Chlorpromazine

What is chlorpromazine prescribed for?

Chlorpromazine is a first-generation, or typical, phenothiazine antipsychotic medication.

Chlorpromazine can be prescribed for several conditions but is primarily used in the treatment of schizophrenia and psychotic disorders. However, it should not be prescribed to treat dementia-related psychosis, due to an increased risk of fatality.^[1]

It is particularly useful in managing the positive symptoms of schizophrenia, such as hallucinations, delusions, disorganized thoughts, and uncontrollable movements. However, it is generally not helpful in managing the negative symptoms of schizophrenia, such as social withdrawal and blunted emotions.^[2]

Chlorpromazine and other phenothiazine derivatives may also be prescribed to treat anxiety before surgery, acute agitation, bipolar disorder, acute intermittent porphyria, intraoperative sedation, nausea and vomiting, tetanus, and chronic hiccups lasting over 48 hours.^[1]

Chlorpromazine brand names

• Largactil
• Promapar (discontinued)
• Thorazine (discontinued)

How does chlorpromazine work?

The exact way in which chlorpromazine can treat psychiatric conditions is not currently fully understood ^[1][3]. It causes several effects in the brain by blocking receptors to certain neurotransmitters. Of note, it reduces the dopamine activity in the brain which can help reduce hallucinations and other symptoms of schizophrenia. This can also be beneficial for those with apprehension before surgery.

This results in a reduction of brain activity and is likely why it is able to reduce symptoms of various mental health conditions, such as schizophrenia and mania.^[1]

It also has some sedative, anti-depressive, and antiemetic (anti-sickness) effects, and can therefore be useful for treating several mental and physical health conditions.^[4]

However, because of the extensive effect that chlorpromazine has on the brain, it also contributes to the development of many side effects, which is why newer medications have been developed that tend to be preferable for treatment.^[2][5]

How is chlorpromazine usually taken?

Chlorpromazine is available as a 10mg, 25mg, 50mg, 100mg, 150mg, or 200mg tablet, that should be swallowed whole.

For the treatment of schizophrenia, your doctor will likely prescribe you a low dose, that can be gradually increased until the most effective dose is reached.

Your prescription may start at 25-75mg doses, to be taken twice per day, increasing to around 200mg per day. A daily dose will not exceed 800mg.

Your dose will depend on your response to the medication and the severity of your condition, as well as your age and weight.

Chlorpromazine can help to manage your condition, but it will not cure it, so it is important to take your medication exactly as prescribed by your doctor. Taking more or less than you are prescribed, or regularly missing doses, can lead to an increase in symptoms and a worsening of your condition.^[6]

Your doctor will monitor any changes in your physical and mental health, particularly at the beginning of your treatment. It is important that you tell your doctor about any physical or mental changes you experience, to ensure that your condition is being managed effectively and safely.

If you forget one dose, take it as soon as you remember, or if it is near to the time of your next dose, skip the missed dose and take the next. Never take double your prescribed dose, as this can cause adverse effects.

How long does chlorpromazine stay in your system?

When you begin taking chlorpromazine, you may notice some changes in your symptoms within the first few days, but it will likely take several weeks before the medication takes full effect.^[7] As such, it is important to take it exactly as prescribed by your doctor.

If chlorpromazine is stopped, the effects of the medication may continue for a few days, but it may take several weeks to entirely leave your system.^[1][7]

Never stop taking chlorpromazine suddenly, even if you feel better, as this can cause unpleasant physical effects, depending on the dosage and length of your treatment, and may worsen your mental health. If your doctor advises that it is safe to stop this medication, they will slowly reduce your dose, to prevent adverse effects from occurring.

Schizophrenia can require lifelong treatment, so you may be required to continue taking this medication for a long time, in order to manage your condition.^[8]

Chlorpromazine side effects

When you begin taking a new medication, you may experience some common side effects. These will likely reduce over the first few weeks, but if they continue or become problematic, consult with your doctor, as you may need a reduced dose or a change of medication.

Common side effects of chlorpromazine include:

• Dry mouth
• Dizziness
• Blurred vision
• Constipation
• Drowsiness
• Increase in appetite or weight
• Difficulty sleeping
• Wide pupils
• Agitation
• Decreased libido
• Lowering of blood pressure
• In females, milk production and irregular menstruation may occur

Serious side effects of chlorpromazine are less common but may still occur. If you experience any of the following, contact your doctor immediately for medical advice:

• Yellowing of the skin or eyes
• Tremors or shaking (excessive motor activity)
• Uncontrollable movements
• Unusual face or mouth movements
• Stiffness, pain, or spasms in the muscles
• Fever or sweating
• Flu-like symptoms
• Rash
• Blisters
• Swelling of the face or limbs
• muscle stiffness
• Unexplained bleeding or bruising
• Irregular heartbeat
• Vision loss
• Breathing difficulties
• Tightness in the throat or chest
• Changes in mental state, including confusion, start or increase of hallucinations, delusions, or mania, or increased agitation
• Sudden death

Chlorpromazine precautions

It is important that your doctor is aware of any past or present mental health conditions you have experienced, to enable safe monitoring of your condition while on chlorpromazine, or to decide if it is safe for you.

Discuss with your doctor all your past and present physical health conditions, as they may impact your ability to take this medication safely.

Because of the potential side effects, it is important that you tell your doctor if you have experienced heart, liver, kidney, or blood conditions, asthma or other lung conditions, cancer or tumor, glaucoma, or seizures. These conditions could mean it is not safe for you to take this medication, or you may require increased monitoring of your physical health during this treatment.

Tell your doctor about all medications you are currently taking, or plan to take (including vitamins and dietary supplements), as they may cause adverse reactions.

Chlorpromazine can cause eye problems, so it is advised to have your eyes checked regularly during this treatment.^[6]

Tell your doctor if you are pregnant or planning to become pregnant while on this medication. Chlorpromazine can cause harm to the fetus, particularly in the third trimester, so it is important that you understand the risks and a decision is made about whether the benefits of this medication outweigh the risks. Lower doses and increased monitoring may be required.^[1][9]

Tell your doctor if you are breastfeeding, as chlorpromazine can be passed to your baby through breast milk. If it is deemed necessary to take this medication while breastfeeding, caution is advised, and you should monitor your baby for any unusual changes to their physical or mental state.^[10]

Chlorpromazine can make your skin more sensitive to sunlight, so excessive sun exposure is advised against.

Chlorpromazine can reduce the ability of the body to cool down after becoming overheated, so you may wish to consult your doctor about managing exercise.

Chlorpromazine can make you feel very lightheaded, increasing the risk of falls, particularly when standing from a seating or lying position, so caution and slower movement is advised.

Chlorpromazine can make you feel drowsy, so it is advised that you do not drive while on this medication, or until you know how it affects you and it is safe to do so.

Chlorpromazine interactions

Selective serotonin reuptake inhibitors (SSRIs) should not be taken while on chlorpromazine.

Because of the potential side effects of chlorpromazine, any medication or substance that impacts the central nervous system should be avoided, as the risks of serious health problems will increase. This includes opioid medications, alcohol, sedatives, cigarettes, and illicit drugs ^[5][6].

Similarly, other medications may interact with chlorpromazine, decreasing the effectiveness of the medication, or increasing the risk of serious side effects, such as blood thinners, antidepressants, antihistamines, barbiturates, chemotherapy medications, lithium, heart and seizure medications, and other psychiatric medications.

Always discuss your medications with your doctor prior to starting a new treatment.

Chlorpromazine storage

Always keep all medications out of reach of children.

Store chlorpromazine in its original packaging, in airtight containers, and at room temperature (never above 86°F).

If you need to dispose of medication that is out of date or no longer needed, contact a medical professional to ensure it is disposed of appropriately. Never flush medications down the toilet or put them in the bin, as this can create unnecessary risks.

What to do if you overdose on chlorpromazine

If you overdose on chlorpromazine, contact a medical professional, or call Poison Control on 1-800-222-1222, or in case of an emergency, call 911. Symptoms of a chlorpromazine overdose include fast or irregular heartbeat, breathing difficulties, seizure, abnormal movements, fever, and loss of consciousness.

Frequently asked questions about chlorpromazine

Are there any alternatives to chlorpromazine?

There are many alternative medications to chlorpromazine. Antipsychotic medications are classified as first-generation, or typical, and second-generation, or atypical, antipsychotics.^[2] Chlorpromazine is a first-generation antipsychotic, as are loxapine, haloperidol, and fluphenazine.

Second-generation antipsychotics include risperidone, olanzapine, and aripiprazole. Clozapine is a second-generation antipsychotic medication that is unique in the way it works.^[5]

First-generation antipsychotics are more likely to cause muscular side effects, such as stiffness and uncontrollable movements, while second-generation antipsychotics are less likely to cause these effects but may be more likely to cause weight gain.^[2][8]

People respond to certain medications differently, so what works for one person may not work for another. You might need to try several medications before you find one that works well for you.

You can discuss alternative medications with your doctor, who will advise you on the potential benefits and side effects of each medication, so that you can make informed decisions about your treatment.

It is also advised that mental health treatment plans include talking therapies, such as cognitive behavioral therapy, group therapy, and family therapy, alongside medication, as this can help you to better manage your condition and the impact it has on your quality of life.^[8]