Drugs List

Therapeutic Indications

Uses

Acute excitement
Anxiety state
Hiccough - intractable
Hypomania
Mania
Nausea,vomiting in terminal care when other drugs ineffective/unavailable
Paranoid psychosis
Schizophrenia
Schizophrenia and autism in childhood
Short term adjunctive management of violent/dangerously impulsive behaviour
Short term moderate-severe psychomotor agitation (adjunctive management)

Contraindications

Benign prostatic hyperplasia
Breastfeeding
Cardiac failure
Central nervous system depression
Coma
Hepatic impairment
History of agranulocytosis
History of narrow angle glaucoma
History of urinary retention
Hypothyroidism
Labour
Long QT syndrome
Myasthenia gravis
Myelosuppression
Parkinson's disease
Phaeochromocytoma
Renal impairment
Torsade de pointes

Precautions and Warnings

Elderly
Family history of long QT syndrome
Photosensitivity
Predisposition to orthostatic hypotension
Predisposition to venous thromboembolism
Prolonged starvation
Risk of cerebrovascular accident
Tobacco smoking
Alcoholism
Cardiac disorder
Cardiovascular disorder
Chronic constipation
Dehydration
Dementia
Depression
Diabetes mellitus
Electrolyte imbalance
Epileptic disorder
Haematological disorder
History of cardiovascular disorder
History of jaundice
History of seizures
History of torsade de pointes
Hypovolaemia
Organic brain syndrome
Pregnancy
Severe respiratory disease

Correct electrolyte disorders before treatment
Advise ability to drive/operate machinery may be affected by side effects
Patients at risk of arrhythmias perform ECG prior to initiating therapy
Reduce initial dose in the elderly
Contains sodium metabisulfite. Caution,may cause allergic reactions
Avoid contact of product with skin
Do not use if solution is discoloured or particulates are apparent
Keep patient supine when receiving injection
Local pain or nodule formation may occur after intramuscular administration
Perform ECG before and during treatment
Discontinue treatment if patient develops seizures
Examine eyes for defects in prolonged use
Haematological monitoring required in long term use
Hypothermia may develop in the elderly
Monitor blood counts regularly
Monitor blood glucose closely in patients with diabetes mellitus
Monitor blood pressure
Monitor patients at risk for signs & symptoms of venous thromboembolism
Monitor serum electrolytes
Neonate exposed in utero: Monitor neonate for adverse effects
Perform blood counts if unexplained infection or fever develops
Advise patient to report unexplained fever, sore throat, bruising, bleeding
May cause postural hypotension especially in elderly
May precipitate diabetes mellitus
Predisposition QT prolongation: Counsel patient on symptoms of arrhythmias
Avoid abrupt withdrawal
Discontinue at first signs of jaundice
Discontinue if fever occurs
Discontinue if paralytic ileus occurs
Discontinue if patient develops neuroleptic malignant syndrome
Dose adjustment required if patient starts/stops smoking during therapy
Not licensed for all indications in all age groups
Advise that effects are potentiated by CNS depressants (including alcohol)
Female: May cause infertility
Advise patient that photosensitivity possible
Advise patient to avoid exposure to direct sunlight

Monitor patients for up to 2 years after discontinued as recurrence symptoms may be delayed.

If an unexplained infection or fever occurs, perform a haematological investigation immediately.

Pregnancy and Lactation

Pregnancy

Use chlorpromazine with caution in pregnancy.

At the time of writing there is limited published information regarding the safety of chlorpromazine in human pregnancy. Animal studies have shown harmful effects, rodents, when exposed to high doses over long periods of time have shown the increased risk of embryotoxicity (Briggs et al, 2015). Schaefer (2015) states studies of chlorpromazine used in the first trimester of pregnancy showed no evidence of teratogenic effects but studies in high doses showed 3 infants to suffer from respiratory distress and die. Briggs (2015) states although chlorpromazine does cross the placenta, the majority of studies using chlorpromazine during pregnancy consider the drug to be safe to use in low doses over a short period of time. The manufacturer suggests chlorpromazine should be avoided during pregnancy unless the potential benefit to the mother outweighs the potential risk to the foetus.

Antipsychotics used during the third trimester of pregnancy have been found to prolong labour and increase adverse effects to neonates including reactions of withdrawal symptoms and respiratory distress. It is advised to monitor newborns that have been exposed to antipsychotics during pregnancy.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Chlorpromazine is contraindicated in breastfeeding.

Schaefer (2015) states chlorpromazine has a long half life of approximately 30 hours. Hale (2015) states chlorpromazine is excreted in breast milk in small amounts and due to its relatively long half life, it increases the potential risk to a breastfed infant if used in breastfeeding long term. Studies have shown infants who have been exposed to chlorpromazine via breastfeeding have became drowsy and lethargic (Briggs et al, 2015).
The manufacturer suggests breastfeeding should be stopped during the use of chlorpromazine.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Acute dystonias
Agitation
Agranulocytosis
Akathisia
Akinesia
Allergic reaction
Amenorrhoea
Anaphylactic reaction
Angioedema
Antimuscarinic effects
Apathy
Aplastic anaemia
Atrial arrhythmia
Atrioventricular block
Autonomic instability
Bronchospasm
Cardiac arrest
Cardiac arrhythmias
Confusion
Constipation
Contact sensitisation
Convulsions
Corneal opacities
Decreased glucose tolerance
Dizziness
Drowsiness
Dry mouth
Dyskinesia
Dystonia
ECG changes
Eosinophilia
Excitement
Extrapyramidal effects
Fever
Galactorrhoea
Gastro-intestinal disturbances
Gynaecomastia
Haemolytic anaemia
Headache
Hyperglycaemia
Hyperprolactinaemia
Hypersensitivity reactions
Hyperthermia
Hypotension
Hypothermia
Impaired consciousness
Impotence
Insomnia
Jaundice
Lens opacities
Leucopenia
Liver damage
Local pain (injection site)
Menstrual disturbances
Micturition disorders
Nasal stuffiness
Neuroleptic malignant syndrome
Nodules (injection site)
Ocular changes
Pallor
Parkinsonism
Photosensitivity
Postural hypotension
Priapism
Prolongation of QT interval
Purplish pigmentation of cornea, conjunctiva, retina
Purplish pigmentation of skin
Rash
Respiratory depression
Rigidity
Sexual dysfunction
ST depression
Sudden death reported
Sweating
Systemic lupus erythematosus
T-wave changes
Tachycardia
Tardive dyskinesia
Thrombocytopenic purpura
Tremor
U-wave changes
Urinary incontinence
Urticaria
Venous thrombosis
Ventricular fibrillation
Ventricular tachycardia
Weight gain

Presentation

Parenteral formulations of chlorpromazine hydrochloride

Drugs List

Therapeutic Indications

Uses

Acute excitement
Anxiety state
Hiccough - intractable
Hypomania
Mania
Nausea,vomiting in terminal care when other drugs ineffective/unavailable
Paranoid psychosis
Schizophrenia
Schizophrenia and autism in childhood
Short term adjunctive management of violent/dangerously impulsive behaviour
Short term moderate-severe psychomotor agitation (adjunctive management)

Dosage

Oral formulation is the preferred method of administration.

Adults

Elderly

Children

Contraindications

Benign prostatic hyperplasia
Breastfeeding
Cardiac failure
Central nervous system depression
Coma
Hepatic impairment
History of agranulocytosis
History of narrow angle glaucoma
History of urinary retention
Hypothyroidism
Labour
Long QT syndrome
Myasthenia gravis
Myelosuppression
Parkinson's disease
Phaeochromocytoma
Renal impairment
Torsade de pointes

Precautions and Warnings

Elderly
Family history of long QT syndrome
Photosensitivity
Predisposition to orthostatic hypotension
Predisposition to venous thromboembolism
Prolonged starvation
Risk of cerebrovascular accident
Tobacco smoking
Alcoholism
Cardiac disorder
Cardiovascular disorder
Chronic constipation
Dehydration
Dementia
Depression
Diabetes mellitus
Electrolyte imbalance
Epileptic disorder
Haematological disorder
History of cardiovascular disorder
History of jaundice
History of seizures
History of torsade de pointes
Hypovolaemia
Organic brain syndrome
Pregnancy
Severe respiratory disease

Correct electrolyte disorders before treatment
Advise ability to drive/operate machinery may be affected by side effects
Patients at risk of arrhythmias perform ECG prior to initiating therapy
Reduce initial dose in the elderly
Contains sodium metabisulfite. Caution,may cause allergic reactions
Avoid contact of product with skin
Do not use if solution is discoloured or particulates are apparent
Keep patient supine when receiving injection
Local pain or nodule formation may occur after intramuscular administration
Perform ECG before and during treatment
Discontinue treatment if patient develops seizures
Examine eyes for defects in prolonged use
Haematological monitoring required in long term use
Hypothermia may develop in the elderly
Monitor blood counts regularly
Monitor blood glucose closely in patients with diabetes mellitus
Monitor blood pressure
Monitor patients at risk for signs & symptoms of venous thromboembolism
Monitor serum electrolytes
Neonate exposed in utero: Monitor neonate for adverse effects
Perform blood counts if unexplained infection or fever develops
Advise patient to report unexplained fever, sore throat, bruising, bleeding
May cause postural hypotension especially in elderly
May precipitate diabetes mellitus
Predisposition QT prolongation: Counsel patient on symptoms of arrhythmias
Avoid abrupt withdrawal
Discontinue at first signs of jaundice
Discontinue if fever occurs
Discontinue if paralytic ileus occurs
Discontinue if patient develops neuroleptic malignant syndrome
Dose adjustment required if patient starts/stops smoking during therapy
Not licensed for all indications in all age groups
Advise that effects are potentiated by CNS depressants (including alcohol)
Female: May cause infertility
Advise patient that photosensitivity possible
Advise patient to avoid exposure to direct sunlight

Monitor patients for up to 2 years after discontinued as recurrence symptoms may be delayed.

If an unexplained infection or fever occurs, perform a haematological investigation immediately.

Pregnancy and Lactation

Pregnancy

Use chlorpromazine with caution in pregnancy.

At the time of writing there is limited published information regarding the safety of chlorpromazine in human pregnancy. Animal studies have shown harmful effects, rodents, when exposed to high doses over long periods of time have shown the increased risk of embryotoxicity (Briggs et al, 2015). Schaefer (2015) states studies of chlorpromazine used in the first trimester of pregnancy showed no evidence of teratogenic effects but studies in high doses showed 3 infants to suffer from respiratory distress and die. Briggs (2015) states although chlorpromazine does cross the placenta, the majority of studies using chlorpromazine during pregnancy consider the drug to be safe to use in low doses over a short period of time. The manufacturer suggests chlorpromazine should be avoided during pregnancy unless the potential benefit to the mother outweighs the potential risk to the foetus.

Antipsychotics used during the third trimester of pregnancy have been found to prolong labour and increase adverse effects to neonates including reactions of withdrawal symptoms and respiratory distress. It is advised to monitor newborns that have been exposed to antipsychotics during pregnancy.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Chlorpromazine is contraindicated in breastfeeding.

Schaefer (2015) states chlorpromazine has a long half life of approximately 30 hours. Hale (2015) states chlorpromazine is excreted in breast milk in small amounts and due to its relatively long half life, it increases the potential risk to a breastfed infant if used in breastfeeding long term. Studies have shown infants who have been exposed to chlorpromazine via breastfeeding have became drowsy and lethargic (Briggs et al, 2015).
The manufacturer suggests breastfeeding should be stopped during the use of chlorpromazine.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Acute dystonias
Agitation
Agranulocytosis
Akathisia
Akinesia
Allergic reaction
Amenorrhoea
Anaphylactic reaction
Angioedema
Antimuscarinic effects
Apathy
Aplastic anaemia
Atrial arrhythmia
Atrioventricular block
Autonomic instability
Bronchospasm
Cardiac arrest
Cardiac arrhythmias
Confusion
Constipation
Contact sensitisation
Convulsions
Corneal opacities
Decreased glucose tolerance
Dizziness
Drowsiness
Dry mouth
Dyskinesia
Dystonia
ECG changes
Eosinophilia
Excitement
Extrapyramidal effects
Fever
Galactorrhoea
Gastro-intestinal disturbances
Gynaecomastia
Haemolytic anaemia
Headache
Hyperglycaemia
Hyperprolactinaemia
Hypersensitivity reactions
Hyperthermia
Hypotension
Hypothermia
Impaired consciousness
Impotence
Insomnia
Jaundice
Lens opacities
Leucopenia
Liver damage
Local pain (injection site)
Menstrual disturbances
Micturition disorders
Nasal stuffiness
Neuroleptic malignant syndrome
Nodules (injection site)
Ocular changes
Pallor
Parkinsonism
Photosensitivity
Postural hypotension
Priapism
Prolongation of QT interval
Purplish pigmentation of cornea, conjunctiva, retina
Purplish pigmentation of skin
Rash
Respiratory depression
Rigidity
Sexual dysfunction
ST depression
Sudden death reported
Sweating
Systemic lupus erythematosus
T-wave changes
Tachycardia
Tardive dyskinesia
Thrombocytopenic purpura
Tremor
U-wave changes
Urinary incontinence
Urticaria
Venous thrombosis
Ventricular fibrillation
Ventricular tachycardia
Weight gain

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: February 2017

Reference Sources

Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. Accessed on 18 January 2018.

Medications and Mothers' Milk, Sixteenth Edition (2014) Hale, T and Rowe, H, Hale Publishing, Plano, Texas.

Paediatric Formulary Committee. BNF for Children (online) London: BMJ Group, Pharmaceutical Press, and RCPCH Publication. Accessed on 18 January 2018.

Summary of Product Characteristics: Largactil Injection. Sanofi-Aventis Pharma. Revised July 2016.

Specialist Pharmacy Service (SPS)
Available at: https://www.sps.nhs.uk/
What are the clinically significant drug interactions with tobacco smoking? Last revised: July 2020
Last accessed: 07 December 2020