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treatment & management

Drug Profiles:
chlorpromazine
AKA Thorazine, Largactil

   
Description
Chlorpromazine is often used to treat the nausea and vomiting and, to some extent, the pain associated with a Migraine attack. It also allows the Migraineur to rest more easily and allows other medications to work better.

General information about Chlorpromazine:
Phenothiazines (FEE-noe-THYE-a-zeens) are used to treat serious mental and emotional disorders, including schizophrenia and other psychotic disorders. Some are used also to control agitation in certain patients, severe nausea and vomiting, severe hiccups, and moderate to severe pain in some hospitalized patients. Chlorpromazine is used also in the treatment of certain types of porphyria, and with other medicines in the treatment of tetanus. Phenothiazines may also be used for other conditions as determined by your doctor.

Phenothiazines may cause unwanted, unattractive, and uncontrolled face or body movements that may not go away when you stop taking the medicine. They may also cause other serious unwanted effects. You and your doctor should talk about the good this medicine will do as well as the risks of using it. Also, your doctor should look for early signs of these effects at regular visits. Your doctor may be able to stop or decrease some unwanted effects, if they do occur, by changing your dose or by making other changes in your treatment.

Oral

  • Extended-release capsules (U.S.)
  • Oral concentrate (U.S. and Canada)
  • Syrup (U.S. and Canada)
  • Tablets (U.S. and Canada)

Parenteral

  • Injection (U.S. and Canada)

Before Using This Medicine
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For lithium, the following should be considered:

Pregnancy-
It is not known whether chlorpromazine will harm an unborn baby. Do not take chlorpromazine without first talking to your doctor if you are pregnant.

Breast-feeding-
Chlorpromazine passes into breast milk and may affect a nursing baby. Do not take chlorpromazine without first talking to your doctor if you are breast-feeding a baby.

Older adults-
If you are over 60 years of age, you may be more likely to experience side effects from chlorpromazine. You may require a lower dose of this medication.

Other medicines-
Always tell your doctor all medications you are taking, both prescription and over-the-counter. It is especially important that your health care professional know if you are taking any of the following:

  • antacids. Take antacids at least 2 hours before or 2 hours after taking a dose of chlorpromazine. They will decrease the effectiveness of chlorpromazine.
  • alcohol; over-the-counter cough, cold, or allergy medications; sleep aids; antidepressants; muscle relaxants; barbiturates; and seizure medications. All of these medications will increase the side of effects of chlorpromazine, especially drowsiness and dizziness.
  • blood pressure medications such as propranolol (Inderal), methyldopa (Aldomet), and clonidine (Catapres). These drugs may cause dizziness and fainting if used with chlorpromazine.
  • anticoagulants such as warfarin (Coumadin). Chlorpromazine may decrease the effectiveness of these medications, and blood clotting could result.
  • phenytoin (Dilantin). Chlorpromazine may increase the effectiveness of phenytoin and cause side effects. You may need smaller doses of phenytoin

Other medical problems-
Make sure you tell your doctor if you have any other medical problems, especially:

  • a bone marrow disease
  • glaucoma
  • seizures
  • Parkinson's disease
  • an enlarged prostate or difficulty urinating
  • kidney disease
  • liver disease


Proper Use of This Medicine-

  • Take chlorpromazine exactly as directed by your doctor. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you.
  • Take each dose with a full glass (8 ounces) of water.
  • Chlorpromazine can be taken with or without food or milk.
  • Do not crush or chew the sustained-release formulations of chlorpromazine. Swallow them whole. They are specially formulated to release slowly in your body. If you do not know if your medication is a sustained-release formulation, ask your pharmacist.
  • Mix the concentrate with 2 to 4 ounces of water, soda, juice, coffee, tea, syrup, milk, or a semisolid food such as applesauce or pudding.
  • Do not stop taking chlorpromazine without the approval of your doctor. It may be several weeks before you begin to feel better, and you may require continuous treatment for quite some time. Talk to your doctor before you stop taking this medication.
  • Throw away any discolored liquid.

Dosing-

For oral extended-release capsule dosage form:

  • For nausea and vomiting:
    • Adults and teenagers—10 to 25 mg every four to six hours as needed.
    • Children up to 6 months of age—Dose must be determined by your doctor.
    • Children 6 months to 12 years of age—Dose is based on body weight or size, and must be determined by your doctor. The usual dose is 0.55 mg per kg (0.25 mg per pound) of body weight, every four to six hours.

For injection dosage form:

  • For nausea and vomiting:
    • Adults—At first, 25 mg injected into a muscle. If needed, doses of 25 to 50 mg may be given every three to four hours.
    • Children up to 6 months of age—Dose must be determined by your doctor.
    • Children 6 months to 12 years of age—Dose is based on body weight or size and must be determined by your doctor. The usual dose is 0.55 mg per kg (0.25 mg per pound) of body weight, injected into a muscle every six to eight hours as needed.

For rectal dosage form (suppositories):

  • For nausea and vomiting:
    • Adults and teenagers—50 to 100 mg, inserted into the rectum every six to eight hours as needed.
    • Children up to 6 months of age—Dose must be determined by your doctor.
    • Children 6 months to 12 years of age—Dose is based on body weight and must be determined by your doctor. The usual dose is 1 mg per kg (0.45 mg per pound) of body weight, inserted into the rectum every six to eight hours as needed.

Missed dose-

  • If you take one dose of chlorpromazine a day, take the missed dose as soon as you remember, then go back to your regular schedule the next day. If you do not remember until it is time for your next dose, skip the dose you missed and take only your next regularly scheduled dose. Do not take a double dose of this medication.
  • If you are taking chlorpromazine on a regular schedule several times a day, take the missed dose within 1 hour of its regular time. If more than 1 hour has passed, skip the missed dose and take only the next regularly scheduled dose. Do not take a double dose of this medication.
  • If you are taking chlorpromazine as needed for nausea and vomiting, take the missed dose as soon as possible if needed, then wait at least 4 hours before taking another dose.
     

Storage-

  • Keep out of the reach of children.
  • Store away from heat and direct light.
  • Do not store the capsule or tablet form of this medicine in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
  • Keep the liquid form of this medicine from freezing.
  • Do not keep outdated medicine or medicine no longer needed.
  • Be sure that any discarded medicine is out of the reach of children.
     

Precautions While Using This Medicine

  • Use caution when driving, operating machinery, or performing other hazardous activities. Chlorpromazine may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities.
  • Dizziness may be more likely to occur when you rise from a sitting or lying position. Rise slowly to prevent dizziness and a possible fall.
  • Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while you are taking chlorpromazine.
  • Avoid prolonged exposure to sunlight. Chlorpromazine may increase the sensitivity of your skin to sunlight. Use a sunscreen and wear protective clothing when sun exposure is unavoidable.

Side Effects of This Medicine

Stop taking this medicine and check with your doctor immediately if any of the following side effects occur:

  • Rare--Symptoms of neuroleptic malignant syndrome
    • Confusion (severe) or coma; difficult or fast breathing; drooling;  fast heartbeat; fever; high or low (irregular) blood pressure;  increased sweating; loss of bladder control; muscle stiffness (severe); trembling or shaking; trouble in speaking or swallowing 

Check with your doctor immediately if any of the following side effects occur:

  • More common
    • Inability to move eyes; increased blinking or spasms of eyelid; lip smacking or puckering; muscle spasms of face, neck, body, arms, or legs causing unusual postures or unusual expressions on face; puffing of cheeks; rapid or worm-like movements of tongue; sticking out of tongue; tic-like or twitching movements; trouble in breathing, speaking, or swallowing; uncontrolled chewing movements ;  uncontrolled movements of arms or legs; uncontrolled twisting movements of neck, trunk, arms, or legs
    • Rare: irregular or slow heart rate;  recurrent fainting 

Also, check with your doctor as soon as possible if any of the following side effects occur:

  • More common
    • Blurred vision, change in color vision, or difficulty in seeing at night; fainting; loss of balance control; mask-like face; restlessness or need to keep moving; shuffling walk; stiffness of arms or legs; trembling and shaking of hands and fingers 
    • Less common: Difficulty in urinating; skin rash; sunburn (severe) 
    • Rare: Abdominal or stomach pains; aching muscles and joints; agitation, bizarre dreams, excitement, or trouble in sleeping; bleeding or bruising (unusual); chest pain; clumsiness; confusion (mild); constipation (severe); convulsions (seizures); dark urine;  fever and chills; hair loss; headaches; hot, dry skin or lack of sweating; itchy skin (severe); muscle weakness; nausea, vomiting, or diarrhea; pain in joints; prolonged, painful, inappropriate erection of the penis; redness of hands; shivering; skin discoloration (tan or blue-gray); sore throat and fever; sores in mouth; unusual bleeding or bruising; unusual tiredness or weakness; yellow eyes or skin 

Phenothiazines may cause your urine to be dark. In most cases, this is not a sign of a serious problem. However, if your urine does become dark, discuss it with your doctor.

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:

  • More common
    • Constipation (mild); decreased sweating; dizziness; drowsiness ;  dryness of mouth; nasal congestion 
  • Less common: Changes in menstrual period  decreased sexual ability; increased sensitivity of eyes to light; rough or “fuzzy” tongue; secretion of milk (unusual); swelling or pain in breasts; watering of mouth; weight gain (unusual) 

After you stop using this medicine, your body may need time to adjust. The length of time this takes depends on the amount of medicine you were using and how long you used it. During this time, check with your doctor if you notice dizziness, nausea and vomiting, stomach pain, trembling of the fingers and hands, or any of the following signs of tardive dyskinesia or tardive dystonia:

  • Inability to move eyes; lip smacking or puckering; muscle spasms of face, neck, body, arms, or legs, causing unusual body positions or unusual expressions on face; puffing of cheeks; rapid or worm-like movements of tongue; sticking out of tongue; tic-like or twitching movements; trouble in breathing, speaking, or swallowing; uncontrolled chewing movements; uncontrolled twisting or other movements of neck, trunk, arms, or legs 

Some commonly used brand names are:

In the U.S.-

  • Chlorpromazine Hydrochloride Intensol
  • Thorazine
  • Thorazine Spansules
  • Thorazine Suppositories

In Canada-

  • Chlorpromanyl-201
  • Chlorpromanyl-401
  • Largactil
  • Largactil Liquid
  • Largactil Oral Drops
  • Largactil Oral Drops
  • Novo-Chlorpromazine

 

 
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Information offered at this Web site by either a lay person or a health professional should not be interpreted as giving a diagnosis or a treatment recommendation. These can only be provided by a physician who has had an opportunity to interact with a patient in person and at length, with access to the patient's previous records and appropriate follow-up.