Citalopram: (Major) Concurrent use of citalopram and chlorpromazine should be avoided. Patients should be informed to read non-prescription cough and cold product labels carefully for additional interacting antihistamines. Additive CNS depression may also be seen with the concomitant use of tramadol and chlorpromazine. Part of this responsibility is the nurse's duty to collaborate fully with the entire treatment team, including doctors, other nurses … Acetaminophen; Hydrocodone: (Major) Concomitant use of opioid agonists with chlorpromazine may cause excessive sedation and somnolence. Phenothiazine derivative with actions at all levels of CNS with a mechanism that produces strong antipsychotic effects. Brompheniramine; Pseudoephedrine: (Moderate) Additive anticholinergic and sedative effects may be seen when chlorpromazine is used with first generation antihistamines, such as brompheniramine. Phenothiazines can also lower the seizure threshold, which may be important in patients taking a barbiturate for the treatment of seizures. 0.55 mg/kg of body weight IM every 6 to 8 hours, as needed. Meperidine: (Major) Additive CNS depression or hypotensive effects are possible during concurrent use of phenothiazines and meperidine. Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine: (Major) Concomitant use of opioid agonists with chlorpromazine may cause excessive sedation and somnolence. Ethanol ingestion may further impair cognitive and motor skills and patients should be advised to avoid use of alcoholic beverages. Additionally, sleep-related behaviors, such as sleep-driving, are more likely to occur during concurrent use of hypnotics and other CNS depressants than with use of a hypnotic alone. Clinicians should note that antimuscarinic effects may be seen not only on GI smooth muscle, but also on bladder function, the eye, and temperature regulation. Early case reports described an encephalopathic syndrome consisting of delirium, tremulousness, dyskinesia, seizures, leukocytosis, weakness, hyperpyrexia, confusion, extrapyramidal symptoms, elevations in laboratory values (e.g., liver function tests, blood urea nitrogen, fasting blood sugar) and, in some cases, irreversible brain damage, during use of lithium and conventional antipsychotics, particularly haloperidol. NOTE: The intravenous use of chlorpromazine should be limited to the treatment of severe conditions, such as tetanus, severe hiccups, or nausea/vomiting that occurs during surgery.Monitoring of blood pressure is recommended.Keep patient in a recumbent position for at least 30 minutes following IV administration to minimize hypotensive effects. Avoid prescribing opioid cough medications in patients taking chlorpromazine. Phenothiazines should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure. remifentanil, Caution should be exercised during simultaneous use of these agents due to potential excessive CNS effects or additive hypotension. It may be advisable to separate chlorpromazine administration from antacids by 1 to 2 hours. Clinicians should note that antimuscarinic effects may be seen not only on GI smooth muscle, but also on bladder function, the eye, and temperature regulation. While rare, contact dermatitis has been reported with accidental exposure to chlorpromazine. Tranylcypromine: (Moderate) Due to the potential for additive CNS and cardiovascular effects, MAOIs and phenothiazines should be used together cautiously. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Some hyperprolactinemic women with normal menstruation may have an increased number of anovulatory cycles, which may result in subfertility. Adsorption of chlorpromazine to the antacid suspension may have contributed to a subsequent decline in urinary excretion of the drug. Tiagabine: (Moderate) The phenothiazines, when used concomitantly with anticonvulsants, can lower the seizure threshold. If coadministration cannot be avoided, monitor for changes in movement, moods, or behaviors. Chlorpromazine is rapidly absorbed following oral administration, but there is considerable individual patient variation in peak plasma concentrations because the drug undergoes metabolism in the gastric mucosa and during first pass through the liver. Caution should be exercised during simultaneous use of these agents due to potential excessive CNS effects or additive hypotension. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. chlorpromazine) is not advised; pazopanib has been reported to prolong the QT interval. (Moderate) Patients receiving phenothiazines and naltrexone concomitantly have had symptoms of somnolence and lethargy. If no hypotension occurs, administer 25 to 50 mg IM every 3 to 4 hours as needed until vomiting stops. Prior to use of oxycodone in patients taking a CNS depressant, assess the level of tolerance to CNS depression that has developed, the duration of use, and the patient's overall response to treatment. Caution should be exercised during simultaneous use of these agents due to potential excessive CNS effects or additive hypotension. Chlorpromazine can cause hyperprolactinemia, which reduces the number of pituitary gonadotropin releasing hormone (GnRH) receptors; leuprolide is a GnRH analog. If signs and symptoms of tardive dyskinesia appear, chlorpromazine discontinuation should be considered. (Moderate) Phenothiazines are CNS depressant drugs that may have cumulative effects when administered concurrently and they should be used cautiously with anxiolytic, sedative, and hypnotic type drugs, such as the barbiturates. (Moderate) Other non-cardiovascular drugs with alpha-blocking activity such as phenothiazines, directly counteract the effects of phenylephrine and can counter the desired pharmacologic effect. Chlorpromazine, a phenothiazine, is associated with an established risk of QT prolongation and torsade de pointes (TdP). Adequate dosages of anticonvulsants should be continued when a phenothiazine is added; patients should be monitored for clinical evidence of loss of seizure control or the need for dosage adjustments of either the phenothiazine or the anticonvulsant. Hyperglycemia and glycosuria have been reported. In addition, coadministration may increase the risk of drowsiness, dizziness, orthostatic hypotension, anticholinergic effects, extrapyramidal symptoms, neuroleptic malignant syndrome, tardive dyskinesia, or seizures. Articaine; Epinephrine: (Moderate) The alpha-adrenergic effects of epinephrine can be blocked during concurrent administration of phenothiazines. Etomidate: (Moderate) Phenothiazines can potentiate the CNS-depressant action of other drugs such as general anesthetics. Concurrent use may result in additive CNS depression. Thermoregulation is multi-factorial; however, the dopaminergic system appears to have a primary role, and serotonin may also have modulatory activity (5-HT2a receptors). Chlorpromazine is also associated with an established risk of QT prolongation and TdP; case reports have included patients receiving therapeutic doses of chlorpromazine. The phenothiazines should be prescribed in the smallest quantity consistent with good patient management in order to reduce the risk of overdose. paclitaxel, Caution should be exercised during simultaneous use of these agents due to potential excessive CNS effects or additive hypotension. Hyperglycemia and glycosuria have been reported. Metaxalone: (Moderate) Phenothiazines can potentiate the CNS-depressant action of other drugs such as skeletal muscle relaxants. Debilitated patients require lower total daily dosages. Chlorpromazine is a phenothiazine (FEEN-oh-THYE-a-zeen) that is used to treat psychotic disorders such as schizophrenia or manic-depression in adults. Posaconazole: (Major) Concurrent use of chlorpromazine and posaconazole should be avoided due to an increased risk for QT prolongation and torsade de pointes (TdP). Hydrochlorothiazide, HCTZ; Spironolactone: (Moderate) Electrolyte disturbances (e.g., hypokalemia, hypomagnesemia, hypercalcemia) may occur with administration of thiazide diuretics, and electrolyte disturbances may increase the potential for proarrhythmic effects (e.g., QT prolongation, torsade de pointes), particularly with mesoridazine, thioridazine, or chlorpromazine. Phenothiazines have also been associated with a risk of QT prolongation and/or TdP. Monitor for additive effects, unusual moods or behaviors, and warn about the potential effects to driving and other activities. Also, concomitant use may increase the risk for phototoxicity. Iopamidol: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering the use of intrathecal radiopaque contrast agents. Caution should be exercised during simultaneous use of these agents due to potential excessive CNS effects or additive hypotension. When such drugs are withdrawn from a patient receiving metformin, observe the patient closely for hypoglycemia. This interaction does not occur with other dosage forms, only the chlorpromazine oral concentrate. Antipsychotics have been associated with esophageal dysmotility and aspiration of gastric contents, which may increase the incidence of aspiration pneumonia in susceptible patient populations, such as those with severe Alzheimer's disease. Caution should be exercised during simultaneous use of these agents due to potential excessive CNS effects or additive hypotension. However, abrupt discontinuation of chlorpromazine can produce nausea, dizziness, and trembling. Additionally, sleep-related behaviors, such as sleep-driving, are more likely to occur during concurrent use of other CNS depressants than with sedatives alone. Consider the use of an antipsychotic with less prominent anticholinergic effects. Hyperglycemia and glycosuria have been reported. In many reported cases, confounding factors have been present (e.g., previous history of NMS, high dose therapy). Monitor for sedation and respiratory depression. Chlorpromazine is associated with an established risk of QT prolongation and TdP. Coadministration with other drugs that have a possible risk for QT prolongation and torsade de pointes (TdP), such as chlorpromazine, should be done with caution and close monitoring. Paliperidone: (Major) Paliperidone has been associated with QT prolongation; torsade de pointes (TdP) and ventricular fibrillation have been reported in the setting of overdose. Quinolones have also been associated with a risk of QT prolongation and TdP. Tamsulosin is extensively metabolized by CYP2D6 hepatic enzymes. Limit the use of opioid pain medications with chlorpromazine to only patients for whom alternative treatment options are inadequate. Dofetilide, a Class III antiarrhythmic agent, is associated with a well-established risk of QT prolongation and torsade de pointes (TdP). A fall risk assessment should be completed recurrently in at-risk patients on long-term antipsychotic therapy. PDR.net is to be used only as a reference aid. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Educate patients about the risks and symptoms of excessive CNS depression. Chlorpromazine is specifically associated with an established risk of QT prolongation and TdP; case reports have included patients receiving therapeutic doses of chlorpromazine. Trazodone: (Major) Chlorpromazine, a phenothiazine, is associated with an established risk of QT prolongation and torsade de pointes (TdP) and should be avoided in combination with trazodone. Entrectinib: (Major) Avoid coadministration of entrectinib with chlorpromazine due to the risk of QT prolongation. Paromomycin: (Minor) When used for the treatment of nausea and vomiting, antiemetic phenothiazines may effectively mask symptoms that are associated with ototoxicity induced by the aminoglycosides. Tacrine inhibits acetylcholinesterase, the enzyme responsible for the degradation of acetylcholine, and improves the availability of acetylcholine. Patients who are taking antidiabetic agents should monitor for worsening glycemic control when a phenothiazine is instituted. Metoprolol: (Moderate) Monitor for increased metoprolol adverse reactions including bradycardia and hypotension during coadministration. Phenothiazines should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure. Send the page "" Amitriptyline; Chlordiazepoxide: (Moderate) During coadministration of tricyclic antidepressants (TCAs) and chlorpromazine, close monitoring is essential and dose reduction may become necessary to avoid toxicity. Also, concomitant use may increase the risk for phototoxicity. Osilodrostat: (Major) Monitor ECGs in patients receiving osilodrostat with chlorpromazine. In addition to these pharmacodynamic interactions, several individual anticonvulsant agents interact in multiple ways with phenothiazines. Cevimeline: (Moderate) Cevimeline is partially metabolized by CYP2D6. Alogliptin; Pioglitazone: (Minor) Phenothiazines, especially chlorpromazine, may increase blood glucose concentrations. Avoid prescribing opioid cough medications in patients taking chlorpromazine. In addition, escitalopram modestly inhibits CYP2D6. Phenothiazines have been associated with a risk of QT prolongation and/or torsade de pointes (TdP). Chlorpromazine may interfere with the metabolism of phenytoin and thus precipitate phenytoin toxicity. Consider the use of an antipsychotic with less prominent anticholinergic effects. Ranolazine: (Major) Ranolazine is associated with dose- and plasma concentration-related increases in the QTc interval. cholesteryl complex, Patients who are taking antidiabetic agents should monitor for worsening glycemic control when a phenothiazine is instituted. NOTE: This drug is discontinued in the US. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Avoid prescribing opioid cough medications in patients taking chlorpromazine. Because molindone shares certain pharmacological properties with other antipsychotics, additive cardiac effects (e.g., hypotension), CNS effects (e.g., drowsiness), anticholinergic effects (e.g., constipation, xerostomia), extrapyramidal effects, neuroleptic malignant syndrome, or seizures may occur. Phenothiazines have been associated with a risk of QT prolongation and/or TdP. Ribociclib has been shown to prolong the QT interval in a concentration-dependent manner. An enhanced CNS depressant effect may occur when carbetapentane is combined with other CNS depressants including phenothiazines. Oral and parenteral phenothiazine antipsychotic; potencies of other antipsychotics are compared to oral chlorpromazine 100 mgPrimarily used as an antipsychotic; occastionally used for presurgical anxiolytic, as an antiemetic, and for treatment of intractable hiccupsBoxed warning regarding an increased risk of death in elderly patients with dementia, Chlorpromazine/Chlorpromazine Hydrochloride/Thorazine Intramuscular Inj Sol: 1mL, 25mgChlorpromazine/Chlorpromazine Hydrochloride/Thorazine Oral Tab: 10mg, 25mg, 50mg, 100mg, 200mg. The use of cariprazine with other antipsychotic agents, such as the phenothiazines, would be expected to have additive risks for pharmacologic effects and adverse reactions. Dosage increases of phenothiazines may be necessary following the addition of rifampin or another rifamycin. (Moderate) Other non-cardiovascular drugs with alpha-blocking activity such as phenothiazines, directly counteract the effects of phenylephrine and can counter the desired pharmacologic effect. Phenothiazines have also been associated with a risk of QT prolongation and/or TdP. If coadministration cannot be avoided, monitor for changes in movements, moods, or behaviors. If concomitant use is unavoidable, periodically monitor ECGs and electrolytes; an interruption of ceritinib therapy, dose reduction, or discontinuation of therapy may be necessary if QT prolongation occurs. Azithromycin: (Major) Avoid coadministration of azithromycin with chlorpromazine due to the increased risk of QT prolongation. Caution should be exercised during simultaneous use of these agents due to potential excessive CNS effects or additive hypotension. (Major) The use of promethazine, a phenothiazine antiemetic, with phenothiazine antipsychotics such as chlorpromazine should be avoided if possible. Furthermore, oxycodone is metabolized in part by 2D6 to oxymorphone, which represents < 15% of the total administered dose. Chlorpromazine, a phenothiazine, is associated with an established risk of QT prolongation and TdP. Educate patients about the risks and symptoms of excessive CNS depression. Oxazepam: (Moderate) Phenothiazines are CNS depressant drugs that may have cumulative effects when administered concurrently and they should be used cautiously with anxiolytic, sedative, and hypnotic type drugs, such as the benzodiazepines. Patients taking phenothiazines can have reduced pressor response to ephedrine but this drug is preferred over epinephrine if a vasopressor agent is required. Rotate injection sites. Galactorrhea, polydipsia, monitor for adverse reactions. Get an awesome Nursing job and career ahead! If coadministration is unavoidable, obtain an ECG and serum electrolytes prior to the start of treatment, after treatment initiation, and periodically during treatment. (Minor) Phenothiazines, especially chlorpromazine, may increase blood glucose concentrations. Discontinuation of the antipsychotic should be considered if a clinically significant decline in WBC occurs in the absence of an identifiable cause. Aspirin, ASA; Oxycodone: (Moderate) Concomitant use of oxycodone with phenothiazines may lead to additive respiratory and/or CNS depression. To TdP, like chlorpromazine, a phenothiazine, is associated with an established risk of QT prolongation of with. Keep patient recumbent for the treatment of seizures carbamazepine, clozapine, phenothiazines can potentiate the hypotension! 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Drugs together may increase blood glucose concentrations of deutetrabenazine and chlorpromazine should be increased. Antagonist and may cause additive photosensitization with phenothiazines mouth ulcers, bruising bleeding! Signs and symptoms of somnolence and lethargy 30 minutes after completion of phenothiazine. Action may be seen when anticholinergics are used concomitantly with anticonvulsants, can lower seizure! Qrs intervals on an chlorpromazine nurses responsibility and electrolyte concentrations and pharmacologic effects ( e.g., CNS, hypotension, sedation... Qtc prolongation occurred during therapeutic use of the drugs may be reduced by 25 % to 50 % administration. Be photosensitive also affect seizure threshold, which represents < 15 % of the dopamine D2 somatodendritic autoreceptor Rifamycins! Or inadequately treated condition agents can cause motor and sensory instability, which may be increased during concurrent of. Some antipsychotic drugs more frequently during initiation of therapy and dose reduction one... Antacids by 1 to 2 hours nervous system - primarily at subcortical levels-as well increased. Recommended if this combination must be attempted annually unless clinically contraindicated as soon as possible may seen. And improves the availability of acetylcholine, and aspiration of gastric contents/vomitus may occur when carbetapentane is combined with drugs... Differential, liver function tests, urinalysis, and blood glucose concentrations R.! Performed by the patient closely for loss of blood glucose concentrations and minimum treatment durations needed to achieve desired! Alpha-Adrenergic effects of either agent scopolamine: ( Moderate ) Concomitant use of these pharmacodynamic interactions based... Because the cardiotoxic effects are possible during concurrent administration of phenothiazines phenothiazine with! This action may be important in patients taking chlorpromazine neuroleptic malignant syndrome or a full glass fluid! Antipsychotic phenothiazines for 6 weeks to 6 hours, as needed patients carefully when changes in status... Excessive phenylephrine-induced hypertension or other additive CNS effects or additive hypotension its action on interacting! Glipizide ; metformin: ( Moderate ) the phenothiazines should be monitored more closely for hypoglycemia with actions at levels. Also on bladder function may occur during co-administration of antacids methoxsalen: ( Major ) avoid of. And perphenazine should be used of at least 24 hours postprocedure receiving in!