Formulary
Chlorpromazine hydrochloride: Indications, Dosing, Side Effects and Interactions
Chlorpromazine hydrochloride clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 7 min read
Chlorpromazine hydrochloride: Indications, Dosing, Side Effects and Interactions
Chlorpromazine hydrochloride clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Schizophrenia and other psychoses,Mania,Short-term adjunctive management of severe anxiety,Psychomotor agitation, excitement, and violent or dangerously impulsive behaviour**
- **Adult** (By Mouth): Initially 25 mg 3 times a day, adjusted according to response, alternatively initially 75 mg once daily, adjusted according to response, dose to be taken at night; maintenance 75-300 mg daily, increased if necessary up to 1 g daily, this dose may be required in psychoses; use a third to half adult dose in the elderly or debilitated patients.
- **Adult** (By Rectum): 100 mg every 6-8 hours, dose expressed as chlorpromazine base.
**Intractable hiccup**
- **Adult** (By Mouth): 25-50 mg 3-4 times a day.
**Relief of acute symptoms of psychoses (under expert supervision)**
- **Adult** (By Deep Intramuscular Injection): 25-50 mg every 6-8 hours.
**Nausea and vomiting in palliative care (where other drugs have failed or are not available)**
- **Child** (By Mouth): 12-17 years 10-25 mg every 4-6 hours.
- **Adult** (By Mouth): 10-25 mg every 4-6 hours.
- **Child** (By Deep Intramuscular Injection): 12-17 years Initially 25 mg, then 25-50 mg every 3-4 hours until vomiting stops.
- **Adult** (By Deep Intramuscular Injection): Initially 25 mg, then 25-50 mg every 3-4 hours until vomiting stops.
- **Adult** (By Rectum): 100 mg every 6-8 hours.
**Childhood schizophrenia and other psychoses (under expert supervision) for chlorpromazine hydrochloride**
- **Child 1-5 years** (By mouth): 500 micrograms/kg every 4-6 hours, adjusted according to response; maximum 40 mg per day.
- **Child 6-11 years** (By mouth): 10 mg 3 times a day, adjusted according to response; maximum 75 mg per day.
- **Child 12-17 years** (By mouth): Initially 25 mg 3 times a day, adjusted according to response, alternatively initially 75 mg once daily, adjusted according to response, dose to be taken at night; maintenance 75-300 mg daily, increased if necessary up to 1 g daily.
**Relief of acute symptoms of psychoses (under expert supervision) for chlorpromazine hydrochloride**
- **Child 1-5 years** (By deep intramuscular injection): 500 micrograms/kg every 6-8 hours; maximum 40 mg per day.
- **Child 6-11 years** (By deep intramuscular injection): 500 micrograms/kg every 6-8 hours; maximum 75 mg per day.
- **Child 12-17 years** (By deep intramuscular injection): 25-50 mg every 6-8 hours.
**Nausea and vomiting in palliative care (where other drugs have failed or are not available) for chlorpromazine hydrochloride**
- **Child 1-5 years** (By mouth): 500 micrograms/kg every 4-6 hours; maximum 40 mg per day.
- **Child 6-11 years** (By mouth): 500 micrograms/kg every 4-6 hours; maximum 75 mg per day.
- **Child 12-17 years** (By mouth): 10-25 mg every 4-6 hours.
- **Child 1-5 years** (By deep intramuscular injection): 500 micrograms/kg every 6-8 hours; maximum 40 mg per day.
- **Child 6-11 years** (By deep intramuscular injection): 500 micrograms/kg every 6-8 hours; maximum 75 mg per day.
- **Child 12-17 years** (By deep intramuscular injection): Initially 25 mg, then 25-50 mg every 3-4 hours until vomiting stops.
Cautions
For all antipsychotic drugs Blood dyscrasias; cardiovascular disease; conditions predisposing to seizures; depression; diabetes (may raise blood glucose); epilepsy; history of jaundice; myasthenia gravis; Parkinson's disease (may be exacerbated) (in adults); photosensitisation (may occur with higher dosages); prostatic hypertrophy (in adults); severe respiratory disease; susceptibility to angle-closure glaucoma Cautions, further information Cardiovascular disease An ECG may be required, particularly if physical examination identifies cardiovascular risk factors, personal history of cardiovascular disease, or if the patient is being admitted as an inpatient. Elderly In adults: Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: for all antipsychotics (other than quetiapine and clozapine) in patients with parkinsonism or Lewy Body Disease (risk of severe extrapyramidal symptoms) in behavioural and psychological symptoms of dementia (BPSD), unless symptoms are severe and other non-pharmacological treatments have failed (increased risk of stroke) for use as a hypnotic, unless sleep disorder is due to psychosis or dementia (risk of confusion, hypotension, extrapyramidal side-effects, and falls) in patients prone to falls (may cause gait dyspraxia, parkinsonism) if prescribed a phenothiazine (other than prochlorperazine for nausea, vomiting, or vertigo; chlorpromazine for relief of persistent hiccups; levomepromazine as an antiemetic in palliative care) as first-line treatment (sedative, significant antimuscarinic (anticholinergic) toxicity in older people, and safer and more efficacious alternatives exist) if prescribed an antipsychotic drug with moderate or marked antimuscarinic effects (e.g. chlorpromazine, clozapine, flupenthixol, fluphenazine, pipothiazine, promazine, and zuclopenthixol) in patients with a history of prostatism or urinary retention (high risk of urinary retention) Cautions For chlorpromazine hydrochloride Susceptibility to QT interval prolongation
Contraindications
CNS depression; comatose states; hypothyroidism; phaeochromocytoma
Side effects
For all antipsychotic drugs Common or very common Agitation; amenorrhoea; arrhythmias; constipation; dizziness; drowsiness; dry mouth; erectile dysfunction; fatigue; galactorrhoea; gynaecomastia; hyperglycaemia; hyperprolactinaemia; hypersalivation; hypotension (dose-related); insomnia; leucopenia; movement disorders; muscle rigidity; neutropenia; parkinsonism; postural hypotension (dose-related); QT interval prolongation; rash; seizure; tremor; urinary retention; vomiting; weight increased Uncommon Agranulocytosis; confusion; neuroleptic malignant syndrome (discontinue-potentially fatal) Rare or very rare Sudden death; withdrawal syndrome neonatal Side-effects, further information For depot antipsychotics-side-effects may persist until the drug has been cleared from its depot site. Overdose Phenothiazines cause less depression of consciousness and respiration than other sedatives. Hypotension, hypothermia, sinus tachycardia, and arrhythmias may complicate poisoning. For details on the management of poisoning see Antipsychotics under Emergency treatment of poisoning . Side-effects For chlorpromazine hydrochloride General side-effects: Common or very common Anxiety; glucose tolerance impaired; mood altered; muscle tone increased Frequency not known Accommodation disorder; angioedema; atrioventricular block; cardiac arrest; embolism and thrombosis; eye deposit; eye disorders; gastrointestinal disorders; hepatic disorders; hypertriglyceridaemia; hyponatraemia; photosensitivity reaction; respiratory disorders; sexual dysfunction; SIADH; skin reactions; systemic lupus erythematosus (SLE); temperature regulation disorder; trismus Specific side-effects: Frequency not known With intramuscular use Nasal congestion Side-effects, further information Acute dystonic reactions may occur; children are particularly susceptible.
Interactions
**Severe interactions:**
- Guanethidine has adverse clinically significant interactions documented.
**Other interactions (16):**
- Antichlolinergic drugs may reduce the antipsychotic effect of Chlorpromazine and the mild anticholinergic effect of Chlorpromazine may be enhanced by other anticholinergic drugs possibly leading to...
- The action of some drugs may be opposed by Chlorpromazine; these include amphetamine, levodopa, clonidine, guanethidine and adrenaline.
- Increases or decreases in the plasma concentrations of a number of drugs e.g.
- Simultaneous administration of deferoxamine and prochlorperazine has been observed to induce a transient metabolic encephalopathy characterised by loss of consciousness for 48-72 hours.
- It is possible this may occur with Chlorpromazine since it shares many of the pharmacological properties of prochlorperazine.
- There is an increased risk of agranulocytosis when neuroleptics are used concurrently with drugs with myelosuppressive potential, such as carbamazepine or certain antibiotics and cytotoxics.
Pregnancy
For all antipsychotic drugs Extrapyramidal effects and withdrawal syndrome have been reported occasionally in the neonate when antipsychotic drugs are taken during the third trimester of pregnancy. Following maternal use of antipsychotic drugs in the third trimester, neonates should be monitored for symptoms including agitation, hypertonia, hypotonia, tremor, drowsiness, feeding problems, and respiratory distress.
Breast feeding
For all antipsychotic drugs There is limited information available on the short- and long-term effects of antipsychotic drugs on the breast-fed infant. Animal studies indicate possible adverse effects of antipsychotic medicines on the developing nervous system. Chronic treatment with antipsychotic drugs whilst breast-feeding should be avoided unless absolutely necessary. Phenothiazine derivatives are sometimes used in breast-feeding women for short-term treatment of nausea and vomiting.
Hepatic impairment
Manufacturer advises caution in severe hepatic failure (increased risk of accumulation).
Renal impairment
Caution in severe renal failure (risk of accumulation). M
Medicinal forms
Capsule,Tablet,Solution,Suppository
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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