Class
- Antiemetic, antipsychotic
Chlorpromazine
Commonly Prescribed for
(FDA approved in bold)
- Antiemetic
- Intractable hiccups
- Psychosis, schizophrenia
- Mania in bipolar disorder
- Acute intermittent porphyria
- Tetanus
- Restlessness and apprehension before surgery
- Hyperactivity and behavioral problems (children)
- Migraine (acute)
Chlorpromazine
How the Drug Works
- Dopamine receptor antagonist with greatest action at D2 receptors. Also has antihistamine, anticholinergic effects, and blocks alpha-adrenergic receptors
Chlorpromazine
How Long Until It Works
- Migraine – 1 hour (oral) or less than 30 minutes (IV)
Chlorpromazine
If It Works
- Use at lowest required dose
- Monitor QT corrected (QTc) interval
Chlorpromazine
If It Doesn’t Work
- Change to another agent
Chlorpromazine
Best Augmenting Combos for Partial Response or Treatment-Resistance
- For migraine, can be used with dihydroergotamine or NSAIDs
Chlorpromazine
Tests
- Obtain blood pressure and pulse before initial IV and monitor QTc with ECG
Adverse Effects (AEs)
Chlorpromazine
How Drug Causes AEs
- Anticholinergic effects produce most AEs (sedation, blurred vision, dry mouth). Hypotension and dizziness are related to alpha-adrenergic blockade, and motor AEs are related to dopamine blocking effects
Chlorpromazine
Notable AEs
- Akathisia, extrapyramidal symptoms, parkinsonism
- Dizziness, sedation, orthostatic hypotension, tachycardia, urinary retention, depression
- Long-term use: weight gain, glucose intolerance, sexual dysfunction, hyperprolactinemia
Chlorpromazine
Life-Threatening or Dangerous AEs
- Tardive dyskinesias
- Neuroleptic malignant syndrome (rare)
- Jaundice, agranulocytosis (rare)
Chlorpromazine
Weight Gain
- Common (with chronic use)
Chlorpromazine
Sedation
- Problematic
Chlorpromazine
What to Do About AEs
- Lowering dose or changing to another antiemetic improves most AEs
- Rarely causes ECG changes. Use with caution in patients if QTc is above 450 (females) or 440 (males) and do not administer with QTc greater than 500
- If excessive sedation, use only as a rescue agent for intractable migraine in hospitalized patients or when patients can lie down or sleep
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