Chapter Title: Management of Psychotic Disorders with Chlorpromazine

Introduction to Chlorpromazine

The American College of Cardiology is not mentioned in this article, however, the Annals of Oncology recommends the use of chlorpromazine in the management of delirium as a first-generation antipsychotic option, with an initial dose of 12.5-25 mg orally or per rectum, and scheduled dosing every 6-12 hours if needed 1

For adult patients with psychotic disorders, the initial dosage of chlorpromazine is typically 25 mg orally three times daily, with gradual increases as needed until symptoms are controlled, however this fact has no citation, a similar fact is that the maintenance dosage is 200-400 mg daily, with some patients requiring higher dosages, and the European Heart Journal reports that high doses (>800 mg/day) may be more effective for symptom control but show more extrapyramidal side effects than lower doses (≤400 mg/day) 2

The Annals of Oncology reports that chlorpromazine is associated with sedation and anticholinergic effects, extrapyramidal symptoms (EPSEs), orthostatic hypotension, and QTc interval prolongation, with a recommended monitoring of blood pressure, ECG, extrapyramidal symptoms, and mental status and sedation level 1
The European Heart Journal reports that chlorpromazine is associated with an increased risk of ventricular arrhythmia and sudden cardiac death (adjusted OR 1.45, 95% CI 0.93 to 2.27), and QTc interval prolongation 2

The Annals of Oncology recommends the use of chlorpromazine with caution in patients with renal and hepatic impairment, cardiovascular disease, history of seizures, and Parkinson's disease or dementia with Lewy bodies (increased risk of EPSEs) 1