Chlorpromazine cardiovascular

Trifluoperazine is also a more potent antipsychotic than chlorpromazine with only minor sedative, anticholinergic and cardiovascular activity. 

D2-receptor activation gives Gai-mediated inhibition of adenylate cyclase (decreasing cAMP) and these receptors are involved in schizophrenia and Parkinson s disease and in control of motor function, cardiovascular function and behaviour by the CNS. The well-known antipsychotics chlorpromazine and haloperidol are D2-R antagonists. A number of hallucinogenic indole alkaloids from ergot-infected grasses and cereals are D2-R agonists (Table 5.4). 

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. 

For each antipsychotic agent there is a licensed maximum dose for example up to 1000 mg of chlorpromazine/day may be given under the United Kingdom licence. Prescribing beyond the licensed maximum dose requires specialist consent. When two antipsychotics are co-prescribed, the maximum antipsychotic dose should not exceed 1000 mg of chlorpromazine equivalents/day except under specialist supervision. For some antipsychotics the licenced maximum dose is considerably less than 1000 mg of chlorpromazine equivalents/day. For instance, the licenced maximum dose of thioridazine was reduced to 600 mg/day following concerns about its cardiovascular toxicity. Note... 

Aliphatic side chain promazine, chlorpromazine low autonomic effects, sedation, cardiovascular, extrapyramidal... 

Chlorpromazine has complex actions on the cardiovascular system, directly affecting the heart and blood vessels and indirectly acting through CNS and autonomic reflexes. Chlorpromazine and less potent antipsychotic agents, as well as reserpine, risperidone, and olanzapine, can cause orthostatic hypotension, usually with rapid development of tolerance. 

The same or similar work by the same authors is described elsewhere. One of the patients was withdrawn from the study because he suffered a cardiovascular collapse while taking both drugs. It has been suggested that the value of propranolol in the treatment of schizophrenia probably results from the rise in serum chlorpromazine levels. ... 

Clinically relevant interactions were not noted when moclobemide was given with one or more neuroleptics (including phenothiazines such as chlorpromazine, levomepromazine, thioridazine). Adverse effects such as hypotension, tachycardia, drowsiness, tremor, and constipation were somewhat more Sequent, probably due to additive effects. A fatal case of overdose with moclobemide and perazine was attributed to syn-ergisSc effects resulSng in funcSonal cardiovascular disorder. ... 

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