Chlorpromazine 

Overview

The first antipsychotic medication used to treat psychosis was chlorpromazine. first-generation antipsychotics, commonly called conventional antipsychotics, are a class of antipsychotics or standard antidepressants. Thorazine was the name given to the brand of chlorpromazine, however it has since been canceled. There is just generic chlorpromazine available at this time. An earlier family of antipsychotics known as first-generation antipsychotics has long been the norm for treating psychotic illnesses. These older antipsychotics are referred to as typical or conventional when contrasted to a more recent class of second-generation antipsychotics, since they do not have the same broad range of therapeutic action. Additionally, there is a higher chance that first-generation antipsychotics may result in side effects that impair mobility compared to the more recent antipsychotics, such as tardive dyskinesia (TD) and extrapyramidal symptoms (EPS).

The potency of chlorpromazine is comparatively lower than that of other first-generation antipsychotics such as (haloperidol) and fluphenazine. In general, low-potency antipsychotics cause sedation and are less likely than high-potency counterparts to produce EPS but more likely to trigger anticholinergic side effects. The United States has authorized chlorpromazine. Food and Drug Administration for psychotic medication illnesses including psychotic depression, schizoaffective disease, acute mania, and schizophrenia. In young ones, For the short-term therapy of severe behavioral issues characterized by combativeness and violent outbursts of rage. Chlorpromazine is also recommended for the treatment of persistent hiccups, nausea, and vomiting. The term “labeled use” refers to the administration of a drug for its authorized uses. In actual practice, however, doctors often prescribe drugs for unlabeled (or “off-label”) applications if the safety and effectiveness of such uses are supported by published clinical studies, case reports, or their own clinical experiences for example, in order to treat acute mania, a mood stabilizer and chlorpromazine may be administered together. The mood stabilizer acts more gradually at first. Once mania symptoms subside, chlorpromazine is discontinued and the mood stabilizer is taken on its own.

Information about Dosing

For acute psychosis, the first dose of chlorpromazine may be 400–1,000 mg/day, administered in split dosages based on the patient’s treatment status (inpatient or outpatient). Rarely is chlorpromazine used as the only medication to treat schizophrenia or schizoaffective disorder. It has been replaced by more tolerable drugs. Chlorpromazine is often used in addition to another antipsychotic for the treatment of acute psychosis. The sedative effects of chlorpromazine may be helpful in calming the patient down and promoting sleep. When combining chlorpromazine with another antipsychotic, smaller daily doses of 100–400 mg are often used before bed or as required timetable.

Typical Side Effects

Patients who are commencing chlorpromazine may feel tired and drowsy. claiming a bigger share of the entire amount taken at night may reduce sedation throughout the day. Usually, tolerance to the sedative develops after around a week. Chlorpromazine may cause extrapyramidal symptoms at higher doses. These are brain-related disruptions in the brain region responsible for controlling motor function brought on by antipsychotics (or a neurological condition) synchronization. Disturbance in a certain region of the brain might result in symptoms that resemble Parkinson’s disease, also known as parkinsonism, is characterized by tremor, drooling, muscular rigidity, and a “mask-like” expression on the face. On the other hand, parkinsonism brought on by antipsychotic therapy is reversible, in contrast to Parkinson’s disease, which is a neurological condition that progresses. It is possible to cure the Parkinson-like symptoms, and avoided by utilizing Cogentin (benztropine), an antiparkinsonian drug (also known as an anticholinergic medication),
(trihexyphenidyl), (procyclidine), and (diphenhydramine).
Another kind of EPS is called akathisia, and it is characterized by a subjective feeling of restlessness coupled with agitation, discomfort in the muscles, anxiousness, and fidgeting. Antiparkinsonian drugs are typically inadequate for the treatment of akathisia. Using the beta-blocker (propranolol) may be beneficial and is as directed by medical professionals.

One kind of EPS with an abrupt onset is dystonia. The patient might have an abrupt spasm of the muscles in the neck, jaw, and tongue. There isn’t an allergy to the antipsychotic drug causing this. Despite the unpleasant and terrifying nature of dystonic reactions, they may be quickly reversed with an intramuscular injection of an anticholinergic drug like Benadryl or Cogentin. When a patient has a dystonic response, they should Get treated right away and obtain medical care.

Prolactin elevation is a typical side effect of traditional antipsychotics. The pituitary gland, located in the brain, is the organ that produces the hormone prolactin. It is often higher among women who have just given birth promoting the production of milk, or lactation. Increased prolactin may cause breast hypertrophy and In both genders, milk production (galactorrhea) occurs. Another correlation between impotence and elevated prolactin is
in males, and irregular or nonexistent menstrual periods in females. If prolactin levels start to concern you, you may try one of the second-generation antipsychotics instead of substances that don’t seem to increase this hormone.

Chlorpromazine may cause you to gain weight. It’s unknown whether there’s a biochemical cause for this alteration brought on by the antipsychotic or by an increase in hunger. Throughout treatment, weight should be regularly evaluated, and if weight gain happens, a diet and activity intervention program should be initiated.  When a drug prevents the nervous system’s cholinergic neurons from acting, it results in an anticholinergic response, which might result in uncomfortable feelings. Since a large number of antipsychotics inhibit cholinergic neurons’ ability to function normally, they usually have anticholinergic side effects When Cholinergic inhibition affects an organ system and has consequences specific to that organ.

Constipation, cramps, and dry mouth might be signs of a gastrointestinal tract infection. Among the adverse effects of anticholinergic medications include impaired vision (when the eye muscles are weakened) and difficulties peeing (When there’s a bladder problem). The anticholinergic action of chlorpromazine is greater than that of high-potency antipsychotics. When tricyclic antidepressants (TCAs) and antiparkinsonian medicines are used with chlorpromazine and other drugs that have strong anticholinergic activity, the combined anticholinergic effect of the drugs may result in severe symptoms. Elderly people and those with a medical condition might make anticholinergic side effects more likely to occur. Overuse of anticholinergic drugs may cause delirium, a toxic response marked by loss of awareness, disorientation, and incapacity to maintain focus.

When a person stands up too quickly, chlorpromazine may prevent the blood vessels from closing as a compensatory reaction to counteract postural shift. This might cause a brief dip in blood pressure It might make you feel lightheaded and dizzy. Orthostatic hypotension is the term for this response.  Be careful and rise slowly, particularly if you’re elderly or on antihypertensive medication, to enable the body to adapt to the altered posture, preventing an abrupt reduction in blood pressure.

Adverse Events and Safety Measures

Chlorpromazine may decrease mental and physical awareness, as well as produce sleepiness and sedation. Patients should refrain from doing any potentially risky tasks, such operating equipment or driving a vehicle, until they are certain that these adverse effects won’t impair their capacity to carry out their duties.
Chlorpromazine may increase the skin’s sensitivity to UV radiation, a condition known as photosensitivity, and increase the risk of sunburn. Patients should wear sunscreen, limit their time spent in the sun, and unless a patient develops a tolerance to the drug, wear protective clothes and use a screen. Patients may be more susceptible to heat-related illnesses and heat stroke in very hot weather because Antipsychotics may cause problems with the body’s temperature regulation system. It is important for patients to adopt preventative measures against extended exposure to hot, muggy conditions. Patients must remain inside and keep appropriate ventilation.

One possible side effect of antipsychotic treatment is tardive dyskinesia. It is distinguished by aberrant involuntary motions that develop slowly. With symptoms that might be permanent, TD is a disorder that often involves darting and writhing tongue motions, “pill-rolling” finger gestures, lip-pursing, grimacing on the face, and other erratic gestures. The length is linked to the risk of TD of antipsychotic drug exposure, and the danger rises with advancing years. The typical antipsychotics that are compared to the more current second-generation antipsychotics, linked to a higher incidence of TD.

An uncommon and severe response to antipsychotics is known as neuroleptic malignant syndrome (NMS). The signs and symptoms include extreme tightness and stiffness of the muscles, a high body temperature, a high heart rate and blood pressure, and irregular heartbeat and heavy perspiration. Coma and delirium may result from NMS. In the event that medical assistance is not given right away. There is no test to determine a person’s susceptibility to developing NMS in response to an antipsychotic exposure. Because NMS is a medical emergency requiring prompt antipsychotic withdrawal, hospitalization, and intense medical care, it is imperative that it be identified as soon as possible.

Antipsychotics have the potential to reduce the threshold for seizures and cause seizures in those who are vulnerable, particularly people who have had seizures in the past. Individuals suffering from a seizure illness and on anticonvulsants of Antipsychotics are given to ten without causing a rise in seizures. The FDA discovered that there may be a higher risk involved with first-generation antipsychotic medications of death when administered to senior citizens suffering from psychosis brought on by dementia. According to the FDA, Chlorpromazine is one antipsychotic drug that is not recommended for treating dementia in older people. doctors who give elderly patients antipsychotic drugs for psychosis associated with dementia ought to talk about this potentially catastrophic danger with the patient, their family, or their caregiver.

Utilization during pregnancy and nursing: Category C

The safety of chlorpromazine during pregnancy has not been investigated in women. It is uncertain how the drug will affect a growing baby in a pregnant woman. Research on animals showed no signs of damage to the developing fetus from chlorpromazine exposure. However, research on animals is not necessarily indicative of impacts on people. Women who are or may become pregnant should talk to their doctor about this.
Recurrences of psychosis in some women may occur after they stop using chlorpromazine. In these situations, the doctor could talk about the need to resume the medicine, look for a different drug, or therapy.

Chlorpromazine shouldn’t be given to nursing moms since little levels will enter breast milk and be consumed by the infant. Breastfeeding should not begin if there is no other option than to cease taking the antipsychotic.

Potential Interactions with Drugs

When some drugs are used with chlorpromazine, there may be drug interactions that cause changes in their levels that might result in unfavorable outcomes. Drugs that have the potential to delay cardiac conduction shouldn’t be administered in conjunction with chlorpromazine due to the potential for increased arrhythmia risk.

• Alcohol use should be avoided by patients on chlorpromazine since it may worsen cognitive, judgmental, and motor functions.
•  Chlorpromazine and tricyclic antidepressants (TCAs) may raise the blood levels of TCAs, which could make arrhythmia more likely.  
• Demerol, or meperidine, in conjunction with chlorpromazine may cause hypotension and severe sedation. 
•  (pimozide) and chlorpromazine should never be used together. The two drugs may interact in an additive way and impact on cardiac conduction prolongation, raising the possibility of an arrhythmia. 
• Anti-Parkinson’s drugs (such as Cogentin, Artane, Benadryl, when chlorpromazine is used with it, anticholinergic activity may exacerbate Parkinson’s disease side symptoms, such as dry mouth, disorientation, constipation, and impaired vision.
• Chlorpromazine with Seroquel (quetiapine) may considerably reduce the Seroquel’s blood levels, decreasing its efficacy. 

Overdosing 

Chlorpromazine overdose is often accompanied with depression of the central nervous system (CNS) with profound somnolence, low blood pressure, EPS, and irregular electrocardiograms. More severe issues might consist of coma, fever, convulsions, restlessness, agitation, and arrhythmias. The chance that an overdose will kill you depends on how much chlorpromazine was consumed and whether it was taken with other drugs, in particular, CNS depressants.

Treating any suspected overdose as an emergency is imperative. The individual has to be brought to the emergency space for care and observation. It is advisable to bring the prescription bottle of medicine (as well as any additional medication that may have been taken in excess) since the information on the label may be useful in helping the treating physician figure out how many tablets the patient has taken.

Precaution Points to Remember

Chlorpromazine should never be stopped without first talking to your doctor.

• Take the missed dosage as soon as you remember. Ignore the missed dosage if the next scheduled dose is approaching and go on with your usual dosage regimen. Avoid taking two doses at once. You may take chlorpromazine with or without meals.
  • Chlorpromazine may make you drowsy and sedentary, particularly when you first start medication. It may also combine your awareness. When driving or doing other duties that call for attentiveness, proceed with care.
  • Chlorpromazine may increase the absorption of UV radiation and raise the risk of sunburn. Make use of a sun screen and stay out of the sun’s direct rays.
  • Keep the medicine out of direct sunlight and dampness, in the light-resistant container that came with it. Warmth and moisture may hasten the disintegration of your drug, causing it to lose its medicinal consequences.
  • Make sure kids can’t get to your medicine.