Chlorpromazine
- 영어발음 듣기
Trade Name
Thorazine (historical brand name); generic chlorpromazine hydrochloride
Classification
Typical (first-generation) antipsychotic; phenothiazine; antiemetic
Dosage/Route
- * Dosage:
- – Tablets: 10 mg, 25 mg, 50 mg, 100 mg, 200 mg
- – Injection: 25 mg/mL (IM/IV)
- – Suppositories: 100 mg
- * Route: Oral (PO), intramuscular (IM), intravenous (IV, rare), rectal
Usual Dosage
- * Psychosis (Adults): Start 25-50 mg PO TID-QID; usual 200-800 mg/day; max 2000 mg/day
- * Nausea/Vomiting: 10-25 mg PO/IM every 4-6 hours PRN; 100 mg suppository PR q6-8h
- * Acute Agitation: 25-50 mg IM; repeat q1-4h PRN (max 600 mg/day IM)
- * Children (≥6 months): 0.5-1 mg/kg/dose PO/IM q4-6h; max 75 mg/day (<12 years)
- * Titrate slowly; IV only in monitored settings
Mechanism of Action
Blocks dopamine D2 receptors in the mesolimbic pathway, reducing psychotic symptoms (hallucinations, delusions). Also antagonizes serotonin, histamine, alpha-adrenergic, and muscarinic receptors, contributing to antiemetic and sedative effects but increasing side effects
Side Effects & Adverse Effects
- * Side Effects: Drowsiness, dry mouth, constipation, blurred vision
- * Adverse Effects:
- – Extrapyramidal symptoms (EPS) (boxed warning; dystonia, parkinsonism, tardive dyskinesia)
- – Neuroleptic malignant syndrome (NMS) (rare; fever, rigidity)
- – Orthostatic hypotension, QT prolongation (arrhythmia risk)
- – Anticholinergic effects (severe: urinary retention, delirium)
- – Agranulocytosis (rare, early treatment)
Nursing Management (Implications & Teachings)
- * Implications:
- – Monitor vital signs, EPS (use AIMS scale), neuro status (NMS signs)
- – Assess CBC (agranulocytosis), EKG (QT prolongation) baseline/periodically
- – IM: Inject deep, rotate sites; IV: Dilute, infuse slowly (hypotension risk)
- – Avoid in coma, severe CNS depression, or with alcohol
- * Teachings:
- – Take with food to reduce GI upset; avoid sun (photosensitivity)
- – Rise slowly to prevent dizziness
- – Report fever, muscle stiffness, or sore throat
- – Use sugar-free gum, fluids for dry mouth/constipation
Indication for This Patient
- * Schizophrenia, bipolar mania (acute psychotic episodes)
- * Severe nausea/vomiting (e.g., chemotherapy, surgery)
- * Intractable hiccups, acute agitation (short-term)
Time
- * Timing: PO: TID-QID or BID (sustained); IM: q4-6h PRN
- * Onset: PO: 30-60 min; IM: 15-30 min
- * Peak: PO: 2-4 hr; IM: 1-2 hr
- * Duration: PO: 4-6 hr; IM: 6-8 hr
