A Clinical Perspective

About Thorazine
Thorazine is SmithKline Beecham's brand name for chlorpromazine. It is prescribed for a number of reasons, but is mostly used to reduce symptoms of psychotic disorders such as schizophrenia. Other uses for Thorazine include the short-term treatment of severe behavioral disorders in children, including explosive hyperactivity and combativeness, and for the hyper-energetic phase of bipolar disorder. It is also used to control nausea and vomiting, and to relieve restlessness and apprehension before surgery. In more rare instances, Thorazine is used as an aid in the treatment of tetanus, and is prescribed for uncontrollable hiccups and acute intermittent porphyria. The first U.S. hospital to use Thorazine was Taylor Manor Hospital, located in Ellicott City, Maryland. It was tested there in 1953 by Dr. Irving Taylor, the hospital's medical director.

Possible Side Effects
Abnormal secretion of milk, abnormalities in movement and posture, agitation, anemia, asthma, blood disorders, breast development in males, chewing movements, constipation, difficulty breathing, difficulty swallowing, dizziness, drooling, drowsiness, dry mouth, ejaculation problems, eye problems causing fixed gaze, fainting, fever, flu-like symptoms, fluid accumulation and swelling, headache, heart attack, high or low blood sugar, hives, impotence, inability to urinate, intestinal blockage, involuntary movements of arms and legs, tongue, face, mouth, or jaw, irregular blood pressure, pulse, and heartbeat, irregular or no menstrual periods, jitteriness, light-headedness on standing up, lockjaw, mas-klike face, muscle stiffness and rigidity, narrow or dilated pupils, nasal congestion, nausea, pain and stiffness in the neck, persistent, painful erections, pill-rolling motion, protruding tongue, puckering of the mouth, puffing of the cheeks, rapid heartbeat, red or purple spots on the skin, rigid arms, feet, head, and muscles including the back, seizures, sensitivity to light, severe allergic reactions, shuffling walk, skin inflammation and peeling, sore throat, spasms in the jaw, face, tongue, neck, mouth, and feet, sweating, swelling of breasts in women, swelling of the throat, tremors, twitching in the body, neck, shoulders and face, twisted neck, visual problems, weight gain, yellowed skin and whites of eyes.

Warnings

  • Thorazine is known to cause tardive dyskinesia, a condition marked by involuntary muscle spasms and twitches in the face or body. It is most common among the elderly, especially women, but if it appears the condition may be permanent.
  • If an individual has ever had asthma, a brain tumor, breast cancer, intestinal blockages, emphysema, glaucoma, heart, kidney, or liver disease, respiratory infections, seizures, or an abnormal bone marrow or blood condition, they should not take Thorazine. Individuals regularly exposed to pesticides and extreme heat should also avoid it. Thorazine can mask symptoms of brain tumors, intestinal blockage, and Reye's syndrome.
  • Thorazine must not be stopped suddenly, as this may cause stomach inflammation, dizziness, nausea, vomiting, and tremors.
  • Because it suppresses the cough reflex, individuals taking Thorazine may have trouble vomiting. They will also have an increased sensitivity to light and should avoid being out in the sun too long.
  • Thorazine can cause a group of symptoms called Neuroleptic Malignant Syndrome, which can be fatal. Symptoms of this syndrome include extremely high body temperature, rigid muscles, mental changes, irregular pulse or blood pressure, rapid heartbeat, sweating, and changes in heart rhythm.
  • Symptoms of Thorazine overdose may include agitation, coma, convulsions, difficulty breathing or swallowing, dry mouth, extreme sleepiness, fever, intestinal blockage, irregular heart rate, low blood pressure, and restlessness.
  • The effects of Thorazine during pregnancy have not been adequately studied, and pregnant women should use Thorazine only if clearly needed. The drug does appear in breast milk and may affect a nursing infant.

Taking Thorazine
If taken in a liquid concentrate form, Thorazine must be diluted with a liquid such as soda, coffee, fruit juice, milk, tea, tomato juice, or water. Semisolid foods such as pudding and soup are also permissible, but alcohol is not. Thorazine tastes best when diluted immediately prior to use. It should always be stored away from heat, light, and moisture. The liquid should not be frozen. The liquid concentrate form is sensitive to light, and must be stored in a dark place but it does not need to be refrigerated.

Recommended Dosage
Psychotic Disorders: Initial doses may range from 30 to 75 milligrams daily, divided into equal doses and taken a few times per day. Improvement may not be seen for weeks or months.
Nausea and Vomiting: The usual tablet dosage is 10 to 25 milligrams, taken every four or six hours as needed. One 100-milligram suppository may be used every six to eight hours.
Uncontrollable Hiccups and Acute Intermittent Porphyria: Doses may range from 75 to 200 milligrams daily, in three or four equal doses.
Children: Thorazine is not generally prescribed for children under six months of age, and above that age the dosage is calculated according to the child's weight.
Older Adults: Lower dosages of Thorazine are recommended because of a greater risk of low blood pressure and tardive dyskinesia.

Contraindications
The following substances should not be combined with Thorazine:
Anesthetics, antacids, anti-seizure drugs, anti-spasmodic drugs, atropine, barbiturates, blood-thinning drugs, captopril, cimetidine (e.g., Tagamet), diuretics, epinephrine (an Epi-Pen), guanethidine, lithium, MAO inhibitors, narcotics (e.g., Percocet and Demerol), or propranolol.

Source
The PDR Pocket Guide to Prescription Drugs, page 1247.

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