Chlorpromazine hydrochloride

CLINICAL USE

  • Anti-emetic
  • Anxiolytic
  • Antipsychotic
  • Hiccups

    DOSE IN NORMAL RENAL FUNCTION

  • Anti-emetic: Oral: 10–25 mg every 4–6 hours —IM: 25–50 mg every 3–4 hours
  • Antipsychotic, anxiolytic: Oral: 25 mg every 8 hours (or 75 mg at —night) initially; increase as necessary; usual maintenance dose 75–300 mg daily (up to 1 g daily)
  • IM: 25–50 mg every 6–8 hours
  • Induction of hypothermia: 25–50 mg every 6–8 hours
  • Hiccups: Oral: 25–50 mg every 6–8 hours
  • PR (unlicensed): 100 mg every 6–8 hours

    PHARMACOKINETICS

  • Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :355.3
  • %Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :95–98
  • %Excreted unchanged in urine &nbsp &nbsp : <1

  • Volume of distribution (L/kg) &nbsp &nbsp &nbsp :7–201

  • half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp :23–37/Unchanged

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

  • 20 to 50 &nbsp &nbsp : Dose as in normal renal function
  • 10 to 20 &nbsp &nbsp : Dose as in normal renal function
  • <10 &nbsp &nbsp &nbsp &nbsp &nbsp : Start with small dose and increase according to response

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:Not dialysed. Dose as in GFR <10 mL/min

  • HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Not dialysed. Dose as in GFR <10 mL/min
  • HDF/high flux &nbsp :Unknown dialysability. Dose as in GFR <10 mL/min
  • CAV/VVHD &nbsp &nbsp &nbsp:Unknown dialysability. Dose as in normal renal function

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugs
  • Anaesthetics: enhanced hypotensive effect
  • Analgesics: increased risk of convulsions with tramadol; enhanced hypotensive and sedative effects with opioids
  • Anti-arrhythmics: increased risk of ventricular arrhythmias with anti-arrhythmics that prolong the QT interval; avoid concomitant use with amiodarone
  • Antibacterials: increased risk of ventricular arrhythmias with moxifloxacin – avoid concomitant use
  • Antidepressants: increased level of tricyclics, possibly increased risk of ventricular arrhythmias and antimuscarinic side effectsAnticonvulsant: antagonises anticonvulsant effectAntimalarials: avoid concomitant use with artemether/lumefantrineAntipsychotics: increased risk of ventricular arrhythmias with pimozide – avoid concomitant useAntivirals: concentration possibly increased with ritonavirAnxiolytics and hypnotics: increased sedative effectsAtomoxetine: increased risk of ventricular arrhythmiasBeta-blockers: enhanced hypotensive effect; increased risk of ventricular arrhythmias with sotalolDiuretics: enhanced hypotensive effect Lithium: increased risk of extrapyramidal side effects and possibly neurotoxicityPentamidine: increased risk of ventricular arrhythmiasSibutramine: increased risk of CNS toxicity – avoid concomitant useUlcer-healing drugs: effects enhanced by cimetidine

    ADMINISTRATION

    Reconstition

    –

    Route

    Oral, deep IM, PR (unlicensed)

    Rate of Administration

    –

    Comments

    Start with small doses in severe renal impairment due to increased cerebral sensitivity
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