Chlorpromazine HCl Uses

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What is Chlorpromazine HCl?

Treating certain mental or mood disorders (eg, schizophrenia), the manic phase of manic-depressive disorder, anxiety and restlessness before surgery, the blood disease porphyria, severe behavioral and conduct disorders in children, nausea and vomiting, and severe hiccups. It is also used with other medicines to treat symptoms associated with tetanus. It may also be used for other conditions as determined by your doctor.

Chlorpromazine HCl is a phenothiazine. The exact way Chlorpromazine HCl works is not known.

Chlorpromazine HCl indications

An indication is a term used for the list of condition or symptom or illness for which the medicine is prescribed or used by the patient. For example, acetaminophen or paracetamol is used for fever by the patient, or the doctor prescribes it for a headache or body pains. Now fever, headache and body pains are the indications of paracetamol. A patient should be aware of the indications of medications used for common conditions because they can be taken over the counter in the pharmacy meaning without prescription by the Physician.
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Chlorpromazine is a phenothiazine neuroleptic and is indicated in the following conditions:

1) Psychotic conditions (especially paranoid), including schizophrenia, mania and hypomania.

2) As an adjunct in the short-term management of anxiety psychomotor agitation excitement, violent or dangerously impulsive behaviour.

3) Nausea or vomiting associated with terminal illness, where other agents are ineffective or unavailable.

4) Intractable hiccup.

5) Childhood schizophrenia and autism.

How should I use Chlorpromazine HCl?

There are specific as well as general uses of a drug or medicine. A medicine can be used to prevent a disease, treat a disease over a period or cure a disease. It can also be used to treat the particular symptom of the disease. The drug use depends on the form the patient takes it. It may be more useful in injection form or sometimes in tablet form. The drug can be used for a single troubling symptom or a life-threatening condition. While some medications can be stopped after few days, some drugs need to be continued for prolonged period to get the benefit from it.

Use Chlorpromazine HCl as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Ask your health care provider any questions you may have about how to use Chlorpromazine HCl.

Chlorpromazine HCl description

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A carbamate with hypnotic, sedative, and some muscle relaxant properties, although in therapeutic doses reduction of anxiety rather than a direct effect may be responsible for muscle relaxation. Chlorpromazine HCl has been reported to have anticonvulsant actions against petit mal seizures, but not against grand mal seizures (which may be exacerbated). It is used in the treatment of anxiety disorders, and also for the short-term management of insomnia but has largely been superseded by the benzodiazepines. (From Martindale, The Extra Pharmacopoeia, 30th ed, p603) Chlorpromazine HCl is a controlled substance in the U.S.

Chlorpromazine HCl dosage

ADULTS

Adjust dosage to individual and the severity of his condition, recognizing that the milligram for milligram potency relationship among all dosage forms has not been precisely established clinically. It is important to increase dosage until symptoms are controlled. Dosage should be increased more gradually in debilitated or emaciated patients. In continued therapy, gradually reduce dosage to the lowest effective maintenance level, after symptoms have been controlled for a reasonable period.

In general, dosage recommendations for other oral forms of the drug may be applied to Spansule® brand sustained release capsules on the basis of total daily dosage in milligrams.

The 100 mg and 200 mg tablets are for use in severe neuropsychiatric conditions.

Increase parenteral dosage only if hypotension has not occurred. Before using I.M., see IMPORTANT NOTES ON INJECTION.

Elderly Patients — In general, dosages in the lower range are sufficient for most elderly patients. Since they appear to be more susceptible to hypotension and neuromuscular reactions, such patients should be observed closely. Dosage should be tailored to the individual, response carefully monitored, and dosage adjusted accordingly. Dosage should be increased more gradually in elderly patients.

Psychotic Disorders — Increase dosage gradually until symptoms are controlled. Maximum improvement may not be seen for weeks or even months. Continue optimum dosage for 2 weeks; then gradually reduce dosage to the lowest effective maintenance level. Daily dosage of 200 mg is not unusual. Some patients require higher dosages (e.g., 800 mg daily is not uncommon in discharged mental patients).

HOSPITALIZED PATIENTS: ACUTE SCHIZOPHRENIC OR MANIC STATES — I.M.: 25 mg (1 mL). If necessary, give additional 25 to 50 mg injection in 1 hour. Increase subsequent I.M. doses gradually over several days— up to 400 mg q4 to 6h in exceptionally severe cases— until patient is controlled. Usually patient becomes quiet and cooperative within 24 to 48 hours and oral doses may be substituted and increased until the patient is calm. 500 mg a day is generally sufficient. While gradual increases to 2,000 mg a day or more may be necessary, there is usually little therapeutic gain to be achieved by exceeding 1,000 mg a day for extended periods. In general, dosage levels should be lower in the elderly, the emaciated and the debilitated. LESS ACUTELY DISTURBED—

Oral: 25 mg t.i.d. Increase gradually until effective dose is reached— usually 400 mg daily. OUTPATIENTS—

Oral: 10 mg t.i.d. or q.i.d., or 25 mg b.i.d. or t.i.d. MORE SEVERE CASES—

Oral: 25 mg t.i.d. After 1 or 2 days, daily dosage may be increased by 20 to 50 mg at semiweekly intervals until patient becomes calm and cooperative. PROMPT CONTROL OF SEVERE SYMPTOMS— I.M.: 25 mg (1 mL). If necessary, repeat in 1 hour. Subsequent doses should be oral, 25 to 50 mg t.i.d.

Nausea and Vomiting

Oral: 10 to 25 mg q4 to 6h, p.r.n., increased, if necessary. I.M.: 25 mg (1 mL). If no hypotension occurs, give 25 to 50 mg q3 to 4h, p.r.n., until vomiting stops. Then switch to oral dosage. Rectal: One 100 mg suppository q6 to 8h, p.r.n. In some patients, half this dose will do.

DURING SURGERY— I.M.: 12.5 mg (0.5 mL). Repeat in 1 / 2 hour if necessary and if no hypotension occurs. I.V.: 2 mg per fractional injection, at 2-minute intervals. Do not exceed 25 mg. Dilute to 1 mg/mL, i.e., 1 mL (25 mg) mixed with 24 mL of saline.

Presurgical Apprehension

Oral: 25 to 50 mg, 2 to 3 hours before the operation. I.M.: 12.5 to 25 mg (0.5 to 1 mL), 1 to 2 hours before operation.

Intractable Hiccups

Oral:

25 to 50 mg t.i.d. or q.i.d. If symptoms persist for 2 to 3 days, give 25 to 50 mg (1 to 2 mL) I.M. Should symptoms persist, use slow I.V. infusion with patient flat in bed: 25 to 50 mg (1 to 2 mL) in 500 to 1,000 mL of saline. Follow blood pressure closely.

Acute Intermittent Porphyria

Oral: 25 to 50 mg t.i.d. or q.i.d. Can usually be discontinued after several weeks, but maintenance therapy may be necessary for some patients. I.M.: 25 mg (1 mL) t.i.d. or q.i.d. until patient can take oral therapy.

Tetanus — I.M.: 25 to 50 mg (1 to 2 mL) given 3 or 4 times daily, usually in conjunction with barbiturates. Total doses and frequency of administration must be determined by the patient's response, starting with low doses and increasing gradually. I.V.: 25 to 50 mg (1 to 2 mL). Dilute to at least 1 mg per mL and administer at a rate of 1 mg per minute.

DOSAGE AND ADMINISTRATION— PEDIATRIC PATIENTS (6 months to 12 years of age)

Chlorpromazine HCl (chlorpromazine) should generally not be used in pediatric patients under 6 months of age except where potentially lifesaving. It should not be used in conditions for which specific pediatric dosages have not been established.

Severe Behavioral Problems — OUTPATIENTS— Select route of administration according to severity of patient's condition and increase dosage gradually as required.

Oral: 1 / 4 mg/lb body weight q4 to 6h, p.r.n. (e.g., for 40 lb child— 10 mg q4 to 6h). Rectal: 1 / 2 mg/lb body weight q6 to 8h, p.r.n. (e.g., for 20 to 30 lb child— half a 25 mg suppository q6 to 8h). I.M.: 1 / 4 mg/lb body weight q6 to 8h, p.r.n.

HOSPITALIZED PATIENTS— As with outpatients, start with low doses and increase dosage gradually. In severe behavior disorders, higher dosages (50 to 100 mg daily, and in older children, 200 mg daily or more) may be necessary. There is little evidence that behavior improvement in severely disturbed mentally retarded patients is further enhanced by doses beyond 500 mg per day. Maximum I.M.

Dosage: Children up to 5 years (or 50 lbs), not over 40 mg/day; 5 to 12 years (or 50 to 100 lbs), not over 75 mg/day except in unmanageable cases.

Nausea and Vomiting — Dosage and frequency of administration should be adjusted according to the severity of the symptoms and response of the patient. The duration of activity following intramuscular administration may last up to 12 hours. Subsequent doses may be given by the same route if necessary.

Oral: 1 / 4 mg/lb body weight (e.g., 40 lb child— 10 mg q4 to 6h). Rectal: 1 / 2 mg/lb body weight q6 to 8h, p.r.n. (e.g., 20 to 30 lb child— half of a 25 mg suppository q6 to 8h). I.M.: 1 / 4 mg/lb body weight q6 to 8h, p.r.n. Maximum I.M.

Dosage: Pediatric patients 6 months to 5 yrs. (or 50 lbs), not over 40 mg/day; 5 to 12 yrs. (or 50 to 100 lbs), not over 75 mg/day except in severe cases. DURING SURGERY— I.M.: 1 / 8 mg/lb body weight. Repeat in 1 / 2 hour if necessary and if no hypotension occurs. I.V.: 1 mg per fractional injection at 2-minute intervals and not exceeding recommended I.M. dosage. Always dilute to 1 mg/ mL, i.e., 1 mL (25 mg) mixed with 24 mL of saline.

Presurgical Apprehension — 1 / 4 mg/lb body weight, either orally 2 to 3 hours before operation, or I.M. 1 to 2 hours before.

Tetanus — I.M. or I.V.: 1 / 4 mg/lb body weight q6 to 8h. When given I.V., dilute to at least 1 mg/mL and administer at rate of 1 mg per 2 minutes. In patients up to 50 lbs, do not exceed 40 mg daily; 50 to 100 lbs, do not exceed 75 mg, except in severe cases.

Important Notes On Injection

Inject slowly, deep into upper outer quadrant of buttock.

Because of possible hypotensive effects, reserve parenteral administration for bedfast patients or for acute ambulatory cases, and keep patient lying down for at least 1 / 2 hour after injection. If irritation is a problem, dilute Injection with saline or 2% procaine; mixing with other agents in the syringe is not recommended. Subcutaneous injection is not advised. Avoid injecting undiluted Chlorpromazine HCl (chlorpromazine) into vein. I.V. route is only for severe hiccups, surgery and tetanus.

Because of the possibility of contact dermatitis, avoid getting solution on hands or clothing. This solution should be protected from light. This is a clear, colorless to pale yellow solution; a slight yellowish discoloration will not alter potency. If markedly discolored, solution should be discarded. For information on sulfite sensitivity, see the WARNINGS section of this labeling.

Note on Concentrate: When the Concentrate is to be used, add the desired dosage of Concentrate to 60 mL (2 fl oz) or more of diluent just prior to administration. This will insure palatability and stability. Vehicles suggested for dilution are: tomato or fruit juice, milk, simple syrup, orange syrup, carbonated beverages, coffee, tea or water. Semisolid foods (soups, puddings, etc.) may also be used. The Concentrate is light sensitive; it should be protected from light and dispensed in amber glass bottles. Refrigeration is not required.

How supplied

Tablets: 10 mg, in bottles of 100; 25 mg or 50 mg, in bottles of 100 and 1000. For use in severe neuropsychiatric conditions, 100 mg and 200 mg, in bottles of 100 and 1000.

NDC 0007-5073-20 10 mg 100's

NDC 0007-5074-20 25 mg 100's

NDC 0007-5074-30 25 mg 1000's

NDC 0007-5076-20 50 mg 100's

NDC 0007-5076-30 50 mg 1000's

NDC 0007-5077-20 100 mg 100's

NDC 0007-5077-30 100 mg 1000's

NDC 0007-5079-20 200 mg 100's

NDC 0007-5079-30 200 mg 1000's

Spansule® brand of sustained release capsules: 30 mg, 75 mg or 150 mg, in bottles of 50.

NDC 0007-5063-15 30 mg 50's

NDC 0007-5064-15 75 mg 50's

NDC 0007-5066-15 150 mg 50's

Ampuls: 1 mL and 2 mL (25 mg/mL), in boxes of 10.

NDC 0007-5060-11 25 mg/mL in 1 mL Ampuls (box of 10)

NDC 0007-5061-11 25 mg/mL in 2 mL Ampuls (box of 10)

Multi-Dose Vials: 10 mL (25 mg/mL), in boxes of 1.

NDC 0007-5062-01 25 mg/mL in 10 mL Multi-Dose Vials (box of 1)

Syrup: 10 mg/5 mL, in 4 fl oz bottles.

NDC 0007-5072-44 10 mg/5 mL 4 fl oz

Suppositories: 25 mg or 100 mg, in boxes of 12.

NDC 0007-5070-03 25 mg (box of 12)

NDC 0007-5071-03 100 mg (box of 12)

All dosage forms except Syrup should be stored between 15° and 30°C (59° and 86°F). Syrup should be stored below 25°C (77°F).

*phenytoin, Parke-Davis.

† metrizamide, Sanofi Winthrop Pharmaceuticals.

‡ norepinephrine bitartrate, Sanofi Winthrop Pharmaceuticals.

§phenylephrine hydrochloride, Sanofi Winthrop Pharmaceuticals.diphenhydramine hydrochloride, Parke-Davis.

WARNING: Chlorpromazine HCl® (chlorpromazine) Spansule capsules are manufactured with carbon tetrachloride and methyl chloroform, substances which harm public health and environment by destroying ozone in the upper atmosphere.

FDA revision date: 4/22/1998. Manufacturer information: n/a

Chlorpromazine HCl interactions

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What other drugs will affect Chlorpromazine HCl?

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Alcohol, barbiturates and other sedatives may intensify the CNS depressant effects of chlorpromazine and respiratory depression may occur.

The hypotensive effect of most antihypertensive agents, especially alpha-adrenoceptor blocking agents, may be exaggerated by chlorpromazine.

Chlorpromazine has mild anticholinergic activity which may be enhanced by other anticholinergic drugs.

Anticholinergic drugs may decrease the antipsychotic effect of chlorpromazine. Chlorpromazine may oppose the action of some drugs, including amphetamine, levodopa, adrenaline, clonidine and guanethidine.

Some drugs interfere with the absorption of neuroleptic agents, e.g. antacids, lithium, anti-Parkinsonian agents. Although increases or decreases have been observed in the plasma concentrations of a number of drugs, including propranolol and phenobarbitone, these were not of clinical significance.

At high dosage, chlorpromazine reduces the response to hypoglycaemic agents, which may require an increase in dosage of the latter.

Clinically significant adverse drug interactions with alcohol, guanethidine and hypoglycaemic agents are documented. Adrenaline must not be used in cases of overdosage with chlorpromazine. Other interactions are of theoretical interest and are not of a serious nature. Concomitant administration of desferrioxamine and prochlorperazine has been reported to cause a transient metabolic encephalopathy with loss of consciousness for 48 to 72 hours. The possibility of a similar occurrence with chlorpromazine exists, because it shares many of the pharmacological activities of prochlorperazine.

Chlorpromazine HCl side effects

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What are the possible side effects of Chlorpromazine HCl?

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Minor side effects include nasal stuffiness, dry mouth, insomnia and agitation.

Cardiovascular: Hypotension, especially postural, is relatively common and elderly patients or subjects with volume depletion are particularly susceptible. Cardiac arrhythmias have been reported in patients receiving neuroleptic agents and may be dose-related. They include atrial arrhythmia, A-V block, ventricular tachycardia and fibrillation. Pre-existing cardiac disease, hypokalaemia, concurrent use of tricyclic antidepressants and old age may predispose to development of arrhythmia. E.C.G. changes may occur, including widened QT interval, ST depression, U waves and T wave changes.

Blood: Mild leucopenia may occur in up to 30% of patients on prolonged high dosage. Agranulocytosis may occur rarely and is not dose-related. Unexplained infections or pyrexia require immediate haematological investigations.

Respiratory: Clinical doses of the neuroleptics usually have little effect on respiration. However, respiratory depression may occur in susceptible patients.

Hepatic: A very small percentage of patients may develop jaundice, which is usually transient and which may be preceded by sudden pyrexia after one to three weeks of treatment. The jaundice is obstructive in type and is frequently accompanied by an eosinophilia, indicating the allergic nature of the event. Chlorpromazine therapy should be withdrawn if jaundice occurs.

Extrapyramidal: Acute dystonic or dyskinetic reactions may occur. These are usually transitory, are commoner in children and young adults and are more likely to occur within the first four days of treatment or after dosage increases. Akathisia may occur, characteristically following large initial doses.

Neuroleptic - induced parkinsonism is commoner in adults and the elderly and usually takes weeks or months of treatment to develop. Tremor is a common sign but rigidity, akinesia or other features of parkinsonism may also occur.

If tardive dyskinesia occurs, it is usually although not always associated with prolonged or high dosage. It may occur after treatment has been discontinued. To reduce the likelihood of tardive dyskinesia, the dosage should be kept low whenever possible.

Skin and Eyes: Various skin rashes may occur during therapy with chlorpromazine. Photosensitivity eruptions may occur and patients receiving high dosage should be advised to avoid exposure to direct sunlight. Contact skin sensitisation is a rare but serious complication in persons who frequently handle chlorpromazine preparations and particular care should be taken to avoid contact of the drug with the skin.

Ocular changes and a metallic greyish-mauve discolouration of exposed skin have been reported in some patients, mainly females, who received chlorpromazine continuously for long periods of between four and eight years.

Endocrine: Hyperprolactinaemia has been reported and may result in galactorrhoea, gynaecomastia or amenorrhoea; impotence has been reported.

Neuroleptic malignant syndrome: The syndrome may occur with use of any neuroleptic agent. Symptoms include clouding of consciousness, rigidity and other extrapyramidal effects, and autonomic dysfunction, most importantly hyperpyrexia. Treatment involves the immediate cessation of neuroleptic therapy and symptomatic management as appropriate.

Cases of venous thromboembolism, including cases of pulmonary embolism and cases of deep vein thrombosis have been reported with antipsychotic drugs- Frequency unknown

Chlorpromazine HCl contraindications

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What is the most important information I should know about Chlorpromazine HCl?

Chlorpromazine is contraindicated in patients with a known hypersensitivity to the drug. Chlorpromazine is also contraindicated in comatose patients, including those under the influence of alcohol or other central nervous system depressants.

Active ingredient matches for Chlorpromazine HCl:

Chlorpromazine HCl


Unit description / dosage (Manufacturer)Price, USD
Chlorpromazine Hcl 50 mg Injection$ 0.04

List of Chlorpromazine HCl substitutes (brand and generic names):

Chlorpromazine HCl-Bodene 50 mg/2 mL x 10's
Clorpromazin 25 mg x 1 Bottle 500 Tablet
Clorpromazin 25 mg x 1 Bottle 1200 Tablet
Clorpromazin 100 mg x 1 Bottle 400 Tablet
Clorpromazin 100 mg x 1 Bottle 1000 Tablet
Hatomazin 12.5 mg/2 mL x 2 mL
Hatomazin 12.5 mg/2 mL x 5 mL
Largactil 100 liquid 100 mg (Sanofi Aventis Canada Inc (Canada))
Largo 25 mg x 1000's (Beacons)
Largo 100 mg x 1000's (Beacons)

References

  1. DailyMed. "CHLORPROMAZINE: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
  2. PubChem. "chlorpromazine". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
  3. DrugBank. "chlorpromazine". http://www.drugbank.ca/drugs/DB00477 (accessed September 17, 2018).

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