Chlorpromazine Withdrawal Symptoms
Abrupt withdrawal of chlorpromazine after long-term therapy may cause gastritis, nausea and vomiting, dizziness, and tremulousness, though chlorpromazine does not cause psychic dependence, tolerance, or addiction. 1
Primary Withdrawal Manifestations
The FDA-approved drug label explicitly identifies the following withdrawal symptoms that can occur following abrupt discontinuation of high-dose chlorpromazine therapy: 1
- Gastritis
- Nausea and vomiting
- Dizziness
- Tremulousness
These symptoms represent physical dependence manifestations rather than addiction, and importantly, they can usually be avoided or reduced by gradual dosage reduction. 1
Movement Disorder Withdrawal Symptoms
When discontinuing antipsychotics like chlorpromazine, abrupt cessation can precipitate serious movement-related withdrawal symptoms including dyskinesias, parkinsonian symptoms, dystonias, and neuroleptic malignant syndrome. 2
Research specifically examining low-potency neuroleptics (which includes chlorpromazine) found that 85% of chronic schizophrenic patients experienced withdrawal symptoms when switched from these medications, with the predominant symptoms being: 3
- Insomnia
- Anxiety
- Tensional restlessness
Critical Management Principles
Gradual withdrawal over a period greater than 1 month is recommended to minimize discontinuation effects. 2 The Mayo Clinic guidelines emphasize that withdrawal should be gradual in most cases, and clinicians may need to re-escalate dosing if persisting withdrawal symptoms cause patient distress. 2
The FDA label specifically states that symptoms can usually be avoided or reduced by: 1
- Gradual reduction of dosage (rather than abrupt cessation)
- Continuing concomitant anti-parkinsonian agents for several weeks after chlorpromazine is withdrawn
Important Clinical Caveats
Chlorpromazine is classified among typical antipsychotics that should be tapered/avoided if possible in older adults, particularly when used for behavioral control in cognitive disease. 2 The Beers Criteria specifically recommend using redirection and other non-pharmacological agents rather than continuing these medications long-term. 2
Research on antipsychotic withdrawal suggests that slower tapering (over months rather than weeks) is associated with lower relapse rates, as faster reductions cause greater disruption of homeostatic equilibria. 4 This is particularly relevant for chlorpromazine given its anticholinergic properties and the potential for cholinergic rebound upon discontinuation.
The mean duration of treatment in patients experiencing significant withdrawal symptoms from low-potency neuroleptics was 15 years, suggesting that longer treatment duration may increase withdrawal symptom severity. 3