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 :355.3

%Protein binding :95–98

%Excreted unchanged in urine : <1

Volume of distribution (L/kg) :7–201

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

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Dose as in normal renal function

<10 : Start with small dose and increase according to response

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

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

HD :Not dialysed. Dose as in GFR <10 mL/min

HDF/high flux :Unknown dialysability. Dose as in GFR <10 mL/min

CAV/VVHD :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

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Route

Oral, deep IM, PR (unlicensed)

Rate of Administration

–

Comments

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

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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