CHLORPROMAZINE

Method of administration For oral administration. Initial dosage should be low and gradually increased until the optimal dosage for the patient is achieved. Patients should be under close supervision at the start of treatment until their optimal dosage has been reached.

Individual patient dosage varies considerably and the optimum dosage may vary according to the formulation.

Posology Dosage of Chlorpromazine in:

Schizophrenia, other psychoses, anxiety, childhood schizophrenia and autism Adult Children under 1 year Children 1- under 6 years Children 6-12 years Elderly or debilitated patients Initially 25mg three time a day or 75mg at bedtime increasing the daily amounts of 25mg to an effective maintenance dose.

This is usually between 75mg and 300mg daily, but some patients may require up to 1g per day. Do not use unless need is life saving. 5mg/kg bodyweight every 4-6 hours to a maximum recommended dose of 40mg daily. 1/3 to ½ of adult dose /to a maximum recommended daily dose of 75mg.

Start with 1/3 to ½ of the usual adult dose with a more gradual increase in dosage. 5mg/kg of bodyweight every 4-6 hours. 5mg/kg of bodyweight every 4-6 hours. Maximum daily dose should not exceed 75mg. Initially ⅓ to ½ the adult dose.

The physician should then use his clinical judgement to obtain control. 40mg

4) Parkinsonism (more common in adults and the elderly. 4), ST depression, U-Wave and T-Wave changes. Cardiac arrhythmias, including Ventricular arrhythmia and atrial arrhythmias, a-v block, Ventricular fibrillation Ventricular tachycardia Torsade de pointes Cardiac arrests have been reported during neuroleptic phenothiazine therapy, possibly related to dosage.

Pre-existing cardiac disease, old age, hypokalaemia and concurrent tricyclic antidepressants may predispose. 4) Vascular disorders Orthostatic hypotension (Elderly or volume depleted subjects are particularly susceptible: it is more likely to occur after intramuscular administration).

6) Reproductive system and breast disorders Priapism General disorders and administration site conditions Temperature regulation disorder Insomnia Agitation 1 may be seen without evidence of clinical disease 2 particularly at the start of treatment 3 particularly during long term treatment; may occur after the neuroleptic is withdrawn and resolve after reintroduction of treatment or if the dose is increased.

4 linked to anticholinergic effects 5 in the anterior segment of the eye caused by accumulation of the drug but generally without any impact on sight 6 A premonitory sign may be a sudden onset of fever after one to three weeks of treatment followed by the development of jaundice.

Chlorpromazine jaundice has the biochemical and other characteristics of obstructive (cholestatic) jaundice and is associated with obstructions of the canaliculi by bile thrombi; the frequent presence of an accompanying eosinophilia indicates the allergic nature of this phenomenon.

Liver injury, sometimes fatal, has been reported rarely in patients treated with chlorpromazine. 4). 7 The development of a metallic greyish-mauve coloration of exposed skin has been noted in some individuals, mainly females, who have received chlorpromazine continuously for long periods (four to eight years).

All patients must be advised that, if they experience fever, sore throat or any other infection, they should inform their physician immediately and undergo a complete blood count. Treatment will be discontinued if any marked changes (hyperleucocytosis, granulocytopenia) are observed in the latter.

As agranulocytosis has been reported, regular monitoring of the complete blood count is recommended. 8) and requires immediate haematological investigation. Neuroleptic malignant syndrome: treatment must be interrupted in the event of unexplained hyperpyrexia since this can be one of the signs of neuroleptic malignant syndrome (pallor, hyperthermia, autonomic dysfunction, altered consciousness, muscle rigidity).

Signs of autonomic instability, such as hyperhydrosis and irregular blood pressure, can precede the onset of hyperthermia and as such constitute premonitory signs of this syndrome. While this neurolepticrelated effect can be of idiosyncratic origin, certain risk factors such as dehydration and brain damage would seem to indicate a predisposition.

Chlorpromazine should be avoided in patients with, hypothyroidism, phaeochromocytoma, myasthenia gravis and prostate hypertrophy. It should be avoided in patients known to be hypersensitive to phenothiazines or with a history of narrow angle glaucoma or agranulocytosis.

Acute withdrawal symptoms, including nausea, vomiting and insomnia, have very rarely been reported following the abrupt cessation of high doses of neuroleptics. Relapse may also occur, and the emergence of extrapyramidal reactions has been reported.

Therefore, gradual withdrawal is advisable. In schizophrenia, the response to neuroleptic treatment may be delayed. If treatment is withdrawn, the recurrence of symptoms may not become apparent for some time. Neuroleptic phenothiazines may potentiate QT interval prolongation which increases the risk of onset of serious ventricular arrhythmias of the torsade de pointes type, which is potentially fatal (sudden death).

6) - Citalopram, escitalopram