Chlorpromazine
From Ganfyd
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Contents |
Introduction
Developed by Rhône-Poulenc as an antihistamine, in 1949 it was noticed by the French anaesthetist Henri Laborit to have “slowed down” bodily processes. After marketing in 1954, it became known as the "drug that emptied the state mental hospitals."
Indications
- Schizophrenia
- Psychosis
- Mania
- Short-term management of agitation or violent behaviour
Administration
Dosage for psychiatric disorders
- Initially 25mg three times a day (or 75mg at night)
- Usual maintenance dose - 75-300mg/day
- Maximum dose - 1000mg/day
- Use 1/3 -1/2 dose in the elderly
Dosage for migraine rescue therapy
Only to be used if all other measures have failed: Adults Given IV 0.1mg/kg bolus, max 3 doses 15 mins apart.
Class Clinical Issues
Contra-indications
Dementia is probably a contraindication for any antipsychotic (fair evidence for increased mortality in long term use) and has an interesting medicolegal potential as it is unclear if following recent changes in datasheets (SPCs) and warnings from the regulatory authorities (eg FDA) any manufacturer will share liability for out of licence use (off license) use in newly commenced patients. In the UK an urgent review is taking place as of 2008.
- CNS depression
- Phaeochromocytoma
Cautions
- Driving
- Breast feeding and pregnancy (many contra-indicated or best avoided)
- Withdrawal should be gradual
- Hepatic impairment
- Renal impairment
- Cardiovascular disease
- Parkinsonism
- Epilepsy
- Blood dyscrasias
- Depression
- Myasthenia gravis
- Associated with increased venous thromboembolic disease
Side-effects
- Postural hypotension
- Parkinsonism
- Dystonia
- Akathisia
- Tardive dyskinesia
- Jaundice
- Drowsiness
- Apathy
- Excitement
- Neuroleptic malignant syndrome
- Insomia
- Anticholinergic side-effects
- Blood dyscrasias
- Hyperprolactinaemia
- Weight gain
- Skin pigmentation (purple)
- Photosensitisation at higher doses
- Cataracts & corneal opacities
