Indications for Chlorpromazine
Chlorpromazine is used in mental disorders such as schizophrenia, insanity, mania, as well as as an adjunct in the treatment of severe emotion and psychomotor disorders, as well as as an anti-nausea and treatment of severe hiccups and porphyria.
-Aliphatic phenothiazine antagonist
-Block of postsynaptic dopamine D2 receptors in the mesolimbic brain
-Strong alpha-adrenergic blockade and suppression of hypothalamic and pituitary hormone secretion
-Effect on basal metabolism, body temperature, weakness, vasomotor tone and vomiting (by suppression of the reticular activating system (RAS))
Absorption: Fast and complete oral
Bioavailability: 32% orally (significant hepatic first pass)
Start of effect:
Muscular 15 minutes
Oral 60-30 minutes
Duration of action: 4-6 hours orally (continuous release 12-10 hours)
Peak effect: Anti-antipsychotic effect 6 weeks to 6 months
Protein binding: 97-92%
Metabolism: Extensive liver (by demethylation and glucuronidation and oxidation of amines to active and inactive metabolites)
The initial phase is 1.1 hours for children and 2 hours for adults
The final phase of children 7.7 hours Adults 30 hours
Excretion: Urine (<1%) within 24 hours
Contraindications to the use of Chlorpromazine
It should not be used if you have heart disease (high or low blood pressure), severe CNS weakness, coma, congenital QT syndrome, a history of cardiac arrhythmias, and genetic defects that reduce P450 isoenzyme activity.
Side effects of Chlorpromazine
Cardiovascular: Abnormal electrocardiogram (non-specific QT changes), postural hypotension, syncope, tachycardia
Central nervous system: cerebral edema, catatonic-like symptoms, dizziness, drowsiness, dystonia (abnormal contraction), extrapyramidal reaction, hyperpyrexia (severe fever), malignant neuroleptic syndrome, parkinsonism, psychotic symptoms, restlessness, dyskinesia tardation Frequent involuntary), Tardio dystonia
Skin: Contact dermatitis, lupus erythematosus, skin sensitivity to light, skin pigmentation (dark gray)
Endocrinology and metabolism: Weight gain
Gastrointestinal: colon atony (weakness), constipation, increased appetite, nausea, severe constipation, ileal paralysis, dry mouth
Genitourinary: breast congestion, ejaculation disorder, false positive pregnancy test, impotence, milk secretion, priapism, urinary retention
Hematology and oncology: agranulocytosis, aplastic anemia, increased eosinophil levels, hemolytic anemia, immunological thrombocytopenia (ITP), leukopenia
Hypersensitivity: Unsafe anaphylaxis
Neuromuscular and musculoskeletal: Lupus-like syndrome
Ocular: Foreign mineral deposits in the cornea, lens disorders (foreign mineral deposits in the lens), pupil stenosis, pupil dilation, stellar cataract, visual disturbances
Respiratory: nasal congestion
Miscellaneous: Mild fever
Category X Interactions (Avoidance)
Achlidinium, aminoluvinolic acid (systemic), amisulperide, azlastine (nasal), bromoperide, bromperidol, cabergoline, cimetropium, citalopram, clarithromycin, demperidone, derondarone, aloxadolol, enterctolin, enterctin Ipratropium (oral inhalation), Losolperid, Moxifloxacin (Systemic), Metoclopramide, Moxifloxacin, Nilotinib, Oxatomide, Orphenadrine, Oxomazine, Paraldehyde, Pimozide, Pipracin, Pyrimidyl, Pyridabil, P Medium risk), quetiapine, rufenacine, ribocycline, sparfloxacin, sulpiride, thalidomide, thioridazine, thiotropium, omeclidinium
Reducing the effects of drugs by Chlorpromazine
Acetylcholinesterase inhibitors, amphetamines, anti-Parkinson drugs (dopamine agonists), gastrointestinal agents (prokinetic), guanthidine, itopride, levosulperide, nitroglycerin, piribidil, kinagolid, secretin
Reducing the effects of Chlorpromazine by drugs
Acetylcholinesterase inhibitors, anti-Parkinson drugs (dopamine agonists), bromedirol, peg interferon alfa-b2, lithium, piribadil, tobacco (smoking)
Increased effects of drugs by Chlorpromazine
Alcohol (ethyl), amifampridine, amifustine, aminoluvinic acid (systemic and topical), amiodarone, anticholinergic drugs, antipsychotic drugs (second generation] atypical [), arsenic trioxide, astizmol, azithromycin ( Badacillin, biperidyl, beta-blockers, blonanserin, brexanolone, buprenorphine, chloroquine, cimetropium, citalopram, clarithromycin, clofazimine, clozapine, CNS depressant, espresso, dasidinhe, demospercine Fleuceniden, Fluconazole, Floactonazole, Fluoponazole, Gadobinate Di Muglamine, Glucagon, Glycopyroducland, Halfanest, Haloperidol, Hypertension, Inotoshum, Ozoogamyein, Iuthhol, Iomprolol, Iopamidol, Lofaxine, Macithzine, Methotrizin, Methylodenin, Methyrosin, Mothercinin, Mirabgeron Moxifloxacin (systemic), nilotinib, nitroprusside, olanzapine, ondansetron, opioid agonists, orphenadrine, osimertinib, oxycodone, paraldehyde, pentamidine (systemic), fulcodine, pilicin Mosaid, Pipraquine, Porphyry, Potassium Chloride, Potassium Citrate, Probucol, Quetiapine, Ramosterone, Rufenacin, Ribocycline, Risperidone, Serotonergic Drugs (High Risk), Sodium Stibogluconate, Sparfluxidase, Sparfluxide Di, Thiopental, thioridazine, thiotropium, topiramate, valproate, vemorafenib, verteporfin, zolpidem
has not been stated.
– Monitor the patient’s mental state and vital signs if needed clinically.
– The patient in terms of depression, suicidal ideation, severe drowsiness, extra-pyramidal complications and changes in the central nervous system at the beginning of treatment and then periodically monitored.
– Weight, height, body mass index and waist size of the patient at the beginning of treatment, at each visit during the first 6 months of treatment and then every 3 months with a fixed dose of antipsychotic to be evaluated.
-Fasting plasma glucose and HbA1C levels should be monitored at the beginning of treatment and then annually. (In case of weight gain or in patients with risk factor for diabetes, at the beginning of treatment, 4 months after the start of treatment and then evaluated annually.)
– The patient’s blood lipid status should be monitored every 2 years at the beginning of treatment and then if the LDL level is normal (if the LDL level> 130 mg / dL, it should be monitored every 6 months).
Involuntary and abnormal activities or Parkinson’s symptoms in the patient should be monitored at the beginning of treatment and then weekly until the dose is stabilized (for at least 2 weeks) and for 2 weeks after any significant dose increase.
– It is necessary in patients with diseases that increase the risk of falling or taking drugs with this complication, the risk of falling to the patient at the beginning of treatment and then periodically during treatment.
Differential blood cell count (CBC with diff) should be monitored as needed (in patients with low white blood cell count or a history of drug-induced leukopenia / neutropenia, be evaluated intermittently during the first few months of treatment).
– The patient in terms of galactorrhea, changes in menstruation, libido, ejaculation and erection, at each visit during the first 12 weeks of treatment or dose stabilization and then monitored annually.
– The patient should be evaluated for the incidence of dyskinesia tardio every 6 months (in people at high risk, should be evaluated every 3 months).
– The patient’s eye examinations should be performed annually in people over 40 years of age and in younger people every 2 years and the patient’s vision changes should be examined annually.
There is a possibility of hypotension in the condition of intramuscular or intravenous injection of the drug. Monitoring of blood pressure during drug infusion or intramuscular injection is essential.
– It is necessary to start taking the drug with a low dose and when discontinuing, gradually reduce the dose.
– It is necessary to assess the patient’s mood, anger and feelings.
Chlorpromazine drug recommendations
- The course of treatment with this drug should be completed. This medicine should not be taken more than the prescribed amount.
- A few weeks may be needed to achieve the desired therapeutic effects.
- If a dose is missed, if the regimen is once a day, the missed dose should be taken as soon as it is remembered. Otherwise, the missed turn should be avoided. If the treatment regimen is several times a day, it should be taken as soon as it is remembered within an hour.Otherwise, the missed dose or doubling the next dose should be avoided.
- You should see a doctor before stopping the drug. Gradual discontinuation of the drug may be necessary.
- Alcohol-containing products and other CNS depressants should be avoided with this drug.
- If you need any surgery or emergency treatment, your doctor should be aware of the use of this drug.
- Caution should be exercised when driving or operating machinery that requires alertness.
- Caution should be exercised when waking up suddenly from a lying or sitting position.
- When exercising, in hot weather or when bathing in hot water, caution should be exercised due to the possibility of heat shock.
- This medicine may cause dry mouth. If the dryness persists for more than two weeks, you should see a doctor.
- There is a possibility of photosensitivity with the use of this drug. Wearing goggles and protective clothing may be necessary.
- Elderly and disabled patients may need smaller amounts of medication.
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