Chlorpromazine
Systematic (IUPAC) name
3-(2-chloro-10H-phenothiazin-10-yl)-N,N-dimethyl-propan-1-amine
Identifiers
CAS number	50-53-3
ATC code	N05AA01
PubChem	2726
DrugBank	APRD00482
Chemical data
Formula	C17H19N2ClS1 •HCl
Mol. weight	355.3 (as hydrochloride)
Pharmacokinetic data
Bioavailability	30-50% (interindividual variations 10–70%)
Metabolism	hepatic
Half life	16–30 hours, in longterm treatment CPZ induces its own metabolism
Excretion	biliar and urine as metabolites (only traces of unchanged drug)
Therapeutic considerations
Pregnancy cat.	C : Only when benefit for the mother exeeds risk to unborn child Image File history File links Download high-resolution version (1100x753, 36 KB) File links The following pages on the English Wikipedia link to this file (pages on other projects are not listed): Chlorpromazine ... Image File history File links Download high-resolution version (994x1100, 242 KB) File links The following pages on the English Wikipedia link to this file (pages on other projects are not listed): Chlorpromazine ... IUPAC nomenclature is a systematic way of naming organic chemical compounds. ... CAS registry numbers are unique numerical identifiers for chemical compounds, polymers, biological sequences and alloys. ... The Anatomical Therapeutic Chemical Classification System is used for the classification of drugs. ... A section of the Anatomical Therapeutic Chemical Classification System. ... PubChem is a database of chemical molecules . ... DrugBank is a database available at the University of Alberta that provides information about thousands of products. ... A chemical formula (also called molecular formula) is a concise way of expressing information about the atoms that constitute a particular chemical compound. ... General Name, Symbol, Number carbon, C, 6 Chemical series nonmetals Group, Period, Block 14, 2, p Appearance black (graphite) colorless (diamond) Atomic mass 12. ... This article is about the chemistry of hydrogen. ... General Name, Symbol, Number nitrogen, N, 7 Chemical series nonmetals Group, Period, Block 15, 2, p Appearance colorless Atomic mass 14. ... General Name, Symbol, Number chlorine, Cl, 17 Chemical series halogens Group, Period, Block 17, 3, p Appearance yellowish green Atomic mass 35. ... General Name, Symbol, Number sulfur, S, 16 Chemical series nonmetals Group, Period, Block 16, 3, p Appearance lemon yellow Atomic mass 32. ... This article is about the chemistry of hydrogen. ... General Name, Symbol, Number chlorine, Cl, 17 Chemical series halogens Group, Period, Block 17, 3, p Appearance yellowish green Atomic mass 35. ... The molecular mass of a substance (less accurately called molecular weight and abbreviated as MW) is the mass of one molecule of that substance, relative to the unified atomic mass unit u (equal to 1/12 the mass of one atom of carbon-12). ... In pharmacology, bioavailability is used to describe the fraction of an administered dose of medication that reaches the systemic circulation, one of the principal pharmacokinetic properties of drugs. ... Overview of the citric acid cycle The citric acid cycle, one of the central metabolic pathways in aerobic organisms. ... The elimination half-life of a drug (or any xenobiotic agent) refers to the timecourse necessary for the quantity of the xenobiotic agent in the body (or plasma concentration) to be reduced to half of its original level through various elimination processes. ... Excretion is the process of eliminating waste products of metabolism and other materials that are of no use. ... The pregnancy category of a pharmaceutical agent is an assessment of the risk of fetal injury due to the pharmaceutical, if it is used as directed by the mother during pregnancy. ...
Legal status	RX-Medication-only The regulation of therapeutic goods, that is drugs and therapeutic devices, varies by jurisdiction. ...
Routes	oral, rectal, i.m., i.v.-infusion

Chlorpromazine was the first antipsychotic drug, used during the 1950s and 1960s. Used as chlorpromazine hydrochloride and sold under the tradenames Largactil® and Thorazine®, it has sedative, hypotensive and antiemetic properties as well as anticholinergic and antidopaminergic effects. It also has anxiolytic (alleviation of anxiety) properties. Today, chlorpromazine is considered a typical antipsychotic. In pharmacology and toxicology, a route of administration is the path by which a drug, fluid, poison or other substance is brought into contact with the body 1. ... The term antipsychotic is applied to a group of drugs used to treat psychosis. ... Oral medication A medication is a licenced drug taken to cure or reduce symptoms of an illness or medical condition. ... 1950 (MCML) was a common year starting on Sunday (link will take you to calendar). ... 1960 (MCMLX) was a leap year starting on Friday (the link is to a full 1960 calendar). ... A sedative is a substance which depresses the central nervous system (CNS), resulting in calmness, relaxation, reduction of anxiety, sleepiness, slowed breathing, slurred speech, staggering gait, poor judgment, and slow, uncertain reflexes. ... In physiology and medicine, hypotension refers to an abnormally low blood pressure. ... An antiemetic is a drug that is effective against vomiting and nausea. ... An anticholinergic agent is a member of a class of pharmaceutical compounds which serve to reduce the effects mediated by acetylcholine in the central nervous system and peripheral nervous system. ... This page is a candidate to be moved to Wiktionary. ... An anxiolytic is any drug or therapy used in the treatment of anxiety. ... Typical antipsychotics (sometimes referred to as conventional antipsychotics or conventional neuroleptics) are a class of antipsychotic drugs first developed in the 1950s and used to treat psychosis (in particular, schizophrenia), and are generally being replaced by atypical antipsychotic drugs. ...

Chemistry

Chlorpromazine is derived from phenothiazine, and has an aliphatic side chain, typical for low to middle potency neuroleptics. The oral bioavailability is estimated to be 30–50% due to extensive first pass metabolization in the liver. Its elimination-halflife is 16–30 hours. It has many active metabolites (approx. 75 different ones) with greatly varying halflives and own pharmacological profiles. The CYP-450 isoenzymes 1A2 and 2D6 are needed for metabolization of chlorpromazine and the subtype 2D6 is inhibited by chlorpromazine (NB: possible interactions with other drugs). Phenothiazines are the largest of the 5 main classes of antipsychotic drugs. ... In chemistry, non-aromatic and non-cyclic (acyclic) organic compounds are called aliphatic. ... The term Side chain can have different meanings depending on the context: In chemistry and biochemistry a side chain is a part of a molecule attached to a core structure. ... In pharmacology, bioavailability is used to describe the fraction of an administered dose of medication that reaches the systemic circulation, one of the principal pharmacokinetic properties of drugs. ... Isozymes, (or isoenzymes) are isoforms (closely related variants) of enzymes. ... This page is a candidate for speedy deletion. ... Cytochrome P450 2D6 (abbreviated CYP2D6, EC 1. ...

Mechanism of action

Central

Chlorpromazine acts as an antagonist (blocking agent) on different postsynaptic receptors: An antagonist is a fictional character or group of characters, or, sometimes an institution of a story who represents the opposition against which the hero(es) or protagonist(s) must contend. ...

• on dopaminergic-receptors (subtypes D1, D2, D3 and D4, different antipsychotic properties on productive and unproductive symptoms),
• on serotonergic-receptors (5-HT1 and 5-HT2, with anxiolytic, antidepressive and antiaggressive properties as well as an attenuation of extrapypramidal side effects, but also leading to weight gain, fall in blood pressure, sedation and ejaculation difficulties),
• on histaminergic-receptors (H1-receptors, sedation, antiemesis, vertigo, fall in blood pressure and weight gain),
• on alpha1/alpha2-receptors (antisympathomimetic properties, lowering of blood pressure, reflex tachycardia, vertigo, sedation, hypersalivation and incontinence as well as sexual dysfunction, but may also attenuate pseudoparkinsonism—controversial), and
• on muscarinic (cholinergic) M1/M2-receptors (causing anticholinergic symptoms like dry mouth, blurred vision, constipation, difficulty/inability to urinate, sinus tachycardia, ECG-changes and loss of memory, but the anticholinergic action may attenuate extrapyramidal side effects).

Additionally, chlorpromazine is a presynaptic inhibitor of dopamine reuptake, which may lead to (mild) antidepressive and antiparkinsonian effects. This action could also account for psychomotor agitation and amplification of psychosis (very rarely noted in clinical use). In human anatomy, the extrapyramidal system is a neural network located in the brain that is part of the motor system involved in the coordination of movement. ... Side-effect can mean: Side-effect (computer science), a state change caused by a function call Adverse drug reaction, an unintended consequence specifically arising from drug therapy Therapeutic effect (medicine), a desirable consequence of any kind of medical treatment, even though resulting as an unintended, unexpected consequence of the treatment...

Peripheral

Antagonist to H1 receptors (antiallergic effects), H2 receptors (reduction of forming of gastric juice), M1/M2-receptors (dry mouth, reduction in forming of gastric juice) and some 5-HT receptors (different anti-allergic/gastrointestinal actions). // H1 receptors Distribution Smooth muscle Endothelial cells Adrenal medulla Heart CNS Effects of Histamine at H1-receptors Vasodilation of small bloods vessels - flushing Increase Capillary Permeability - leaky endothelial cells - oedema Vasoconstriction of large vessels Contraction of smooth muscle - bronchial muscle H1-receptors Activates phospholipase C Mediated by a pertussis toxin... H2 receptors positively coupled to adenylate cyclase via Gs. ... Muscarinic receptors are those membrane bound acetylcholine receptors that are more sensitive to muscarine than to nicotine. ... In the field of neurochemistry, 5-HT receptors are receptors for the neurotransmitter and peripheral signal mediator serotonin, also known as 5-hydroxytryptamine or 5-HT. 5-HT receptors are located on the cell membrane of nerve cells and other cell types in animals and mediate the effects of serotonin...

Because it acts on so many receptors, chlorpromazine is often referred to as a "dirty drug", whereas the atypical neuroleptic amisulpride for example acts only on central D2/D3-receptors and is therefore a "clean drug". A lot more research needs to be done to understand the implications of this 'fact'. Here, it suffices to simply describe the relative pharmacology. This article or section does not cite its references or sources. ... Amisulpride (brand name Solian®) is an antipsychotic drug sold by Sanofi laboratories. ...

History

The drug had been developed by Laboratoires Rhône-Poulenc in 1950 but they sold the rights in 1952 to Smith-Kline & French (today's GlaxoSmithKline). The drug was being sold as an antiemetic when its other use was noted. Smith-Kline was quick to encourage clinical trials and in 1954 the drug was approved in the US for psychiatric treatment. The effect of this drug in emptying psychiatric hospitals has been compared to that of penicillin and infectious diseases.^[1] Over 100 million people were treated but the popularity of the drug fell from the late 1960s as the severe extrapyramidal side effects and tardive dyskinesia became more of a concern. From chlorpromazine a number of other similar neuroleptics were developed (e.g. triflupromazine, trifluoperazine). Hoechst AG was a German life-sciences company that became Aventis after its merger with Rhône-Poulenc S.A. in 1999. ... 1950 (MCML) was a common year starting on Sunday (link will take you to calendar). ... GlaxoSmithKline plc (LSE: GSK NYSE: GSK) is a British based pharmaceutical, biologicals, and healthcare company. ... A psychiatric hospital (also called a mental hospital or asylum) is a hospital specializing in the treatment of persons with mental illness. ... Penicillin nucleus Penicillin (sometimes abbreviated PCN) refers to a group of β-lactam antibiotics used in the treatment of bacterial infections caused by susceptible, usually Gram-positive, organisms. ... In human anatomy, the extrapyramidal system is a neural network located in the brain that is part of the motor system involved in the coordination of movement. ... Tardive dyskinesia is a serious neurological disorder caused by the long-term and/or high-dose use of dopamine antagonists, usually antipsychotics and among them especially the typical antipsychotics. ... The term antipsychotic is applied to a group of drugs used to treat psychosis. ... Triflupromazine is an antipsychotic medication. ... Trifluoperazine (Eskazinyl®, Eskazine®, Jatroneural®, Modalina®, Stelazine®, Terfluzine®) is a typical antipsychotic drug of the phenothiazine group. ...

Previously used as an antihistamine and antiemetic its effects on mental state were first reported by the French doctor Henri Laborit in 1951 or 1952 (different sources) as sedation without narcosis. It became possible to cause 'artificial hibernation' in patients, if used as a cocktail together with pethidine and hydergine. Patients with shock, severe trauma or burns, become, if treated so, sedated, without anxiety and unresponsive/indifferent to painful external stimuli like minor surgical interventions. The first published clinical trial was that of Jean Delay and Pierre Deniker at Ste. Anne Hôspital in Paris in 1952, in which they treated 38 psychotic patients with daily injections of chlorpromazine.^[1] Drug treatment with chlorpromazine went beyond simple sedation with patients showing improvements in thinking and emotional behaviour. Ironically, the antipsychotic properties of chlorpromazine appear to be unrelated to its sedative properties. During long term therapy some tolerance to the sedative effect develops. An antihistamine is a drug which serves to reduce or eliminate effects mediated by histamine, an endogenous chemical mediator released during allergic reactions, through action at the histamine receptor. ... An antiemetic is a drug that is effective against vomiting and nausea. ... Henri Laborit (November 21, 1914 - May 18, 1995) was a French physician, writer and philosopher. ... For the effect of diving deep with nitrogen, see Nitrogen narcosis. ... Pierre Deniker (born 1917) was involved in the introduction of chlorpromazine (Thorazine) the first antipsychotic used in the treatment of schizophrenia, in the 1950s. ...

Chlorpromazine substituted and eclipsed the old therapies of electro and insulin shocks and other methods such as psychosurgical means (lobotomy) causing permanent brain injury. Before the era of neuroleptics, starting with chlorpromazine, positive long-term results for psychotic patients were only 20%. Small TextElectroconvulsive therapy (ECT), also known as electroshock therapy, is a controversial medical treatment involving the induction of a seizure in a patient by passing electricity through the brain. ... Insulin shock therapy is a treatment for schizophrenia, psychosis and drug addiction which involves injecting a patient with massive amounts of insulin, which causes convulsions and coma. ... A human brain that had undergone lobotomy. ...

Side effects

Side effects of chlorpromazine are typical of early generation neuroleptics. They include extrapyramidal side effects such as tardive dyskinesia and akathisia. A particularly severe side effect is the neuroleptic malignant syndrome which occurs in approximately 0.05% and can be fatal. Also, chlorpromazine may lower seizure threshold. The agent is also known to accumulate in the posterior corneal stroma, lens, and uveal tract. Because it is a phototoxic compound, the potential exists for it to cause cellular damage after light exposure. Research confirms a significant risk of blindness from continued use of chlorpromazine. Tardive dyskinesia is a serious neurological disorder caused by the long-term and/or high-dose use of dopamine antagonists, usually antipsychotics and among them especially the typical antipsychotics. ... Akathisia (or acathisia) is an often extremely unpleasant subjective sensation of inner restlessness that manifests itself with an inability to sit still or remain motionless, hence the origin of its name: Greek a (without) + kathesis (sitting). ... Neuroleptic malignant syndrome (NMS) is a life-threatening, neurological disorder most often caused by an adverse reaction to neuroleptic or antipsychotic drugs. ...

Additional side effects include dry mouth, increased appetite with weight gain, constipation and urinary retention. Glucose tolerance may be impaired. An allergic skin rash and photosensitivity may occur. Other important and severe side effects are a strong reduction in the number of white blood cells, referred to as leukopenia, or, in extreme cases, even agranulocytosis may result, which may lead to death via uncontrollable infections and/or sepsis. Chlorpromazine is the neuroleptic drug with the highest rates (0.5% to 1%) of liver toxicity of the cholestatic type. Constipation or irregularity, is a condition of the digestive system where a person (or animal) experiences hard feces that are difficult to eliminate; it may be extremely painful, and in severe cases (fecal impaction) lead to symptoms of bowel obstruction. ... A glucose tolerance test in medical practice is the administration of glucose to determine how quickly it is cleared from the blood. ... Leukopenia or leukocytopenia refers to a decrease in the number of circulating white blood cells (leukocytes) in the blood. ... Sepsis (in Greek Σήψις, putrefaction) is a serious medical condition, resulting from the immune response to a severe infection. ...

The sedation effect combined with indifference to physical stimuli, anecdotally known as the "thorazine shuffle," has long been associated with the drug. The image of psychiatric patients staggering mute around a padded cell has earned those particular side effects a place in mainstream pop culture.

Interactions

Chlorpromazine intensifies the central depressive action of drugs with such activity (tranquilizers, barbiturates, narcotics, antihistamines, OTC-antiemetics etc.). A dose reduction of chlorpromazine or the other drug may be necessary. Chlorpromazine also intensifies the actions and undesired side effects of antihypertensive medications and anticholinergic drugs. The combination of chlorpromazine with other antipsychotics may result in increased central depression, hypotension and extrapyramidal side effects, but may sometimes enhance the clinical results of therapy. The anti-worm drug (antihelminthic) piperazine may intensify extrapyramidal side effects. In general, all neuroleptics may lead to seizures in combination with tramadol (Ultram). Chlorpromazine may increase the insulin needs of diabetic patients. A sedative is a drug that depresses the central nervous system (CNS), which causes calmness, relaxation, reduction of anxiety, sleepiness, slowed breathing, slurred speech, staggering gait, poor judgment, and slow, uncertain reflexes. ... Barbiturates are drugs that act as central nervous system (CNS) depressants, and by virtue of this they produce a wide spectrum of effects, from mild sedation to anesthesia. ... The term narcotic, derived from the Greek word for stupor, originally referred to a variety of substances that induced sleep (such state is narcosis). ... An antihistamine is a drug which serves to reduce or eliminate effects mediated by histamine, an endogenous chemical mediator released during allergic reactions, through action at the histamine receptor. ... Wikipedia does not yet have an article with this exact name. ... An anticholinergic agent is a member of a class of pharmaceutical compounds which serve to reduce the effects mediated by acetylcholine in the central nervous system and peripheral nervous system. ... Depression in physiology and medicine refers to a lowering, in particular a reduction in a particular biological variable or the function of an organ. ... In physiology and medicine, hypotension refers to an abnormally low blood pressure. ... Basic piperazine structure Piperazine is a six-sided organic ring compound containing two opposing nitrogen atoms (see image). ... Tramadol (INN) (IPA: ) is an atypical opioid which is a centrally acting analgesic, used for treating moderate to severe pain. ... This article is about the disease that features high blood sugar. ...

Drugs like SSRIs, St. John's Wort and barbiturates can inhibit various CYP-isoenzymes such as CYP2D6, needed for metabolization of chlorpromazine and/or its metabolites. Theoretically, this should increase the half-lives of chlorpromazine and possibly its metabolites, dosing changes necessary. The exact clinical significance of this enzyme induction and its therapeutic consequences are unknown at present time and remain to be evaluated. Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressants used in the treatment of depression, anxiety disorders and some personality disorders. ... Binomial name Hypericum perforatum Linnaeus, St Johns wort used alone refers to the species Hypericum perforatum, also known as Klamath weed or Goat weed, but is used with qualifiers to refer to any species of the genus Hypericum. ... Barbiturates are drugs that acts as central nervous system (CNS) depressants, and by virtue of this they produce a wide spectrum of effects, from mild sedation to anesthesia. ... Isozymes (also known as isoenzymes) are enzymes that differ in amino acid sequence but catalyze the same chemical reaction. ... Cytochrome P450 2D6 (abbreviated CYP2D6, EC 1. ... Enzyme induction is a process in which a molecule ( a drug) induces ( initiates or enhances) the expression of an enzyme. ...

Uses

Common uses

Great care needs to be exercised when evaluating the use of drugs such as chlorpromazine developed in an era of 'fashionable' substance use and medicine. Modern clinical practice is followed up by a vastly superior patient monitoring system .It is increasingly clear that there was substantive 'abuse' of chlorpromazine often seen as a panacea for a whole range of anti-social behaviours whose interplay with economic and political conditions is often more important than 'generic' behavioural 'defects'. Just as 50-100 years ago , 'mad' houses were often substitute 'prisons', chlorpromazine and other drugs touted by their makers as the miracle in a 'pill' have been used to the same 'effect'. Todays computers with their ability to collate vast amounts of information and a much more 'open' medical practice with a wider array of drugs available mean that there is that ever more greater chance of preventing abuse.

As an antipsychotic

The use of chlorpromazine has been primarily replaced by newer generation of atypical antipsychotics which have an improved side effect profile. Chlorpromazine is classified as a low- to moderate-potency antipsychotic and in the past was used in the treatment of both acute and chronic psychoses, including schizophrenia and the manic phase of manic depression as well as amphetamine-induced psychoses. The atypical antipsychotics (also known as second generation antipsychotics) are a class of prescription medications used to treat psychiatric conditions. ... Psychosis is a generic psychiatric term for a mental state in which thought and perception are severely impaired. ... Bipolar disorder was once known as manic-depression. ...

Chlorpromazine formerly was the drug of choice to treat LSD (and other psychedelic/hallucinogen) intoxication in a hospital setting, resulting in it gaining an erroneous reputation as the LSD "antidote". Now haloperidol is more commonly used in such situations. For other uses, see LSD (disambiguation). ... The word psychedelic is a neologism coined from the Greek words for mind, ψυχη (psyche), and manifest, δηλειν (delein). ... Hallucinogenic drug - drugs that can alter sensory perceptions. ... Haloperidol (sold as Aloperidin®, Bioperidolo®, Brotopon®, Dozic®, Einalon S®, Eukystol®, Haldol®, Halosten®, Keselan®, Linton®, Peluces®, Serenace®, Serenase®, Sigaperidol®) is a conventional butyrophenone antipsychotic drug. ...

Other uses

It has also been used in porphyria, as part of tetanus treatment and for behavioral problems in children. This article is about the disease. ... Tetanus is a medical condition characterized by a prolonged contraction of skeletal muscle fibers. ...

It still is well recommended for short term management of severe anxiety and aggressive episodes.

Resistant and severe hiccups, severe nausea/emesis and preanesthetic conditioning have been other indications in the past. A hiccup is an involuntary spasm of the diaphragm. ... For other uses, see Nausea (disambiguation). ... Vomiting (or emesis) is the forceful expulsion of the contents of ones stomach through the mouth. ...

It can be used to treat amphetamine overdose. [1] Amphetamine (alpha-methyl-phenethylamine), also known as speed whiffles, is a stimulant, and club drug, used to diminish the appetite, control weight, and treat disorders including narcolepsy and attention-deficit hyperactivity disorder. ...

they are also potent antiemetics. they act by blocking the D2 receptors in the CTZ.however they are not effective for treatment of morion sickness due to the fact the the vestibular pathway does not involve dopaminergic link.

Off-label and controversial uses

Chlorpromazine is occasionally used off-label for treatment of severe migraine. Sometimes it is used in small doses to improve nausea/emesis opioid-treated cancer patients encounter and to intensify and prolong the analgesic action of the opioids given. Interestingly, it remains controversial whether or not chlorpromazine has its own analgesic properties. Analgesic properties may result from a central action on the hypothalamus; the patient may feel the pain much less than before. Other mechanisms may be an interaction with opioid receptors centrally and/or in the spinal cord. Some experts on the contrary say that chlorpromazine, like other phenothiazines, may even have antianalgesic properties. Chlorpromazine has been proposed as useful in newborns for the treatment of opioid withdrawal, if the mother was opioid-dependent. The latter indication remains highly controversial. An opioid is a chemical substance that has a morphine-like action in the body. ... An analgesic (colloquially known as a painkiller) is any member of the diverse group of drugs used to relieve pain (achieve analgesia). ... The hypothalamus (from Greek ὑποθαλαμος = under the thalamus) is a region of the mammalian brain located below the thalamus, forming the major portion of the ventral region of the diencephalon and functioning to regulate certain metabolic processes and other autonomic activities. ... The Spinal cord nested in the vertebral column. ...

Chlorpromazine, as well as other neuroleptics, may also be used to alleviate the symptoms of alcohol withdrawal (chlorpromazine may lower the seizure-threshold in alcoholics). Alcoholism is the consumption of, or preoccupation with, alcoholic beverages to the extent that this behavior interferes with the drinkers normal personal, family, social, or work life, and may lead to physical or mental harm. ...

It has a unique action in cholera, reducing the loss of water by approximately 30%. Cholera is a water-borne disease caused by the bacterium Vibrio cholerae, which is typically ingested by drinking contaminated water, or by eating improperly cooked fish, especially shellfish. ...

In Germany, the brand of chlorpromazine drug Propaphenin® has additional indications for insomnia and itching skin disease. Insomnia is characterized by an inability to sleep and/or inability to remain asleep for a reasonable period. ... An itch (Latin: pruritus) is a sensation felt on an area of skin that makes a person or animal want to scratch it. ...

Some jurisdictions in the United States use Thorazine as a sedative/tranquilizer prior to carrying out a death sentence where capital punishment is used. The condemned may be offered the sedative and some states require that it be administered, even against the wishes of the condemned.^{[citation needed]}http://www.clarkprosecutor.org/html/death/methods.htm

Veterinary uses

Chlorpromazine is primarily used as an antiemetic in dogs and cats. It is also sometimes used as a preanesthetic and muscle relaxant in cattle, swine, sheep, and goats. It is generally contraindicated for use with horses, due to a high incidence of ataxia and altered mentation. An antiemetic is a drug that is effective against vomiting and nausea. ... Trinomial name Canis lupus familiaris The dog Canis lupus is a type of canine, a mammal in the order Carnivora. ... Trinomial name Felis silvestris catus (Linnaeus, 1758) The cat (or domestic cat, house cat) is a small carnivorous mammal. ... A muscle relaxant is a drug which decreases the tone of a muscle. ... Binomial name Bos taurus Linnaeus, 1758 Cattle (often called cows in vernacular and contemporary usage, or kye as the Scots plural of cou) are domesticated ungulates, a member of the subfamily Bovinae of the family Bovidae. ... Binomial name Sus scrofa Linnaeus, 1758 Synonyms The domestic pig is usually given the scientific name Sus scrofa, though some authors call it , reserving for the wild boar. ... Species See text. ... Species See Species and subspecies The goat is a mammal in the genus Capra, which consists of nine species: the Ibex, the West Caucasian Tur, the East Caucasian Tur, the Markhor, and the Wild Goat. ... Binomial name Equus caballus Linnaeus, 1758 The horse (Equus caballus, sometimes seen as a subspecies of the Wild Horse, Equus ferus caballus) is a large odd-toed ungulate mammal, one of ten modern species of the genus Equus. ... Ataxia (from Greek ataxiā, meaning failure to put in order) is unsteady and clumsy motion of the limbs or torso due to a failure of the gross coordination of muscle movements. ...

Dosage

In any case, use is determined by an attending physician. The following information is intended to serve as a guideline: A wide range is covered from 25 mg oral or intramuscular for mild sedation, every 8 hours, up to 100 mg every 6 hours for severely ill patients. Different qualified sources give 800 mg/day to 1,200 mg/day as highest dose. There has been at least one small clinical trial in treatment-resistant patients with a daily dose of 1,200 mg chlorpromazine (and 4 mg Benztropine to counteract early extrapyramidal side effects, which were anticipated with this unusual high chlorpromazine dose). Initial doses should be low and be increased gradually. It is recommended that most of the daily dose (e.g. 2/3) is given at bedtime for maximum hypnotic activity and minimal daytime sedation and hypotension. In the USA there are controlled release forms of Thorazine (e.g. 300 mg). After the individual dose is well established, such a CR capsule can be given with the evening meal as a single dose, covering the next 24 hours. Benztropine (Cogentin®) is an anticholinergic drug principally used for the treatment of: Drug-induced parkinsonism, akathisia and acute dystonia; Parkinson disease; and Idiopathic or secondary dystonia. ... In physiology and medicine, hypotension refers to an abnormally low blood pressure. ...

The lowest dosage compatible with good therapeutic effect should be given. Dosage in ambulatory patients should be particularly low (minimizing sedation and hypotension). The direct i.v.-injection of undiluted solution is contraindicated (massive fall in blood pressure, cardiovascular collapse), for i.v.-infusion of dilutions the (hospitalized) patient should be lying and the infusion rate should be as slow as possible. Afterwards the patient should rest in the lying position for at least 30 minutes. Sedation is a medical procedure involving administration of sedative drugs, generally to facilitate a medical procedure, such as endoscopy, vasectomy, or minor surgery with local anaesthesia. ... In physiology and medicine, hypotension refers to an abnormally low blood pressure. ...

Necessary examinations and laboratory checks during treatment

All patients treated with chlorpromazine on a long-term-basis should have the following checked regularly: blood-pressure, pulse rate, laboratory-tests (liver function tests, kidney-values, blood cell counts including differenciated white blood counts, counts of red blood cells and thrombocytes), ECG and EEG. The frequency of all checks should be determined for the individual patient and may be done in shorter intervals during the first 3 months of treatment and less often afterwards. Some side effects seem to appear more frequently during the first months of therapy (sedation, hypotension, liver damage) while others do not (e.g. tardive dyskinesia). A sphygmomanometer, a device used for measuring blood pressure. ... In medicine, a persons pulse is the throbbing of a persons arteries as an effect of their heart beat, which can be felt at the wrist and other places. ... Liver function tests (LFTs or LFs), which include liver enzymes, are groups of clinical biochemistry laboratory blood assays designed to give information about the state of a patients liver. ... The kidneys are bean-shaped excretory organs in vertebrates. ... Schematics of shorthand for complete blood count commonly used by physicians. ... ECG may also refer to the East Coast Greenway Lead II An Electrocardiogram (ECG or EKG, abbreviated from the German Elektrokardiogramm) is a graphic produced by an electrocardiograph, which records the electrical voltage in the heart in the form of a continuous strip graph. ... EEG can mean: Electroencephalography - the method and science of recording and interpreting traces of brain electrical activity as recorded from the skull surface or the device used to record such traces Emperor Entertainment Group - A Hong Kong entertainment company. ... Sedation is a medical procedure involving administration of sedative drugs, generally to facilitate a medical procedure, such as endoscopy, vasectomy, or minor surgery with local anaesthesia. ... In physiology and medicine, hypotension refers to an abnormally low blood pressure. ... Hepatotoxicity (from hepatic toxicity) is chemical-driven liver damage. ... Tardive dyskinesia is a serious neurological disorder caused by the long-term and/or high-dose use of dopamine antagonists, usually antipsychotics and among them especially the typical antipsychotics. ...

Discontinuation of treatment

At regular intervals the treating physician should evaluate whether continued treatment is needed. The drug should never be discontinued suddenly, due to very unpleasant 'withdrawal-symptoms', such as agitation, sleeplessness, states of anxiety, etc. (which should not be construed as stemming from psychological or physical dependence). The dose should rather be slowly reduced at a rate of approximately 20–25% per week, or even slower, to avoid the aforementioned bothersome symptoms.

Sources

• Goodman & Gilman, The Pharmacological Basis of Therapeutics
• Bezchlibnyk-Butler, K. Z. Clinical Handbook of Psychotropic Drugs (German Edition)
• Rote Liste (German Drug Compendium)
• Benkert, O. and H. Hippius. Psychiatrische Pharmakotherapie (German. 6th Edition, 1996)
• Physician's Desk Reference (2004)
• Heinrich, K. Psychopharmaka in Klinik und Praxis (German, 2nd Edition, 1983)
• Römpp, Chemielexikon (German, 9th Edition)
• NINDS Information Homepage (see External links section)
• Plumb, Dondal C. Plumb's Veterinary Drug Handbook (Blackwell, 5th Edition, 2005)

External links

• Medlineplus.org article on chlorpromazine
• National Institute of Neurological Disorders and Stroke (NINDS) Tardive Dyskinesia information page
• Links to external chemical sources