Chlorpromazine adverse effects

The answer is d, (Katzung, p 482.) Although many antipsychotic agents can cause orthostatic hypotension, chlorpromazine is the most likely choice of the agents above for causing this adverse effect. 

Because chlorpromazine (CPZ, aka Thorazine) had commonly been used clinically to treat belladonna-induced delirium, George Aghajanian tested its effectiveness in reversing cognitive impairment in NF% scores when given in doses of either 25 or 50 mg of Thorazine at 45 minutes (Fig. 72). Decrements in NF% scores were actually increased by chlorpromazine - clearly an adverse effect on cognitive function rather than a beneficial one. 

The term behavioral toxicity has been used in the child psychiatry literature to describe the following adverse effects of antipsychotics, particularly low-potency phenothiazines (e.g., chlorpromazine, thioridazine) ... 

Most patients are able to tolerate the antimuscarinic adverse effects of antipsychotic drugs. Those who are made too uncomfortable or who develop urinary retention or other severe symptoms can be switched to an agent without significant antimuscarinic action. Orthostatic hypotension or impaired ejaculation—common complications of therapy with chlorpromazine or mesoridazine—should be managed by switching to drugs with less marked adrenoceptor-blocking actions. 

Chlorpromazine is a tranquilizing and antiemetic agent that may cause a number of side effects in the circulatory and nervous system and adverse effects on blood cells, skin, and the eye. Recent studies suggest a possible genotoxic activity for chlorpromazine, whereas it has been established that certain reactive metabolic intermediates are capable of binding with macromolecules including DNA. 

Abidi S, Bhaskara SM. From chlorpromazine to clozapine—antipsychotic adverse effects and the clinician s dilemma. Can J Psychiatry. 2003 48 749-755. 

Chlorpromazine Used infrequently because of adverse effects ... 

In 42 elderly patients (mean age 67 years) with schizophrenia randomly assigned to clozapine, titrated to 300 mg/day (n = 24), or chlorpromazine, titrated to a maximum of 600 mg/day (n = 18), the two medications were equally effective at 5 weeks (47). In each group there was one patient with a serious and potentially fatal adverse effect agranulocytosis in the clozapine group and paralytic ileus in the chlorpromazine group both drugs significantly lowered the white cell count. 

High doses of piperazine can enhance the adverse effects of chlorpromazine and other phenothiazines (667). 

Miller FA, Rampling D. Adverse effects of combined propranolol and chlorpromazine therapy. Am J Psychiatry 1982 139(9) 1198-9. 

Hypotension is the most commonly observed cardiovascular adverse effect of neuroleptic drugs, particularly after administration of those that are also potent alpha-adrenoceptor antagonists, such as chlorpromazine, thioridazine, and clozapine (34). A central mechanism involving the vasomotor regulatory center may also contribute to the lowering of blood pressure. 

The authors thought that the pigmentary changes were probably due to thioridazine, as adverse effects on the retina are rare with chlorpromazine. 

CHLORPROMAZINE, CLOZAPINE, HALOPERIDOL, OLANZAPINE BUPROPION T plasma concentrations of these drugs with risk of toxic/adverse effects Smoking induces mainly CYP1A2 and CYP2E1. Thus de-induction takes place following cessation of smoking Be aware and watch for early features of toxicity. Consider reducing the dose... 

ANTIPSYCHOTICS-CHLORPROMAZINE, CLOZAPINE, HALOPERI-DOL, OLANZAPINE, PERPHENAZINE, RISPERIDONE, SERTINDOLE, THIORIDAZINE, ZUCLOPENTHIXOL H2 RECEPTOR BLOCKERS -CIMETIDINE t plasma concentrations of these antipsychotics, with risk of associated adverse effects Cimetidine is an inhibitor of CYP3A4 (sertindole, haloperidol, risperidone), CYP2D6 (chlorpromazine, risperidone, zudopenthixol, thioridazine, perphenazine) and CYP1A2 (clozapine, olanzapine, sertindole, haloperidol) Avoid concomitant use. Choose an alternative acid suppression, e.g. H2 antagonist... 

Patients who are neuroleptic naive (i.e. have never previously taken any antipsychotic agent) should start at the lowest available dosage, such as haloperidol 0.5 mg/day or chlorpromazine 25 mg/ day, in case the patient is particularly susceptible to adverse effects, especially extrapyramidal motor... 

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