CHLORPROMAZINE oral

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    Last updated: February 2024

     

    Prescription under medical supervision

     

     
    Due to the numerous and potentially severe adverse effects of chlorpromazine, patients should be kept under close surveillance.

     

    Therapeutic action

    • Sedative antipsychotic 

    Indications

    • Acute or chronic psychosis, in the event of intolerance or treatment failure with other antipsychotics (preferably use haloperidol for this indication) 

    Forms and strengths

    • 25 mg and 100 mg tablets

    Dosage

    • Adult: 25 to 50 mg once daily in the evening for one week. Increase gradually to 50 mg in the morning and 100 mg in the evening; if insufficient, administer 100 mg 3 times daily. 
    • Reduce the dose by half in older patients.
    • Use the lowest effective dose, especially in the event of prolonged treatment.

    Duration

    • Acute psychosis: at least 3 months
    • Chronic psychosis: at least one year

     

    Discontinue treatment gradually (over 4 weeks). If signs of relapse occur, increase the dose  then decrease it more gradually.

    Contra-indications, adverse effects, precautions

    • Do not administer to patients with cardiac disorders (heart failure, recent myocardial infarction, conduction disorders, bradycardia, etc.), dementia (e.g. Alzheimer's disease), closed-angle glaucoma, prostate disorders, Parkinson's disease and history of neuroleptic malignant syndrome.
    • Administer with caution and carefully monitor use in older patients and patients with hypokalaemia, hypotension, renal or hepatic impairment, history of seizures. 
    • May cause:
      • drowsiness (caution when driving/operating machinery), dyskinesia, extrapyramidal symptoms, weight gain, orthostatic hypotension, hyperprolactinaemia, anticholinergic effects (dry mouth, blurred vision, urinary retention, constipation, tachycardia);
      • hyperglycaemia, photosensitivity, impaired thermoregulation; agranulocytosis, neuroleptic malignant syndrome (unexplained hyperthermia with neuromuscular disorders), rare but requiring immediate treatment discontinuation.  
    • In case of extrapyramidal symptoms, try reducing the dose of chlorpromazine or, if the extrapyramidal symptoms are severe, add biperiden or trihexyphenidyl.
    • Avoid or monitor combination with: 
      • central nervous system depressants (opioid analgesics, sedatives, H1 antihistamines, etc.); drugs with anticholinergic effects (amitriptyline, atropine, promethazine, etc.), antidiabetics, lithium;
      • antihypertensive drugs (risk of hypotension); drugs that prolong the QT interval (amiodarone, chloroquine, erythromycin, fluconazole, mefloquine, pentamidine, quinine, etc.). 
    • Avoid alcohol during treatment (increased risk of adverse effects).
    • Pregnancy: re-evaluate whether the treatment is still necessary; if it is continued, use the lowest effective dose. Observe the neonate the first few days (risk of agitation, tremors, hypertonia/hypotonia, respiratory difficulties, sleeping disorders, etc.) if the mother was under treatment in the 3rd trimester. If treatment starts during pregnancy, preferably use haloperidol. 
    • Breast-feeding: if absolutely necessary, use the lowest effective dose.

    Remarks

    • Do not crush tablets (risk of contact dermatitis).

    Storage

     
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    –  Below 25 °C