CHLORPROMAZINE oral

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 3^rd 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