Chlorpromazine
Thorazine
First-Generation AntipsychoticGeneric availableTDM data
Clinical Pharmacology The precise mechanism whereby the therapeutic effects of chlorpromazine are produced is not known. The principal pharmacological actions are psychotropic. It also exerts sedative and antiemetic activity. Chlorpromazine has actions at all levels of the central nervous system, primarily at subcortical levels, as well as on multiple organ systems. It has strong antiadrenergic and weaker peripheral anticholinergic activity; ganglionic blocking action is relatively slight. It also possesses slight antihistaminic and antiserotonin activity.
Compare Chlorpromazine →FDA-Approved Indications
- Schizophrenia and management of manifestations of psychotic disorders
- Manic-type manic-depressive illness — control of manic manifestations
- Severe behavioral problems in children (combativeness, explosive hyperexcitability)
- Short-term treatment of hyperactive children with conduct disorders
- Control of nausea and vomiting
- Pre-surgical relief of restlessness and apprehension
- Acute intermittent porphyria
- Adjunct in tetanus
What Sets This Drug Apart
- Prototypical low-potency FGA with balanced D2/H1/alpha-1 antagonism; highly sedating and orthostatic — rarely used first-line but retained for refractory agitation
- Broadest FDA indication set among FGAs: psychosis, mania, intractable hiccups, nausea/vomiting, porphyria, tetanus adjunct, behavioral problems in children
- Photosensitivity is characteristic; chronic high-dose use can cause blue-gray skin discoloration and corneal/lens deposits
- Orthostatic hypotension is early and severe; obtain orthostatic vitals at baseline and each titration step
- CPZ equivalents (chlorpromazine equivalents) remain the standard unit for FGA dose comparison across the class
Boxed Warning
WARNING Increased Mortality in Elderly Patients with Dementia-Related Psychosis Elderly patients with dementia-related psychosis treated wit