
Adult: In terminal illness: Initially, 25 mg then 25-50 mg 3-4 hourly as needed, until vomiting stops then switch to oral therapy. Dose must be adjusted according to individual response, using the lowest possible effective dose. Child: 1-5 years 0.5 mg/kg 6-8 hourly. Max: 40 mg daily; 6-12 years 0.5 mg/kg 6-8 hourly. Max: 75 mg daily. Dose must be adjusted according to individual response, using the lowest possible effective dose.
Oral Acute manic episodes of bipolar disorder, Psychoses, Schizophrenia
Adult: Initially, 25 mg tid or 75 mg once daily at bedtime, increase by 25 mg daily to an effective maintenance dose. Usual dose range: 75-300 mg daily up to 1 g daily. Dose must be adjusted according to individual response. Dosage and treatment recommendations may vary among individual products and between countries (refer to detailed product guidelines). Elderly: Initially, 1/3 to 1/2 of the usual adult dose, may be increased gradually. Dose must be adjusted according to individual response, using the lowest possible effective dose. Child: 1-5 years 0.5 mg/kg 4-6 hourly. Max: 40 mg daily; 6-12 years1/3 to 1/2 of the usual adult dose. Max: 75 mg daily. Dose must be adjusted according to individual response, using the lowest possible effective dose. Dosage and treatment recommendations may vary among individual products and between countries (refer to detailed product guidelines).
Oral Nausea and vomiting
Adult: In terminal illness: 10-25 mg 4-6 hourly. Dose must be adjusted according to individual response, using the lowest possible effective dose. Elderly: Initially, 1/3 or 1/2 of the usual adult dose, may be increased more gradually. Dose must be adjusted according to individual response, using the lowest possible effective dose. Child: 1-5 years 0.5 mg/kg 4-6 hourly. Max: 40 mg daily; 6-12 years1/3 or 1/2 of the adult dose. Max: 75 mg daily. Dose must be adjusted according to individual response, using the lowest possible effective dose. Dosage and treatment recommendations may vary among individual products and between countries (refer to detailed product guidelines).
Oral Intractable hiccup
Adult: 25-50 mg 3-4 times daily. If symptoms persist for 2-3 days, parenteral therapy is needed. Dose must adjusted according to individual response, using the lowest possible effective dose.
What are the brands available for Chlorpromazine in Thailand?
Chlorpromazine May be taken with or without food. May be taken w/ meals to reduce GI discomfort.
Reconstitution
Solution for IV infusion: Reconstitute with 500-1,000 mL NaCl 0.9%.
Incompatibility
Solution for inj: Incompatible with benzylpenicillin K, pentobarbital Na and phenobarbital Na.
Contraindications
Bone marrow depression, comatose states, phaeochromocytoma, history of blood dyscrasias (e.g. agranulocytosis). Risk of angle-closure glaucoma, urinary retention related to urethroprostatic disorders. Presence of large amounts of CNS depressants (e.g. alcohol, opioids). Lactation.
Special Precautions
Patient with myasthenia gravis, decreased gastrointestinal motility, pyloroduodenal obstruction; respiratory disease (e.g. severe asthma, emphysema); urinary retention, benign prostatic hyperplasia, bladder neck obstruction; predisposition to falls; diabetes mellitus or its risk factors; Parkinson's disease; risk of stroke and thromboembolism, CV disease; epilepsy, conditions predisposing seizures. Not indicated for use in dementia-related psychosis in the elderly. Avoid use in patients with signs and symptoms suggestive of Reye's syndrome. Avoid abrupt withdrawal. Debilitated patients. Renal and hepatic impairment. Children and elderly. Pregnancy.
Adverse Reactions
Significant: Hyperprolactinaemia; altered cardiac conduction (e.g. ECG abnormality, atrial fibrillation, atrial flutter); anticholinergic effects (e.g. cognitive impairment, constipation, mydriasis, urinary retention, xerostomia); skin photosensitivity, photoallergic contact dermatitis, skin pigmentation (prolonged use at high doses); cholestatic jaundice; extrapyramidal symptoms (e.g. akathisia, acute dystonia, drug-induced parkinsonism, tardive dyskinesia); metabolic syndrome (e.g. significant weight gain [increase of ≥7% from baseline], dyslipidaemia, hypertension); orthostatic hypotension (particularly with high doses or after parenteral use); seizures (dose-dependent), EEG pattern changes; sedation, drowsiness; impaired core body temperature regulation; hyperglycaemia or impaired glucose tolerance. Rarely, leucopenia, neutropenia and agranulocytosis. Eye disorders: Ocular changes. Gastrointestinal disorders: Nausea. General disorders and administration site conditions: Lethargy, fatigue, hyperpyrexia. Hepatobiliary disorders: Jaundice. Musculoskeletal and connective tissue disorders: Hypertonia. Nervous system disorders: Somnolence, dizziness. Psychiatric disorders: Anxiety, mood altered, agitation, insomnia. Reproductive system and breast disorders: Amenorrhoea, gynaecomastia, erectile dysfunction, priapism. Respiratory, thoracic and mediastinal disorders: Nasal congestion. Skin and subcutaneous tissue disorders: Urticaria, allergic and contact dermatitis. Vascular disorders: DVT; hypotension (IV/IM). Potentially Fatal: Neuroleptic malignant syndrome (NMS), arrhythmias (e.g. ventricular arrhythmias of torsades de pointes type); severe liver toxicity; heart failure, infections (e.g. pneumonia) particularly in elderly.
Patient Counseling Information
Avoid exposure to sunlight; wear protective clothing and use sunscreen. This drug may cause sedation and drowsiness, if affected, do not drive or operate machinery.
Monitoring Parameters
Perform ECG, ocular exam and monitor electrolytes, renal and liver function, TSH, CBC, vital signs at baseline and as clinically indicated; fasting plasma glucose or HbA1C, lipid panel at baseline, 4 weeks after treatment initiation, then annually. Monitor for extrapyramidal symptoms at baseline, every visit, 4 weeks after treatment initiation, during dose change and annually; fall risk (particularly in elderly) at baseline and as clinically indicated; weight, height, BMI, waist circumference (particularly in individuals at risk for metabolic syndrome) at baseline, every visit for the 1st 6 months, then quarterly; tardive dyskinesia at baseline, every visit, then annually. Assess for signs and symptoms of infection, mental status and alertness every visit.
Overdosage
Symptoms: Drowsiness, loss of consciousness, hypotension, tachycardia, ECG changes, ventricular arrhythmias, hypothermia, Parkinsonism, motor restlessness, hyperflexia, severe extrapyramidal dyskinesias, convulsions, coma. Management: Symptomatic and supportive treatment. Perform gastric lavage within 6 hours after ingestion of toxic doses; administer activated charcoal. For generalised vasodilatation that may lead to circulatory collapse, may raise patient's legs; may give IV fluids for volume expansion in severe cases. If fluid replacement is insufficient to correct circulatory collapse, consider positive inotropic agents (e.g. dopamine). Restore normal body temperature and correct circulatory or metabolic disturbances; may administer appropriate antiarrhythmic agents (in persistent or life-threatening cases) for ventricular or supraventricular arrhythmias. Provide airway maintenance or assisted respiration (in extreme cases) for pronounced CNS depression. Administer IV or IM procyclidine or orphenadrine for severe dystonic reactions and IV diazepam for convulsions. Cool the patient or give dantrolene Na for NMS.
Drug Interactions
May result in reciprocal antagonism with dopaminergic agents (e.g. quinagolide, amantadine, bromocriptine, cabergoline, levodopa, lisuride, pergolide, piribedil, ropinirole). Increased risk of arrhythmias with QT-prolonging drugs such as quinidine, disopyramide, amiodarone, sotalol. Increased risk of agranulocytosis with carbamazepine. Enhanced anticholinergic and reduced antipsychotic effects with other anticholinergic drugs. May diminish the therapeutic effect of guanethidine. May potentiate CNS depressant effects of anaesthetics, barbiturates, and narcotics.
Food Interaction
May enhance the CNS depressant effect of alcohol.
Lab Interference
May cause false-positive results for phenylketonuria, amylase, uroporphyrins, urobilinogen, and pregnancy tests. May interfere with urine detection for amphetamine or methamphetamine and methadone which may lead to false-positive results.
Action
Description: Mechanism of Action: Chlorpromazine is a phenothiazine antipsychotic agent. It blocks the postsynaptic mesolimbic dopaminergic receptors in the brain and inhibits the release of hypothalamic and hypophyseal hormones. It exhibits sedative effect, anticholinergic, antiemetic, weak antihistaminic, serotonin-blocking, and slight ganglion-blocking activity. Duration: 4-6 hours (oral). Pharmacokinetics: Absorption: Readily and rapidly absorbed from the gastrointestinal tract. Bioavailability: Approx 32%. Time to peak plasma concentration: 2-4 hours. Distribution: Widely distributed into most body tissues and fluids. Crosses the blood-brain barrier and placenta, enters breast milk. Plasma protein binding: 92-97% (mainly to albumin). Metabolism: Extensively metabolised in the liver via demethylation, glucuronide conjugation, N-oxidation and hydroxylation into active and inactive metabolites. Excretion: Via urine (<1% as unchanged drug); faeces. Terminal half-life: Approx 30 hours.
Chemical Structure
Chlopromazine Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 2726, Chlorpromazine. https://pubchem.ncbi.nlm.nih.gov/compound/Chlorpromazine. Accessed Feb. 26, 2025.
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