Brand Name:

Generic Name:

Classification: PHENOTHIAZINES (ALIPHATIC)

Recommended Dosage, Route, and Frequency:

PO (Adults): Psychoses—10– 25 mg 2– 4 times daily; mayqevery 3– 4 days (usual dose is 200 mg/day;
up to 1 g/day). Nausea and vomiting—10– 25 mg q 4 hr as needed. Preoperative sedation—25– 50 mg 2–
3 hr before surgery. Hiccups/porphyria—25– 50 mg 3– 4 times daily.

PO (Children): Psychoses/nausea and vomiting—0.55 mg/kg (15 mg/m2 )q4– 6 hr as needed.

Preoperative sedation—0.55 mg/kg (15 mg/m2 ) 2– 3 hr before surgery.

IM (Adults):Severe psychoses—25– 50 mg initially, may be repeated in 1 hr;qto maximum of 400 mg q

3– 12 hr if needed (up to 1 g/day). Nausea/vomiting—25 mg initially, may repeat with 25– 50 mg q 3– 4
hr as needed. Nausea/vomiting during surgery—12.5 mg, may be repeated in 30 min as needed.
Preoperative sedation—12.5– 25 mg 1– 2 hr prior to surgery. Hiccups/tetanus—25– 50 mg 3– 4 times
daily. Porphyria—25 mg q 6– 8 hr until patient can take PO.

IM (Children 6 mo): Psychoses/nausea and vomiting—0.55 mg/kg (15 mg/m2 ) q 6– 8 hr (not to exceed
40 mg/day in children 6 mo– 5 yr, or 75 mg/day in children 5– 12 yr). Nausea/vomiting during surgery—
0.275 mg/kg, may repeat in 30 min as needed. Preoperative sedation—0.55 mg/kg 1– 2 hr prior to
surgery. Tetanus—0.55 mg/kg q 6– 8 hr.

IV (Adults): Nausea/vomiting during surgery—up to 25 mg. Hiccups/tetanus—25– 50 mg. Porphyria—

25 mg q 8 hr.

IV (Children): Nausea/vomiting during surgery—0.275 mg/kg. Tetanus— 0.55 mg/kg

Drug Action: ADME, Onset, Peak, Duration

Alters the effects of dopamine in the CNS. Has significant anticholinergic/alpha-adrenergic blocking
activity. Therapeutic Effects: Diminished signs/symptoms of psychosis. Relief of
nausea/vomiting/intractable hiccups. Decreased symptoms of porphyria.

Absorption: Variable absorption from tablets. Well absorbed following IM administration.

Distribution: Widely distributed; high CNS concentrations. Crosses the placenta; enters breast milk.

Metabolism and Excretion: Highly metabolized by the liver and GI mucosa. Some metabolites are
active.

Drug-Drug and Drug-Food Interactions:

Drug-Drug: Pimozideqthe risk of potentially serious cardiovascular reactions; concurrent use

contraindicated. May alter serum phenytoin levels.ppressor effect of norepinephrine and eliminates
bradycardia. Antagonizes peripheral vasoconstriction from epinephrine and may reverse some of its
actions. Maypelimination andqeffects of valproic acid. Maypthe pharmacologic effects of amphetamine
and related compounds. Maypthe effectiveness of bromocriptine. Mayqblood levels and effects of
tricyclic antidepressants. Antacids or adsorbent antidiarrheals maypadsorption; administer 1 hr before or 2
hr after chlorpromazine.q risk of anticholinergic effects with antihistamines, tricyclic antidepressants,
quinidine, or disopyramide. Premedication with chlorpromazineqthe risk of neuromuscular excitation and
hypotension when followed by barbiturate anesthesia.

Drug-Natural Products: Concomitant use of kava-kava, valerian, chamomile, or hops canqCNS

depression.qanticholinergic effects with angel’s trumpet, jimson weed, and scopolia
Indications:

Second-line treatment for schizophrenia and psychoses after failure with atypical antipsychotics.
Hyperexcitable, combative behavior in children. Nausea and vomiting. Intractable hiccups. Preoperative
sedation. Acute intermittent porphyria. Unlabeled Use: Vascular headache. Bipolar disorder.

Contraindications:

Contraindicated in: Hypersensitivity; Hypersensitivity to sulfites (injectable); Cross-sensitivity with

other phenothiazines may occur; Angle-closure glaucoma; Bone marrow depression; Severe
liver/cardiovascular disease; Concurrent pimozide use.

Use Cautiously in: Diabetes; Respiratory disease; Prostatic hyperplasia; CNS tumors; Epilepsy;
Intestinal obstruction; OB: Neonates atqrisk for extrapyramidal symptoms and withdrawal after delivery
when exposed during the 3rd trimester; use only if benefit outweighs risk to fetus; Lactation: Discontinue
drug or bottle feed; Pedi: Children with acute illnesses, infections, gastroenteritis, or dehydration (qrisk of
extrapyramidal reactions); Geri:qrisk of mortality in elderly patients treated for dementia-related
psychosis; Geri: Geriatric/debilitated patients (pinitial dose).

Side Effects: By system

CNS: dizziness, drowsiness, restlessness, headache GU: difficulty urinating, breast swelling or discharge,
changes in your menstrual periods, trouble having an orgasm, impotence, increased or decreased
interest in sex, EENT: blurred vision, stuffy nose, GI: dry mouth, vomiting, constipation, diarrhea, Derm:
itching or skin rash.

Adverse Reaction: By system

CNS: NEUROLEPTIC MALIGNANT SYNDROME, sedation, extrapyramidal reactions, tardive

dyskinesia. EENT: blurred vision, dry eyes, lens opacities. CV: hypotension (qwith IM, IV), tachycardia.
GI: constipation, dry mouth, anorexia, hepatitis, ileus, priapism. GU: urinary retention. Derm:
photosensitivity, pigment changes, rash. Endo:galactorrhea, amenorrhea.Hemat: AGRANULOCYTOSIS,
leukopenia.Metab: hyperthermia.Misc:allergic reactions

Nursing Responsibilities: (ADPIE Format)

Assessment

● Assess mental status (orientation, mood, behavior) prior to and periodically during therapy. initiation of
therapy, with recovery 1– 2 wk following discontinuation. May recur if medication is restarted. Liver
function abnormalities may require discontinuation of therapy. May cause false-positive or false-negative
pregnancy tests and false-positive urine bilirubin test results.

● Assess fasting blood glucose and cholesterol levels initially and periodically throughout therapy.

● May causeqserum prolactin levels.

Potential Nursing Diagnoses

Disturbed thought process (Indications) Imbalanced nutrition: risk for more than body requirements (Side
Effects) Implementation

● Do not confuse chlorpromazine with chlorpropamide, chlordiazepoxide, or prochlorperazine.

● Keep patient recumbent for at least 30 min following parenteral administration to minimize hypotensive
effects.

● Hiccups: Initial treatment is with oral doses. If hiccups persist 2– 3 days, IM injection may be used,
followed by IV infusion.

● PO: Administer oral doses with food, milk, or a full glass of water to minimize gastric irritation. Tablets
may be crushed.

● IM: Do not inject subcut. Inject slowly into deep, well-developed muscle. May be diluted with 0.9%
NaCl or 2% procaine. Lemon-yellow color does not alter potency of solution. Do not administer solution
that is markedly discolored or contains a precipitate.
Patient/Family Teaching

● Advise patient to take medication as directed and not to skip doses or double up on missed doses. If a
dose is missed, take within 1 hr or omit dose and return to regular schedule. Abrupt withdrawal may lead
to gastritis, nausea, vomiting, dizziness, headache, tachycardia, and insomnia.

● Inform patient of possibility of extrapyramidal symptoms and tardive dyskinesia. Instruct patient to
report these symptoms immediately to health care professional.

● Advise patient to change positions slowly to minimize orthostatic hypotension.

● May cause drowsiness. Caution patient to avoid driving or other activities requiring alertness until
response to the medication is known.

● Caution patient to avoid taking alcohol or other CNS depressants concurrently with this medication.

● Advise patient not to take chlorpromazine within 2 hr of antacids or antidiarrheal medication.

● Inform patient that this medication may turn urine a pink-to-reddish-brown color.

● Advise patient to notify health care professional of medication regimen prior to treatment or surgery.

● Instruct patient to notify health care professional promptly if sore throat, fever, unusual bleeding or
bruising, rash, weakness, tremors, visual disturbances, dark-colored urine, or clay-colored stools occur.

● Advise female patients to notify health care professional if pregnancy is planned or suspected or if
breast feeding.

● Emphasize the importance of routine follow-up exams to monitor response to medication and detect
side effects. Encourage continued participation in psychotherapy as indicated.

● Treatment is not a cure; symptoms may recur after discontinuation of medication.

Evaluation/Desired Outcomes

● Decrease in excitable, manic behavior. Therapeutic effects may not be seen for 7– 8 wk.

● Relief of nausea and vomiting.

● Relief of hiccups.

● Preoperative sedation.

● Management of porphyria.

● Relief of vascular headache.

● Decrease in positive (hallucinations, delusions, agitation) symptoms of schizophrenia