NAME OF DRUG
chlorpromazine HCl

CLASSIFICATION

Antipsychotic-antiemetic-anxiolytic

ALTERNATE NAME

LARGACTIL

 INDICATIONS

• treatment of psychotic and behavioural disorders
• prevention and treatment of nausea and vomiting
• to decrease blood pressure during surgery
• relief of intractable hiccups
• relief of preoperative agitation
• treatment of acute migraine headache

 RECONSTITUTION AND STABILITY

• protect ampoules from light; slight yellow colour does not affect potency; discard if markedly discoloured or pink

 COMPATIBILITY

• compatible with dextrose solutions and NS
   
• see Appendix X for syringe compatibilities
• see Appendix II for subcutaneous administration compatibilities

ROUTES OF ADMINISTRATION

• SC injection
• IM - deeply into upper outer quadrant of the buttock
• IV direct - dilute to 1 mg/mL and administer at a rate of 1 mg/minute in adults and 0.5 mg/minute in children
• IV intermittent - in 50-100 mL NS or D5W; infuse over 15-30 minutes
• IV infusion - in 500-1,000 mL NS or D5W

 VH & HSC ADMINISTRATION POLICY

B - Direct IV route restricted to nurses in Special and Critical Care areas. On general nursing units the direct IV route must be administered by a physician.

F - May be administered by direct IV by nurses in the Palliative Care Unit provided venipuncture has been established, and according to policies and recommendations stated in this manual.

DOSAGE

Adults:

Acutely agitated, manic or disturbed patient:

• Initial dose:  25 mg IM, SC
• Additional doses of 25-50 mg may be given in 1 hour if necessary. 
• Subsequent IM dosage should be gradually increased to a maximum of 400 mg every 4-6 hours

Nausea and vomiting:

• Usual:
  • 25 mg IM, SC additional doses of 25-50 mg every 3-4 hours
  • 25-50 mg/hour continuous SC infusion (see Policy for Administration of Continuous Subcutaneous Infusion) or 40-120mg/m²/day continuous IV infusion
• During surgery:
  • 12.5 mg IM, repeat in 30 minutes if necessary
  • 2 mg doses may be given IV at 2 minute intervals up to a max. of 25 mg

Intractable hiccups

• 25-50 mg IM, SC, IV infusion

Migraine headaches

• 5-10 mg/dose IV (up to 40-50 mg/day in divided dosage)

Children:

IM:  0.55 mg/kg every 6-8 hours

Maximum: less than 5 years (less than 22.7 kg); 40 mg daily 5-12 years (22.7-45.5 kg); 75 mg daily

During Surgery:

• 0.275 mg/kg IM, repeat in 30 minutes if necessary
• up to 1 mg doses IV at 2 minute intervals;  total IV dose not to exceed 0.275 mg/kg

 POTENTIAL HAZARDS OF PARENTERAL ADMINISTRATION

• hypotension (including postural hypotension), tachycardia, syncope and dizziness following the first parenteral dose
• irritation or nodule formation at IM, SC injection site

 IMPORTANT IMPLICATIONS

• IV administration of undiluted chlorpromazine injection should be avoided
• if irritation at the IM injection site is a problem, the drug can be diluted with 0.9% NS or 2% procaine HCl
• keep patients supine for at least 1/2 hour after administration
• monitor blood pressure during IV administration
• may potentiate the action of CNS depressants
• avoid skin contact due to possibility of contact dermatitis
• contraindicated in comatose patients
• caution in patients with epilepsy, respiratory disorders, cardiovascular disease, glaucoma, liver disease, and in pregnancy

Rev. Feb 2000