Is Chlorpromazine on the Beers List?
Yes, chlorpromazine is on the Beers Criteria list as a potentially inappropriate medication for older adults, particularly when used for behavioral management in dementia, due to increased mortality risk and other serious adverse effects. 1, 2
Classification and Restrictions
Chlorpromazine is classified as an antipsychotic that should be avoided in older adults, especially for long-term management of cognitive behavioral problems in patients with dementia. 1 The American Geriatrics Society recommends avoiding antipsychotics in older adults due to increased mortality risk, particularly in patients with dementia. 2
Documented Risks
The use of chlorpromazine in older adults carries an FDA black box warning for increased mortality risk in those with dementing disorders. 1 Specific risks include:
- Increased mortality in patients with dementia 1, 2
- Delirium induction or worsening 1
- Falls and fractures due to sedation and motor impairment 1
- Cerebrovascular accidents (stroke) 1
- Cognitive impairment and movement disorders 1
Acceptable Use Exceptions
The American Geriatrics Society permits chlorpromazine use only in limited, specific situations: 1
- Short-term use during chemotherapy as an antiemetic
- Treatment of schizophrenia
- Management of acute delirium in controlled settings
Clinical Approach
First-line management should prioritize non-pharmacological approaches, including redirection techniques and environmental modifications for behavioral symptoms in older adults. 1, 2 If antipsychotic use becomes unavoidable, employ the shortest possible duration and conduct regular medication reviews using STOPP/START or Beers Criteria to identify deprescribing opportunities. 1, 2
When chlorpromazine is used for behavioral management and shows perceived lack of benefit, deprescribing is recommended, with safe tapering to discontinuation feasible in most cases. 1
Common Pitfalls
Avoid using chlorpromazine for routine behavioral management in dementia patients, as this represents the highest-risk scenario. 1, 2 The Beers Criteria should be applied systematically at every care transition to identify inappropriate antipsychotic use. 2, 3 Prioritize removal of antipsychotics when conducting medication rationalization, as they rank among medications with the highest morbidity and mortality risks. 2, 3