What is the indication for Chlorpromazine?

From the Guidelines

Chlorpromazine is indicated for the treatment of psychotic conditions, including schizophrenia.

Indications and Usage

• Chlorpromazine is a low-potency neuroleptic that can be used as a first-line treatment for psychotic conditions, including schizophrenia, as recommended by the World Health Organization (WHO) 1.
• It can be used as an alternative to second-generation antipsychotics, especially in low- and middle-income countries where availability and cost may be a concern.
• Chlorpromazine has been used in the treatment of aggressive behavior in child and adolescent psychiatric institutions, particularly in cases where environmental strategies are not effective 1.

Dosage and Administration

• The dosage of chlorpromazine may vary depending on the individual patient and the specific condition being treated.
• High doses of chlorpromazine may be required in treatment-resistant psychotic conditions, but this should be done with caution and under close clinical monitoring.

Important Considerations

• Chlorpromazine should be used with caution in patients with a history of extrapyramidal side effects, as it can exacerbate these symptoms 1.
• The use of chlorpromazine in combination with other medications, such as anticholinergics, should be done with caution and only when necessary, as it can increase the risk of adverse effects 1.

From the FDA Drug Label

Psychotic Disorders – Increase dosage gradually until symptoms are controlled Maximum improvement may not be seen for weeks or even months. Hospitalized Patients: Acute Schizophrenic or Manic States – It is recommended that initial treatment be with chlorpromazine hydrochloride injection until patient is controlled. Nausea and Vomiting– 10 mg to 25 mg q4 to 6h, p.r.n., increased, if necessary. Presurgical Apprehension– 25 mg to 50 mg, 2 to 3 hours before the operation. Intractable Hiccups– 25 mg to 50 mg t.i.d. or q.i.d. Acute Intermittent Porphyria– 25 mg to 50 mg t.i.d. or q.i. d.

The indication for Chlorpromazine is for the treatment of:

• Psychotic disorders, such as acute schizophrenic or manic states
• Nausea and vomiting
• Presurgical apprehension
• Intractable hiccups
• Acute intermittent porphyria 2

From the Research

Indication for Chlorpromazine

• Chlorpromazine is used to treat schizophrenia and schizophrenia-like psychoses 3, 4, 5
• It is one of the most common drugs used for people with schizophrenia worldwide, and a benchmark against which other treatments can be evaluated 4
• Chlorpromazine promotes a global improvement in people with schizophrenia, although a considerable placebo response is also seen 4
• It is used to reduce psychosis regardless of the underlying diagnosis, and goes beyond nonspecific sedation 6

Clinical Use

• The optimal dose of chlorpromazine has been the subject of evaluative research, but summaries of this work are rare 3
• The average dose of chlorpromazine given to people with schizophrenia has declined across time, but this has come about by long- and sometimes hard- experience rather than from direction from high-grade trial-based evidence 3, 5
• Low- and middle-income countries may have more complete evidence upon which to base their practice compared with richer nations using recent innovations 4

Efficacy and Safety

• Chlorpromazine is sedating, increases a person's chances of experiencing acute movement disorders, Parkinsonism, and causes low blood pressure with dizziness and dry mouth 4
• The dosage of chlorpromazine has changed drastically over the past 50 years with lower doses now being the preferred choice 5
• Chlorpromazine is more efficacious than some antipsychotics (butaperazine, mepazine, oxypertine, and reserpine) and less efficacious than others (clomacran, clozapine, olanzapine, and zotepine) in the treatment of schizophrenia 7