First-generation antipsychotic, aliphatic-side-chain phenothiazine
Brand names: Thorazine
Updated · Methodology
Third line
Chlorpromazine is third-line antipsychotic for schizophrenia. SEPB reserves it after atypical APs due to high rates of extrapyramidal symptoms, hyperprolactinaemia and QT prolongation. Also used in acute agitation and hiccup.
Sources
ICD-10: F20 · ICD-11: 6A20
Blocks D2 receptors (antipsychotic effect), 5-HT2A, alpha-1 adrenoceptors (orthostatic hypotension, sedation), muscarinic M1 (dry mouth) and H1 (sedation). Clinically prolongs QT (10–20 ms). Metabolised by CYP2D6 + CYP1A2.
Third-trimester use linked to neonatal extrapyramidal symptoms and withdrawal.
Passes into breast milk. Breastfeeding not recommended.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
2 pairs found. Sorted from critical to minor.
Mechanism
Dual QT prolongation, additive hypotension (chlorpromazine alpha-1 block).
Symptoms
QTc above 500 ms, syncope, torsades de pointes risk.
Management
Combination contraindicated.
Sources
Mechanism
Additive QT prolongation.
Symptoms
QTc above 500 ms, syncope, torsades de pointes risk.
Management
Alternative – levofloxacin.
Verbatim lines from the interaction sections, in the language of the label
«Medicamentos que inducen Torsades de pointes: Algunos antipsicóticos, como clorpromazina, tioridazina, flufenazina, pimozida, haloperidol, amisulprida y sertindol.»AEMPS, section 4.5 · Open on CIMA
«DRUG INTERACTIONS: Because pimozide prolongs the QT interval of the electrocardiogram, an additive effect on QT interval would be anticipated if administered with other drugs, such as phenothiazines…»FDA, section 7 · Open on DailyMed
«CONTRAINDICATIONS: dofetilide, sotalol, quinidine, other Class Ia and III anti-arrhythmics, mesoridazine, thioridazine, chlorpromazine, droperidol, pimozide, sparfloxacin, gatifloxacin, moxifloxacin…»FDA, section 4 · Open on DailyMed
«Sustancias que pueden desencadenar torsades de pointes: - ciertos antipsicóticos: fenotiazinas (por ejemplo, clorpromazina, ciamemazina, levomepromazina, tioridazina, trifluoperazina), benzamidas…»AEMPS, section 4.5 · Open on CIMA
«Potential for Other Drugs to Affect Clozapine: Use caution when administering concomitant medications that prolong the QT interval or inhibit the metabolism of clozapine. Drugs that cause QT…»FDA, section 7 · Open on DailyMed
«Drugs that Prolong the QT Interval: Do not use fluoxetine in combination with thioridazine or pimozide. Use fluoxetine with caution in combination with other drugs that cause QT prolongation. These…»FDA, section 7 · Open on DailyMed
«Clorpromazina (agente neuroléptico): las dosis altas (> 100 mg de clorpromazina al día) aumentan la glucemia (liberación reducida de insulina) Advertir al paciente y destacar la importancia de la…»AEMPS, section 4.5 · Open on CIMA
«Medicamentos afectados por alteraciones de los niveles de potasio: Algunos antipsicóticos (p.ej., trioridazina, clorpromazina, levomepromazina, trifluoperazina, ciamemazina, sulpirida, sultoprida…»AEMPS, section 4.5 · Open on CIMA
«Medicamentos que ocasionan “torsades de pointes”, pero sin limitarse a: fenotiazinas (ej. clorpromazina, ciamemazina, levomepromazina, tioridazina, trifluoperazina),»AEMPS, section 4.5 · Open on CIMA
«Interacciones que disminuyen los niveles de litio: Antipsicóticos típicos y atípicos : se han reportado casos de reacciones neurotóxicas en pacientes tratados tanto con litio como con un…»AEMPS, section 4.5 · Open on CIMA
«Dado que la bradicardia constituye un factor de riesgo en la aparición de torsades de pointes, se debe observar con precaución e incluso puede requerirse una monitorización clínica (ECG), si se…»AEMPS, section 4.5 · Open on CIMA
«Clinically-Significant Drug Interactions: Chlorpromazine Use with caution Hypotensive effects»FDA, section 7 · Open on DailyMed
«clorpromazina, metilfenidato, reserpina.»AEMPS, section 4.5 · Open on CIMA
«derivados de fenotiazina, clorpromazina,»AEMPS, section 4.5 · Open on CIMA
«Medicamentos que pueden aumentar las concentraciones plasmáticas de haloperidol: Inhibidores de la CYP2D6: bupropión, clorpromazina, duloxetina, paroxetina, prometazina, sertralina, venlafaxina.»AEMPS, section 4.5 · Open on CIMA
«Combinación no recomendada: Clorpromazina:»AEMPS, section 4.5 · Open on CIMA
«Clinically Significant Drug Interactions: E xamples: Specific antipsychotics (e.g., ziprasidone, iloperidone, chlorpromazine, mesoridazine, droperidol); specific antibiotics (e.g., erythromycin…»FDA, section 7 · Open on DailyMed
«Fenotiazinas: Trazodona ha sido bien tolerado en pacientes con esquizofrenia y depresión que recibían terapia estándar con fenotiazina. Se ha observado hipotensión ortostática grave en el caso de uso…»AEMPS, section 4.5 · Open on CIMA
«Drugs Having Clinically Important Interactions with Trazodone Hydrochloride Tablets: Examples: Class 1A antiarrhythmics: quinidine, procainamide, disopyramide; Class 3 antiarrhythmics: amiodarone…»FDA, section 7 · Open on DailyMed
«Effects of Co-Administered Drugs on Valproate Clearance: Chlorpromazine A study involving the administration of 100 to 300 mg/FDA, section 7 · Open on DailyMed
«Otros fármacos: Cuando se administró zolpidem con warfarina, haloperidol, clorpromazina, digoxina o ranitidina, no se observaron interacciones farmacocinéticas significativas.»AEMPS, section 4.5 · Open on CIMA
«DRUG INTERACTIONS: Chlorpromazine: Impaired alertness and psychomotor performance observed ( 7.1 )»FDA, section 7 · Open on DailyMed
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Chlorpromazine is evaluated for the following indications with varying evidence strength: Schizophrenia (evidence tier B). See the full indication matrix with dosing and citations above on this page.
Common side effects of Chlorpromazine (≥ 1 in 100): Sedation, Orthostatic hypotension, Extrapyramidal symptoms, Dry mouth, Weight gain. See the Safety section for uncommon and serious reactions.
Third-trimester use linked to neonatal extrapyramidal symptoms and withdrawal.
Passes into breast milk. Breastfeeding not recommended.
Chlorpromazine is contraindicated in: Coma, severe CNS depression; Combination with other QT-prolongers; Closed-angle glaucoma; Severe hepatic impairment. Full list in the Safety section.
Direct links to regulator labels. Open in a new tab.
Clobazam, Clozapine, Diazepam, Droperidol, Haloperidol, Melatonin, Pimozide, Zolpidem