Photosensitivity chlorpromazine

Kochevar, I.E., (1981) Phototoxicity mechanisms chlorpromazine photosensitized damage to DNA and cell membranes, J. Invest. Dermatol., 77 59-64. 

Ishida, K., Hoshino, T., Irie, T. and Uekama, K. (1988) Alleviation of chlorpromazine-photosensitized contact dermatitis by P-cyclodextrin derivatives and their possible mechanisms. Xenobiotic Metab. Dispos. 3 377-386. 

Several drug classes, including tetracycline, sulfonamide, and quinolone antibiotics, as well as chlorothiazide, chlorpromazine, and amiodarone hydrochloride, have been shown to be photoantigens. Photosensitivity may persist even after withdrawal of the drug, as has been observed with the antiarrhythmic drug amiodarone hydrochloride, since it is lipophilic and can be stored for extended periods in the body fat (Unkovic et al., 1984). In addition, it is quite common for cross-reactions to occur between structurally related drugs of the same class. 

A variety of relatively uncommon dermatological side effects have been noted to be associated with antipsychotic agents. These include maculopapular rashes, urticaria, and erythema multiforme (Arana, 2000). Photosensitivity and skin pigmentation can also occur during treatment with these drugs. Although skin pigmentation has been most frequently reported with chlorpromazine, this can occur with thioridazine and trifluoperazine (Harth and Rapoport, 1996). In addition, treatment-induced alopecia has been reported for haloperidol, olanzapine, and risperidone (Mercke et ah, 2000). 

The role played by the sulfoxide metabolites in the photosensitization caused by chlorpromazine and promazine is unknown. However, phenothiazine sulfoxide... 

Many skin reactions have been reported with neuroleptic drugs, including urticaria, abscesses after intramuscular injection, rashes, photosensitivity or exaggerated sunburn, contact dermatitis, and melanosis or blue-gray skin discoloration. Skin rashes are usually benign. Chlorpromazine is most often implicated (incidence 5-10%). 

Chlorpromazine most often causes photosensitivity reactions (incidence around 3%), which may result from formation of a cytotoxic by-product after exposure to ultraviolet light. Patients should be advised to avoid prolonged exposure to strong indoor light, to wear protective clothing, and to use a combined para-aminobenzoic acid plus benzophenone sunscreen when exposure to strong sunlight is unavoidable. 

A schizophrenic patient experienced delirium, tonic-clonic seizures, and photosensitivity after the addition of propranolol to chlorpromazine, suggesting that chlorpromazine concentrations are increased by propranolol (16). 

CHLORPROMAZINE, FLUPHENAZINE PORFIMER t risk of photosensitivity reactions Attributed to additive effects Avoid exposure of skin and eyes to direct sunlight for 30 days after porfimer therapy... 

PORFIMER I. ACE INHIBITORS -enalapril 2. ANALGESICS -celecoxib, ibuprofen, ketoprofen, naproxen 3. ANTIARRHYTHMICS — amiodarone 4. ANTIBIOTICS -ciprofloxacin, dapsone, sulphonamides, tetracyclines 5. ANTICANCER AND IMMUNOMODULATING DRUGS -fluorouracil (topical and oral) 6. ANTIDIABETIC DRUGS-glipizide 7. ANTIMALARIALS -hydroxychloroquine, quinine 8. ANTIPSYCHOTICS -chlorpromazine, fluphenazine 9. CALCIUM CHANNEL BLOCKERS - diltiazem 10. DIURETICS -bumetanide, furosemide, hydrochlorothiazide II. PARA-AMINOBENZOIC ACID (TOPICAL) 12. RETINOIDS-acitretin, isotretinoin 13. SALICYLATES (TOPICAL) t risk of photosensitivity reactions Attributed to additive effects Avoid exposure of skin and eyes to direct sunlight for 30 days after porfimer therapy... 

Hall RD, Buettner GR, Motten AG, ChigneU CF. Near-infrared detection of singlet molecular oxygen produced by photosensitization with promazine and chlorpromazine. Photochem Photobiol 1987 46 295-300. 

Chignell CF, Motten AG, Buettner GR. Photoinduced free radicals from chlorpromazine and related phenothiazines relationship to phenothiazine-induced photosensitization. Env Health Perspect 1985 64 103-110. 

Systemically taken drugs that can induce photosensitivity are many. Of the drug groups given below, those most commonly reported are antimitotics dacarbazine, vinblastine antimicrobials demeclocycline, doxycycline, nalidixic acid, sulphonamides antipsychotics chlorpromazine, prochlorperazine cardiac arrhythmic amiodarone diuretics frusemide (furosemide), chlorothiazide, hydrochlorothiazide fibric acid derivatives, e.g. fenofibrate hypoglycaemic tolbutamide... 

Hoshino, T, Ishida, K., Irie, T. et al. An attempt to reduce the photosensitizing potential of chlorpromazine with the simultaneous use of (3- and dimethyl-(3-cyclodextrins in guinea pigs. Arch. Dermatol. Res. 1989, 281, 60-65. 

Kochevar, I.E. and Lamola, A.A. (1979) Chlorpromazine and protriptyline phototoxicity photosensitized oxygen-independent red cell hemolysis, Photochem. Photobiol., 29 1177-1197. 

Li, A.S.W. and Chignell, C.F. (1987c) Spectroscopic studies of cutaneous photosensitizing agents. XI. Photolysis of chlorpromazine metabolites a spin-trapping study, Photo-chem. Photobiol., 45, 695-701. 

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