Thorazine (chlorpromazine hydrochloride) is a first-generation antipsychotic medication with a well-established history in the management of severe psychiatric conditions. As a phenothiazine derivative, it functions primarily as a dopamine antagonist, effectively modulating neurotransmitter activity in the central nervous system to reduce psychotic symptoms, agitation, and severe nausea. Its robust efficacy and extensive clinical profile make it a cornerstone in acute and maintenance treatment protocols for schizophrenia, bipolar mania, and other treatment-resistant psychiatric presentations. This agent is also utilized off-label in certain medical contexts, underscoring its versatility under expert supervision.

Features

• Active ingredient: Chlorpromazine hydrochloride
• Available formulations: Oral tablets, syrup, injectable solution, and rectal suppositories
• Standard strengths: 10 mg, 25 mg, 50 mg, 100 mg, and 200 mg tablets
• Mechanism of action: Dopamine D2 receptor antagonism
• Half-life: Approximately 30 hours
• Bioavailability: Oral bioavailability ranges from 10-30% due to significant first-pass metabolism

Benefits

• Rapid reduction of acute psychotic symptoms such as hallucinations, delusions, and disorganized thinking
• Effective management of severe agitation and aggression in emergency psychiatric settings
• Proven efficacy in controlling intractable hiccups and severe nausea/vomiting
• Long-standing safety and efficacy data from decades of clinical use
• Cost-effective treatment option within public health and institutional formularies
• Useful as an adjunct in treatment-resistant cases when newer antipsychotics prove insufficient

Common use

Thorazine is primarily indicated for the treatment of schizophrenia and other psychotic disorders, including manifestations of bipolar disorder during manic or mixed episodes. It is also FDA-approved for the management of severe nausea and vomiting, preoperative restlessness, and intractable hiccups. Off-label uses may include acute agitation in dementia (with extreme caution), adjunctive treatment in tetanus, and as a second-line option for certain anxiety disorders. It is often employed in inpatient settings due to its sedative properties and rapid onset when administered via intramuscular injection.

Dosage and direction

Dosage must be individualized based on diagnosis, severity, patient response, and tolerability. For psychosis in adults, initial oral doses typically range from 25–100 mg daily, divided into two or four doses, titrating gradually to a therapeutic range of 400–800 mg/day. Severe cases may require higher doses under close monitoring. Intramuscular administration for acute agitation is usually 25–50 mg, repeatable in one hour if necessary. For nausea/vomiting, oral doses of 10–25 mg every 4–6 hours are common. Elderly or debilitated patients should receive lower initial doses. Always take with food or milk to minimize gastrointestinal upset.

Precautions

Patients should be monitored regularly for extrapyramidal symptoms (EPS), tardive dyskinesia, and neuroleptic malignant syndrome (NMS). Orthostatic hypotension may occur, especially during initial dosing. Caution is advised in patients with cardiovascular disease, seizure disorders, or glaucoma. Thorazine may impair cognitive and motor skills; advise against driving or operating machinery. Periodic CBC monitoring is recommended due to risk of agranulocytosis. Avoid abrupt discontinuation to prevent withdrawal symptoms or rebound psychosis.

Contraindications

Thorazine is contraindicated in patients with known hypersensitivity to chlorpromazine or other phenothiazines. It should not be used in comatose states, significant bone marrow suppression, or severe central nervous system depression. Avoid in patients with suspected or established subcortical brain damage, with caution in those with a history of seizures. Concomitant use with large doses of hypnotics or alcohol is contraindicated.

Possible side effect

Common side effects include drowsiness, dizziness, dry mouth, blurred vision, constipation, and weight gain. Extrapyramidal symptoms such as dystonia, akathisia, parkinsonism, and tardive dyskinesia may occur. Serious adverse effects include neuroleptic malignant syndrome (characterized by fever, muscle rigidity, autonomic instability), agranulocytosis, seizures, hypotension, and jaundice. Photosensitivity is also possible; sun exposure should be limited.

Drug interaction

Thorazine may potentiate CNS depressants including alcohol, benzodiazepines, and opioids. Concurrent use with anticholinergic agents may increase the risk of heat stroke and paralytic ileus. It may antagonize the effects of levodopa and other dopamine agonists. Caution is advised with antihypertensive agents due to additive hypotensive effects. QT prolongation may occur when combined with other drugs that prolong the QT interval.

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next dose. In that case, skip the missed dose and resume the regular schedule. Do not double the dose to make up for a missed one. Consistent dosing is important to maintain therapeutic levels and symptom control.

Overdose

Symptoms of overdose include severe drowsiness, agitation, coma, hypotension, tachycardia, and extrapyramidal symptoms. ECG may show prolonged QT interval. Management is supportive and symptomatic; there is no specific antidote. Gastric lavage may be considered if ingestion was recent. Maintain airway and blood pressure; avoid epinephrine due to risk of paradoxical hypotension. Contact poison control immediately.

Storage

Store at room temperature (15–30°C or 59–86°F) in a tightly closed container, protected from light and moisture. Do not freeze liquid formulations. Keep out of reach of children and pets. Do not use beyond the expiration date printed on the packaging.

Disclaimer

This information is intended for educational purposes and does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before starting, changing, or discontinuing any medication. Individual responses to Thorazine may vary, and only a licensed practitioner can determine the appropriate therapy based on a patient’s specific condition and medical history.

Reviews

Clinical studies and decades of use support Thorazine’s efficacy in managing acute psychosis and severe agitation, though its side effect profile necessitates careful patient selection and monitoring. Many clinicians value its reliability in treatment-resistant cases, though newer antipsychotics are often preferred for long-term maintenance due to better tolerability. Patient experiences vary; some report significant symptom relief, while others describe burdensome side effects such as sedation and movement disorders. It remains an important tool in psychiatric therapeutics, particularly in inpatient and emergency settings.