Typical (low-potency) antipsychotic Pregnancy: Inadequate evidence of safety in human pregnancy; harmful effects in animals — avoid in pregnancy unless the physician considers it essential. Neonates exposed in the third trimester are at risk of extrapyramidal and/or withdrawal symptoms — monitor. Should not be used during lactation (excreted in breast milk; risk of drowsiness and tardive dyskinesia in the infant).

Chlorpromazine hydrochloride

Brand names: Largactil

Chlorpromazine is a first-generation (typical) antipsychotic used for schizophrenia and other psychoses and for the short-term management of severe psychomotor agitation.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Schizophrenia/other psychoses/mania/anxiety/psychomotor agitation: initially 25 mg three times daily, or 75 mg at bedtime, increasing daily by 25 mg to an effective maintenance dose (usually 75-300 mg daily)

Route: Oral

Frequency: Three times daily initially (or once at bedtime), titrated

Max: May be up to 1 g daily in some patients

Chlorpromazine Hydrochloride 100 mg/5 ml Oral Syrup (SPC); for oral administration only. Start low and increase gradually under close supervision until the optimum individual dose within the recommended range is reached. Intractable hiccup (adult): 25-50 mg three or four times daily. Vomiting and nausea of terminal illness (adult): 10-25 mg every 4-6 hours. Elderly or disabled: start with 1/3-1/2 the usual adult dose with a more gradual increase. Children <1 year: not recommended unless the need is life-saving. See paediatric detail below.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to chlorpromazine or any excipient
Comatose states
Severe CNS depression
History of blood dyscrasias including bone marrow depression and agranulocytosis
Severe cardiovascular disease
Risk of angle-closure glaucoma
Risk of urinary retention related to urethroprostatic disorders
Concomitant dopaminergic antiparkinsonism agents
Nursing mothers
Citalopram and escitalopram

Side effects

Nervous system: sedation, somnolence, extrapyramidal disorder, tardive dyskinesia, acute dystonias/dyskinesias, parkinsonism, neuroleptic malignant syndrome
Cardiac: QT prolongation and ECG changes, ventricular/atrial arrhythmias, torsade de pointes, sudden death
Endocrine: hyperprolactinaemia, amenorrhoea, galactorrhoea, gynaecomastia, erectile dysfunction
Blood: agranulocytosis, leucopenia, eosinophilia, thrombocytopenia
Vascular: orthostatic hypotension; venous thromboembolism/pulmonary embolism/DVT
Gastrointestinal: dry mouth, constipation, paralytic ileus, intestinal perforation/necrosis (sometimes fatal)

Interactions

Dopaminergic antiparkinsonism agents (contraindicated)
Citalopram and escitalopram (contraindicated)
Other drugs known to prolong the QT interval — increased risk of torsade de pointes
Concurrent tricyclic antidepressants may predispose to cardiac arrhythmia/arrest
Conditions/drugs causing bradycardia or hypokalaemia (exacerbate QT prolongation)

Clinical monograph

How it works

It blocks dopamine D2 receptors (with additional antagonism at histaminergic, muscarinic and adrenergic receptors), reducing positive psychotic symptoms while accounting for its sedative and autonomic effects.

Prescribing in practice

It causes photosensitisation and contact sensitisation, so patients should avoid direct sunlight and those handling it should avoid skin contact, and it can also markedly lower the seizure threshold.
Like other antipsychotics it can prolong the QT interval and cause extrapyramidal effects, postural hypotension and, rarely, neuroleptic malignant syndrome.
Use with particular caution in the elderly, in whom antipsychotics increase the risk of stroke and death in dementia.

Monitoring

Monitor weight, metabolic parameters, blood pressure, ECG where indicated, and for extrapyramidal and sedative side-effects.

Counselling the patient

Protect your skin from strong sunlight and use a high-factor sunscreen.
Stand up slowly to avoid dizziness, especially when starting treatment.
Report any high fever with muscle stiffness urgently.

Evidence & guidelines

Chlorpromazine is an established antipsychotic; MHRA advice notes the increased risk of stroke and mortality with antipsychotics in elderly patients with dementia.

Reference: Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways