Generic Thorazine ( Chlorpromazine )

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Thorazine is a typical antipsychotic used to treat schizophrenia and other psychotic disorders. It is also used to control nausea and vomiting, to relieve restlessness and anxiety before surgery, and to manage manic symptoms in bipolar disorder. The medication works by blocking dopamine receptors in the brain, which helps calm hallucinations, delusions, and disorganized thinking.
The usual starting dose for schizophrenia in adults is 25 mg three times daily. Your doctor will increase the dose gradually based on how you respond. The effective range is usually 50 mg to 400 mg per day, though some people need higher doses. For nausea and vomiting, the dose is typically 10 mg to 25 mg every 4 to 6 hours as needed.
The administration form is film-coated tablets in 25 mg, 50 mg, and 100 mg strengths. The injectable form was discontinued from the Canadian market. Thorazine is the U.S. brand name; in Canada, chlorpromazine is sold under the brand name Largactil and as generic Teva-Chlorpromazine.
Thorazine does not work overnight. Some calming effects may appear within the first few days, but the full benefit for psychotic symptoms usually takes several weeks of steady dosing.
Alcohol should be avoided during treatment. It adds to the drowsiness and dizziness that chlorpromazine can cause, and it can increase the risk of low blood pressure and breathing problems.
The most common side effects are drowsiness, dizziness, dry mouth, blurred vision, and constipation. Movement side effects such as tremor, stiffness, and restlessness are also common with this medication.
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Common Use Thorazine

Chlorpromazine is a phenothiazine antipsychotic. It was the first antipsychotic drug developed and remains a standard for treating schizophrenia and other psychotic disorders. It works by blocking dopamine D2 receptors in the brain, which helps reduce hallucinations, delusions, and disorganized thinking. It also blocks serotonin, histamine, and muscarinic receptors, which explains its sedative and anticholinergic effects. Health Canada has approved chlorpromazine for the treatment of schizophrenia and other psychotic illnesses. It is also used to prevent and treat nausea and vomiting, for relief of restlessness and anxiety before surgery, and to manage symptoms of mania in bipolar disorder. In children, it is most commonly used for nausea and vomiting and to calm them before surgery. Chlorpromazine is not approved for treating behavioural problems in older adults with dementia, and it carries a boxed warning about increased mortality in that population.

Basic Thorazine Information

• INN (International Nonproprietary Name): Chlorpromazine hydrochloride
• Brand names available in Canada: Largactil® (original brand, now discontinued); generic Teva-Chlorpromazine (Teva Canada Limited) is currently marketed. Thorazine is the U.S. brand name and is not marketed in Canada.
• ATC Code: N05AA01
• Forms and dosages: Film-coated tablets – 25 mg, 50 mg, and 100 mg. An injectable formulation was also available but has been discontinued from the Canadian market.
• Manufacturers in Canada: Teva Canada Limited (Teva-Chlorpromazine). The original Largactil brand was marketed by Rhone-Poulenc Rorer-Ethical Division Products.
• Registration status in Canada: Approved by Health Canada. Teva-Chlorpromazine 25 mg is listed under DIN 00232823, 50 mg under DIN 00232807, and 100 mg under DIN 00232831. The Largactil 100 mg suppository (DIN 01930001) was cancelled after market in 2006. The injectable form (DIN 00743518) was cancelled after market in 2019.
• OTC / Rx classification: Prescription only (Rx) – not legally sold over-the-counter in Canadian pharmacies

Dosage & Direction

Take chlorpromazine exactly as your doctor prescribes. The dose depends on what is being treated. For schizophrenia and other psychotic illnesses in adults, the usual starting dose is 25 mg three times daily, or 75 mg at bedtime. Your doctor will increase the dose gradually over a period of days or weeks until the best results are achieved with the fewest side effects. The usual effective range is 50 mg to 400 mg per day, though some individuals may need higher doses. For nausea and vomiting in adults, the typical dose is 10 mg to 25 mg every 4 to 6 hours as needed. For relief of restlessness and anxiety before surgery, the dose is usually 25 mg to 50 mg taken 2 to 3 hours before the procedure. For children, the dose is based on age and weight, and your child's doctor will determine the best dose. Take the tablet with or without food. If it upsets your stomach, take it with a meal. Swallow the tablet whole with water. Do not crush or chew it. Chlorpromazine can cause drowsiness, so taking it at bedtime may help. If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed one and continue with your regular schedule. Do not take two doses at once to make up for a missed one. Do not stop taking chlorpromazine suddenly without talking to your doctor. Stopping abruptly after long-term use can cause withdrawal symptoms such as nausea, vomiting, dizziness, and trouble sleeping. Your doctor will taper the dose gradually if you need to stop.

Precautions

Chlorpromazine can cause drowsiness, dizziness, and problems with coordination, especially during the first few days of treatment. Until you know how it affects you, do not drive, operate heavy machinery, or do anything else that requires you to be alert. These effects may fade with time, but some people continue to feel drowsy. Taking chlorpromazine with alcohol or other central nervous system depressants can increase the sedative effect and may cause severe breathing problems. Avoid alcohol and check with your doctor before taking other medications that cause drowsiness, such as benzodiazepines, opioids, or antihistamines. Chlorpromazine can cause a drop in blood pressure when you stand up, leading to dizziness and falls, especially in older adults. Move slowly when getting up from a sitting or lying position. The medication can cause movement side effects called extrapyramidal symptoms, which include tremor, stiffness, restlessness, and involuntary muscle contractions. These are more common with chlorpromazine than with some other antipsychotics. If you develop any abnormal movements, tell your doctor right away. Tardive dyskinesia is a serious movement disorder that can develop after months or years of treatment and may be irreversible. The risk increases with longer treatment and higher total doses. Neuroleptic malignant syndrome (NMS) is a rare but life-threatening reaction that has been reported with chlorpromazine. It causes high fever, severe muscle rigidity, confusion, and autonomic instability. Stop the medication and seek emergency care if these symptoms occur. Chlorpromazine can raise blood sugar and cholesterol levels. Your doctor should check your blood sugar and lipid levels before you start and periodically during treatment. Chlorpromazine may increase prolactin levels, which can cause breast enlargement, milk production, and menstrual irregularities. It can also cause a condition called priapism, a prolonged and painful erection that requires emergency medical attention. Chlorpromazine can cause a serious skin reaction called drug reaction with eosinophilia and systemic symptoms (DRESS), which involves a rash, fever, swollen lymph nodes, and organ inflammation. If you develop a rash with fever, stop the medication and seek medical attention. Tell your doctor if you have a history of seizures, heart disease, liver disease, kidney disease, or glaucoma. Chlorpromazine is not recommended during pregnancy unless the benefit clearly outweighs the risk. It can cause extrapyramidal and/or withdrawal symptoms in a newborn if used in the third trimester. It passes into breast milk, so breastfeeding is not recommended during treatment. Women who could become pregnant should use effective contraception. Chlorpromazine can make your skin more sensitive to sunlight. Use sunscreen and avoid prolonged sun exposure.

Contraindications

Do not take chlorpromazine if you have had an allergic reaction to chlorpromazine, other phenothiazines, or any of the inactive ingredients in the tablet. The medication is contraindicated in patients with a condition called pheochromocytoma, a tumour of the adrenal gland, because it can trigger a hypertensive crisis. Chlorpromazine should not be used in patients with severe heart disease, severe blood disorders, or bone marrow depression. It is contraindicated in patients with a brain lesion or severe liver disease. Do not use chlorpromazine in patients who are comatose or have severe central nervous system depression caused by alcohol, barbiturates, or other drugs. It should not be used in patients with a history of agranulocytosis or other blood cell disorders such as anemia, leukopenia, or thrombocytopenia. Chlorpromazine is contraindicated in children under 6 months of age. It should not be used during pregnancy or breastfeeding unless specifically directed by a doctor. Do not take chlorpromazine if you are scheduled to have spinal anesthesia or any other procedure that requires anesthesia of the arms, legs, or lower body.

Possible Side Effects

More than 1 in 10 people experience drowsiness, dizziness, dry mouth, blurred vision, and constipation. These effects are often most noticeable when starting treatment or increasing the dose. Other common side effects include nasal congestion, urinary retention, and changes in appetite. Some people experience movement side effects such as tremor, stiffness, restlessness, and involuntary muscle contractions. These are more common with chlorpromazine than with some other antipsychotics. Weight gain is possible, as is swelling of the breasts and milk production in both men and women. Menstrual irregularities can occur. Some people notice increased sensitivity to sunlight. Serious side effects require immediate medical attention. Extrapyramidal symptoms, including akathisia, dystonia, and parkinsonism, can occur. Tardive dyskinesia causes involuntary movements of the face, tongue, or limbs. Neuroleptic malignant syndrome presents with high fever, severe muscle rigidity, confusion, and autonomic instability. Agranulocytosis, a severe drop in white blood cells, can cause fever, sore throat, and mouth ulcers. Torsades de pointes, a dangerous heart rhythm, can cause palpitations, fainting, or sudden collapse. Sudden cardiac death has been reported with chlorpromazine. Low blood pressure can cause fainting. Liver problems, including jaundice, can cause yellowing of the skin and eyes. Severe skin reactions such as DRESS syndrome can cause fever, rash, swollen lymph nodes, and organ inflammation. If you develop any of these serious effects, stop the medication and seek medical help right away.

Drug Interaction

Chlorpromazine interacts with a long list of medications. Anticholinergic drugs, such as benztropine and trihexyphenidyl, can reduce the antipsychotic effect of chlorpromazine and add to its anticholinergic side effects, leading to constipation and heat stroke. The action of some drugs may be opposed by chlorpromazine, including amphetamine, levodopa, clonidine, guanethidine, and adrenaline. There is an increased risk of arrhythmias when chlorpromazine is used with other drugs that prolong the QT interval, such as certain antiarrhythmics and other antipsychotics. Alcohol potentiates the sedative effect of chlorpromazine and should be avoided. Concomitant administration of high chlorpromazine doses (100 mg per day or more) and antidiabetic agents can lead to an increase in blood sugar levels because chlorpromazine decreases insulin release. If you take antidiabetic medication, your doctor may need to adjust your dose and monitor your blood sugar more closely. Antacids and anti-diarrheal medications that contain magnesium, aluminium, or calcium can reduce the absorption of chlorpromazine. Take them at least 2 hours apart from your chlorpromazine dose. Drugs that inhibit the liver enzyme CYP1A2, such as fluvoxamine and ciprofloxacin, can increase chlorpromazine levels and raise the risk of side effects. Lithium, when taken with high doses of neuroleptics, can cause a confusional syndrome with muscle rigidity and hyperreflexia. Chlorpromazine can also interact with deferoxamine and prochlorperazine to cause a transient metabolic encephalopathy. Tell your doctor and pharmacist about every medication you take, including over-the-counter products, vitamins, and herbal supplements.

Missed Dose

If you miss a dose of Thorazine, take it as soon as you remember. If it is almost time for your next dose, skip the missed one and continue with your regular schedule. Do not take two doses at once to make up for a missed one. If you miss several doses in a row, contact your doctor before restarting. Missing doses can increase the risk of symptom relapse, so try to take the medication at the same times each day.

Overdose

Overdose with chlorpromazine is a medical emergency. Symptoms include severe drowsiness, confusion, agitation, hallucinations, muscle rigidity, and seizures. The heart can develop dangerous arrhythmias, including QT prolongation and torsades de pointes, which can lead to cardiac arrest. Blood pressure can drop dangerously low, and breathing can slow. In severe cases, coma can occur. There is no specific antidote. Treatment is supportive and may include activated charcoal if the overdose was recent, intravenous fluids, and medications to control seizures and support blood pressure. Close monitoring of heart rhythm and vital signs is necessary. Contact a poison control centre or go to an emergency department immediately if you or someone else has taken too much. Do not try to manage an overdose at home.

Storage

Store Thorazine tablets at room temperature between 20 and 25 degrees Celsius (68 and 77 degrees Fahrenheit). Brief exposure to temperatures between 15 and 30 degrees Celsius (59 and 86 degrees Fahrenheit) is acceptable. Protect from light and moisture. Keep the container tightly closed and store it in a dry place. Do not store in the bathroom or near a sink. Keep out of reach of children and pets. Do not use after the expiry date on the label. Dispose of unused medication according to local guidelines. Do not flush chlorpromazine down the toilet or pour it down the sink.

Disclaimer

We provide only general information about medications which does not cover all directions, possible drug integrations, or precautions. Information at the site cannot be used for self-treatment and self-diagnosis. Any specific instructions for a particular patient should be agreed with your health care adviser or doctor in charge of the case. We disclaim reliability of this information and mistakes it could contain. We are not responsible for any direct, indirect, special or other indirect damage as a result of any use of the information on this site and also for consequences of self-treatment.

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