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Home , Chlorpromazine, Perphenazine

ChlorproMAZINE HCl

Brand names Thorazine, generic

Medication error Look-alike, sound-alike drug names potential ISMP reports that has been confused with chlordiazepoxide and chlorprop- amide. USP also reports that chlorproMAZINE has been confused with chlordiazepoxide (no patient harm resulted) and (patient harm resulted).(1) USP also reports that chlorproMAZINE has been confused with , chlortha- lidone, , Compazine, , , , and ; no patient harm resulted.(2) USP reports that Thorazine has been confused with thiamine, thioridazine, , and ; no patient harm resulted.(2)

Contraindications U.S. boxed warning: Chlorpromazine carries warnings for increased mortality in elderly and warnings patients with -related .(3) Contraindications: Known to the drug, use in comatose patients, con- comitant large doses of CNS .(3) Other warnings: Do not use in children <6 months of age, except where potential exists to save the child’s life.(3) may occur secondary to chlorpromazine and may be confused with signs of an undiagnosed primary disease such as Reye syndrome or other encepha- lopathy. Chlorpromazine should be avoided in children and adolescents with signs and symptoms of Reye syndrome.(3) Chlorpromazine injection contains sodium metabisulfite and sodium sulfite, which may cause allergic-type reactions including anaphylaxis and life-threatening asthmatic episodes in certain susceptible people.(3) can develop in patients receiving chlorpromazine.(3) Neuroleptic malignant syndrome has been reported in association with drugs. Clinical manifestations include hyperpyrexia, muscle rigidity, altered mental status, and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diapho- resis, and cardiac dysrhythmias).(3) Neonates exposed to chlorpromazine in the third trimester are at risk for extrapyramidal symptoms and withdrawal after delivery. There are cases of prolonged jaundice in neo- nates born to mothers who were treated with chlorpromazine. Chlorpromazine is excreted into breast milk. Because of the potential for serious adverse reactions in nursing infants from chlorpromazine, a decision should be made whether to discontinue nursing or to discontinue the drug.(3) /neutropenia and agranulocytosis have been reported with the use of anti- psychotic agents. Possible risk factors for leukopenia/neutropenia include preexisting low white blood cell count and history of drug-induced leukopenia/neutropenia.(3)

Infusion-related Systemic has occurred in neonates.(4) Because of the risk of hypotension, cautions patients should continue to lie down for 30 minutes after the injection.(3) Thrombophlebitis may occur.(5)

 200 ChlorproMAZINE HCl

Dosage and : 0.5–1 mg/kg IM/IV q 6–8 hr PRN(3,6) Nonchemotherapy induced IM: 0.275 mg/kg; if nausea and vomiting persist after 30 minutes and hypoten- sion has not occurred, the regimen may be repeated.(3) IV: 1 mg at 2-minute intervals up to a total dose of 0.275 mg/kg; do not exceed IM dosage.(3) Chemotherapy-induced (prevention) IV: 0.5 mg/kg/dose q 6 hr; may increase up to 1 mg/kg/dose; do not exceed 50 mg/dose. Recommended when corticosteroids are contraindicated.(7) Cyclic vomiting syndrome IV: 0.5–1 mg/kg/dose q 6 hr; maximum dose 50 mg(8) Neonatal abstinence syndrome/withdrawal: Although is preferred, IM chlorpromazine has been used for this indication. If used, initial IM doses range from 0.5–0.7 mg/kg q 6 hr for up to 4 days, then dose should be changed to oral route and decreased gradually over 2–3 weeks.(6) Chlorpromazine 0.5 mg/kg q 6 hr has been used to treat neonatal withdrawal after in utero selective reuptake inhibitor (SSRI) exposure.(5) Presurgical apprehension: 0.5 mg/kg (max 25 mg/kg) IM 1–2 hours before surgery(3) Sedation for imaging: For infants and children, 0.5 mg/kg 45 minutes prior to scan(7) Severe behavioral problems: 0.55 mg/kg IM q 6–8 hr PRN; for severe disorders, larger doses may be necessary; start low and increase gradually up to maximum doses (see the Maximum Dosage section); older patients may require 200 mg or more daily (further behavior improvement not seen with doses >500 mg/day).(3,6) : 0.5 mg/kg IM/IV q 6–8 hr. Higher doses may be required in severe cases.(4)

Dosage adjustment Although one reference suggests that no dosage adjustment is necessary in renal dys- in organ dysfunction function,(8) the manufacturer recommends chlorpromazine be administered cautiously in patients with renal disease.(3) It should also be used cautiously in patients with cardio- vascular, , or chronic respiratory disease.(3) Not dialyzable

Maximum dosage 6 months–5 years or <23 kg: 40 mg/day(3,6) 5–12 years or 23–45 kg: 75 mg/day(3,6) >45 kg: 400 mg/day(3,6)

Additives 1- and 2-mL ampules (25 mg/mL chlorpromazine) contain per mL: 2 mg ascorbic acid, 1 mg sodium metabisulfite, 6 mg sodium chloride, and 1 mg sodium sulfite(3,11) See Appendix C for more specific information about potential adverse effects of sulfites.

Suitable diluents NS, ½NS, D2.5W, D5W, D10W, LR, R, D-LR combinations, D-R combinations, D-saline combinations(3,11)

Maximum 1 mg/mL(11) concentration

Preparation and See Appendix D for PN compatibility information. delivery  201