US Brand Name: Thorazine

generic name: chlorpromazine hydrochloride

Other Forms: Sustained-release spansule capsules, syrup, intramuscular injection, and the ever-so-popular suppositories (as base chlorpromazine).

Class: antipsychotics (APs) Specifically a Phenothiazine

1.  Other brand names & branded generic names¹

• Ampliactil (Argentina)
• Aspersinal (Argentina)
• Chlomazine (Japan)
• Chloractil (United Kingdom)
• Chlorazin (Bulgaria; Switzerland)
• Chlorpromanyl (Canada)
• Chlorpromed (Thailand)
• Clonazine (Ireland)
• Contomin (Japan)
• Duncan (Thailand)
• Esmino (Japan)
• Hibernal (Hungary; Sweden)
• Klorproman (Czech Republic; Finland)
• Klorpromazin (Finland)
• Laractyl (Philippines)
• Largactil (Australia; Bahamas; Bahrain; Barbados; Belize; Benin; Bermuda; Burkina Faso; Canada; Costa Rica; Curacao; Cyprus; Czech Republic; Denmark; Dominican Republic; Ecuador; Egypt; El Salvador; Ethiopia; Finland; France; Gambia; Ghana; Greece; Guatemala; Guinea; Guyana; Honduras; Hong Kong; Indonesia; Iraq; Italy; Ivory Coast; Jamaica; Kenya; Kuwait; Lebanon; Liberia; Libya; Lebanon; Malawi; Mali; Mauritania; Mauritius; Morocco; Dutch Antilles; Netherlands; New Zealand; Niger; Nigeria; Norway; Oman; Panama; Peru; Portugal; Qatar; Republic of Yemen; Saudi Arabia; Senegal; Seychelles; Sierra Leone; South Africa; Spain; Sudan; Surinam; Switzerland; Syria; Tanzania; Trinidad; Tunisia; Uganda; United Arab Emirates; United Kingdom; Zambia; Zimbabwe)
• Largactil Forte (New Zealand)
• Matcine (Malaysia; Thailand)
• Neomazine (Korea)
• Plegomazine (Bahamas; Barbados; Belize; Bermuda; Curacao; Guyana; Iraq; Jamaica; Dutch Antilles; Surinam; Trinidad)
• Promactil (Indonesia)
• Promexin (Japan)
• Propaphenin (Germany)
• Prozil (Denmark)
• Prozin (Italy)
• Psynor (Philippines)
• Taroctyl (Israel)
• Winsumin (Taiwan)
• Wintermin (Japan; Taiwan)

2.  FDA Approved Uses of Thorazine (chlorpromazine hydrochloride)

Schizophrenia, bipolar disorder (one of the first and predating lithium), intractable hiccoughs, severe nausea & vomiting (cancer chemotherapy severe), pre-surgical anxiety, tetanus, porphyria, and several conduct disorders in children. Thorazine (chlorpromazine HCl) is approved to treat both adults and children for schizophrenia and bipolar disorder.

3.  Off-Label Uses of Thorazine (chlorpromazine hydrochloride)

• Migraines Mainly in emergency rooms, where it is really effective.
• Insomnia
• Managing the pain in blind eyes.
• Steroid-induced psychosis. AKA Roid rage.
• Augmenting AIDS treatments.

4.  Thorazine’s pros and cons

4.1  Pros

It’s cheaper than dirt, it’s effective, and it treats so many seemingly unrelated things (migraines, tetanus, AIDS) that it might help you reduce the number of other meds you need to take.

4.2  Cons

You’re more likely to be hit with a movement disorder like TD or EPS than you would be if you were taking most AAPs. Unlike other standard/typical/first-generation APs (FGAs) the chance for weight gain isn’t that much less than atypical antipsychotics (AAPs) such as Zyprexa and Seroquel.

5.  Thorazine’s (chlorpromazine hydrochloride) Side Effects

5.1  Typical Side Effects

The usual that come with any antipsychotic: weird dreams, drowsiness and lethargy, a feeling of being disconnected from reality, emotional numbing, not really giving a damn. Put it all together and they add up to what is known as, “zombification.” Fortunately most of these tend to go away, at varying rates, usually within a matter of weeks.
Because Thorazine is such a potent antihistamine weight gain is a common side effect and the lethargy/daytime drowsiness doesn’t always go away, unlike most other FGAs.

5.2  Not So Common Side Effects

Again, the same as most APs: movement disorders, the prolactin-related side effects of enlarged tits and/or surprise lactation (for both men and women), changes in menstruation, and assorted sexual dysfunctions including priapism. Before Viagra and Cialis this guy decided to take matters into his own hands, as it were. Only because I’m batshit crazy can I understand how crushing Thorazine tablets and shoving them up your urethra to deal with erectile dysfunction could seem like a good idea. Which it’s not.

5.3  Freaky Rare Side Effects

Floppy iris syndrome, and turning your skin blue - which would look totally awesome at a Star Trek convention if you went as an Andorian.

6.  Interesting Stuff Your Doctor Probably Won’t Tell You about Thorazine (chlorpromazine HCl)

Thorazine can result in a false positive for amphetamines in a urine test. As that was from 1992 the test may no longer be used, but this is why you really do need to list all the meds you take whenever you are required to pee in a cup.
You may have had Thorazine and never knew it. Some standard antipsychotics are given in emergency rooms every day as anti-nausea medications when their chemical cousins aren’t potent enough to stop the spenching, or aren’t available for one reason or another².

---

---

7.  Thorazine’s (chlorpromazine hydrochloride) Dosage and How to Take Thorazine

We’re going to deal only with schizophrenia and mania, only for out-patients, and, as always, only adults. See the PI sheet for all the other situations and approved uses. Also, per the PI sheet, the dosages apply only to tablets and sustained-release Spansule capsules.
I really have to hand it to the guys at SmithKline Beecham (or whoever wrote the last PI sheet) for their honesty in admitting they have no clue as to what the dosages for the injections, oral concentrate, and suppositories really should be for long-term use:

Quote: Adjust dosage to individual and the severity of his condition, recognizing that the milligram for milligram potency relationship among all dosage forms has not been precisely established clinically. It is important to increase dosage until symptoms are controlled. Dosage should be increased more gradually in debilitated or emaciated patients. In continued therapy, gradually reduce dosage to the lowest effective maintenance level, after symptoms have been controlled for a reasonable period.

I’ve never read anything like that in a PI sheet. Their titration schedule is fairly sane:

Quote: Psychotic Disorders —Increase dosage gradually until symptoms are controlled. Maximum improvement may not be seen for weeks or even months. Continue optimum dosage [whenever the symptoms stop, usually in a range of 200–800mg a day] for 2 weeks; then gradually reduce dosage to the lowest effective maintenance level. Daily dosage of 200 mg is not unusual. Some patients require higher dosages (e.g., 800 mg daily is not uncommon in discharged mental patients). OUTPATIENTS— Oral: 10 mg t.i.d. or q.i.d. [Three or four times a day], or 25 mg b.i.d. or t.i.d. [Two or three times a day MORE SEVERE CASES— Oral: 25 mg t.i.d. After 1 or 2 days, daily dosage may be increased by 20 to 50 mg at semiweekly intervals until patient becomes calm and cooperative. PROMPT CONTROL OF SEVERE SYMPTOMS— I.M.[Intramuscular injection]: 25 mg (1 mL). If necessary, repeat in 1 hour. Subsequent doses should be oral, 25 to 50 mg t.i.d.

That “calm and cooperative” part is somewhat stereotypical. Not everyone in the lock ward, let alone outpatients, needs to be calmed down³ or forced into cooperation. Other than that the only quibble I have is a dosage increase twice a week, but only because that might be too fast for some people.

8.  How Long Thorazine (chlorpromazine hydrochloride) Takes to Work

Thorazine is kind of slow for an antipsychotic. Like all antipsychotics it will do something within a day, sooner if injected, but it take up to a week before there’s a noticeable effect and, as it states in the PI sheet, it can take months before you know if Thorazine is going to fully control your symptoms or not.
The effect on vomiting is nearly instant. Really. It’s TV-fast.

9.  How to Stop Taking Thorazine (chlorpromazine hydrochloride)

With most APs you can stop taking them rapidly, or immediately, in case of an emergency like a severe allergic reaction, and your ‘only’ real worry is rebound symptoms. Just as the sudden discontinuation of an antiepileptic drug can give you a seizure as a “rebound symptom” for something you don’t have, if you suddenly stop taking Thorazine (chlorpromazine hydrochloride) all at once you can get “rebound,” non-stop vomiting. Thorazine also has a reputation for severe rebound symptoms. Stahl recommends a 6–8 week discontinuation schedule, which is probably a bit long if you’re taking 200mg a day or less. If you’re taking 400mg a day or more, six-to-eight weeks seems about right, as you would want to reduce your dosage by 30–50mg a day every 3 to seven days.

10.  Thorazine’s (chlorpromazine hydrochloride) Half-Life & Average Time to Clear Out of Your System

The half-life is anywhere from 8 to 33 hours, although it averages about four days for Thorazine to clear out of your system. Go figure.

11.  Days to Reach a Steady State

Good question. Thorazine’s pharmacokinetics are too variable to pin this down.

12.  How Thorazine (chlorpromazine hydrochloride) Works

Based on the chemical imbalance theory of mental illness (brain cooties, the crazies, etc.), Thorazine (and all standard/typical/first-generation antipsychotics) interferes with the transmission of dopamine to the D2 receptors to reduce the positive symptoms of schizophrenia and other psychoses, the manic side of bipolar, and similar conditions. Its antihistamine action combined with the dopamine blockade is why it works for anxiety and insomnia. The antihistamine and potent anticholinergic activity at specific receptors is what make Thorazine and other phenothiazines,⁴ so effective for nausea.
Your guess is as good as mine as to why Thorazine works for hiccups, tetanus, porphyria, HIV/AIDS, and even malaria.

13.  Comments

14.  Discussion board

Crazy Meds’ Thorazine discussion board

15.  Your Comments About and Experiences with Thorazine

Tell us what you think about Thorazine

---

Enter your own Comments & Experiences with Thorazine here.
You must be a registered member of the Crazy Meds Talk forum to post a comment on this page.

16.  Full US PI sheet, Global SPCs & PILs, check for drug-drug interactions

Thorazine Full US Prescribing Information / PI Sheet
Australian Largactil PI
Australian Largactil CMI
New Zealand Largactil MDS
South African chlorpromazine IM injection PI All that’s available
UK chlorpromazine SPC

Check for drug-drug interactions

17.  Bibliography

Physicians’ Desk Reference Edition 53 Maria Deutsch & Anu Gupta, Drug Information Specialists, et al. © 1999. Published by Medical Economics Company.

The Prescriber’s Guide (Essential Psychopharmacology Series) Third edition by Stephen Stahl

Mosby’s 2004 Drug Guide David Nissen PharmD, Editor.© 2004. An imprint of Elsevier.

Drugs for Mental Illness: Feeling/Organism (Series of Books in Psychology) Marvin E. Lickey, Barbara Gordon. © 1983 by W. H. Freeman & Company. Published by W. H. Freeman & Company.

The New Chemotherapy in Mental Illness edited by Hirsch L. Gordon M.D., Ph.D., F.A.P.A. © 1958 Philosophical Library, Inc. Published by Philosophical Library.

¹ The term "branded generic" has three meanings:
1) A generic drug produced by a generics manufacturer that is a wholly-owned subsidiary of the company that makes the branded version. E.g. Greenstone Pharmaceuticals makes gabapentin, and they are owned by Pfizer, who also own Parke-Davis, the makers of Neurontin.
2) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Teva's Budeprion), but otherwise has the same active ingredient as the original branded version (Wellbutrin).
3) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Sanofi-Aventis' Aplenzin, which is bupropion hydrobromide) and uses a salt of the active ingredient that is different from the original branded version and other generics (Wellbutrin, Budeprion and all the others are bupropion hydrochloride). We aren't sure if that really makes a difference or not. The FDA says they're the same thing. As usual, the data are contradictory, but most evidence indicates that the FDA is right and the differences are negligible.
For our purposes a "branded generic name" refers to the second and third definitions.

² Such as running out of money.

³ Although when I had a timeout in a psychiatric hospital's lock ward there were a few people who badly needed to be calmed down and made to cooperate, and a B-52 (Benadryl 5mg haloperidol 2mg lorazepam) sucks less for everyone involved than strapping them to a bed with someone always sitting next to them until a relative could be contacted or court order came through; as was the case with one poor bastard who looked and sounded like star of a low-budget exorcism movie.

⁴ There are a whole bunch of meds classified as phenothiazines that aren't crazy meds and are used in hospitals and prescribed as anti-emetics and super antihistamines. Phenergan (promethazine HCl) is one especially effective one with as many approved and off-label uses as Thorazine. It also works on migraine-induced nausea so quickly you'll want an IV kit at home, because as soon as it's hooked up to the drip the spenching stops and you're ready to fall asleep.

Date created 20 Jul 2011 - 17:26 Page Creator: Jerod Poore Last edited by:

Page design and explanatory material copyright © 2004 - 2012 Jerod Poore. All rights reserved.

Almost all of the material on this site is copyright © 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, and 2012 Jerod Poore. Except, of course, the PI sheets - those are the property of the drug companies who developed the drugs the sheets are about - and any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That’s usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that’s OK to just do. Go for it! Please. As long as you include this copyright notice and the following disclaimer, I’m usually cool with it.

All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you.
The information on Crazy Meds pertains to and is intended for adults. While some information about children and adolescents is occasionally presented (e.g. US FDA approvals), pediatric-specific data such as dosages, side effects, off-label applications, etc. are rarely included in the articles on drugs or discussed on the forum. If you are looking for information regarding meds for children you’ll have to go somewhere else.
Know your sources!
Nobody on this site is a doctor, therapist, or a pharmacist. We don’t portray them either here or on TV. Only doctors can diagnose and treat an illness. Some doctors tend to get pissed off by patients who know too much about medications, so tread lightly when and where appropriate. Diagnosing yourself from a website is like defending yourself in court, you suddenly have a fool for a doctor. Don’t be a cyberchondriac, thinking you have every disease you see a website about, or that you’ll get every side effect from every medication¹. Self-prescribing is as dangerous as buying meds from fraudulent online pharmacies that promise you medications without prescriptions.
All information on this site has been obtained through our personal experience and the experiences family, friends, what people have reported on various reputable sites all over teh intergoogles, the medications’ product information / summary of product characteristic (PI/SPC) sheets, and from sources that are referenced throughout the site. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or patient information leaflet (PIL) that comes with your medications and never ever throw them away.
Crazy Meds is not responsible for the content of sites we provide links to. We like them, or they’re paid advertisements, or they’re something else we think you should read to help you make an informed decision about a particular med. Sometimes they’re more than one of those things. But what’s on those sites is their business, not ours.
Very little information about visitors to this site is collected or saved. From time to time I look at search terms used and which pages they bring up in an effort to make the information I present more relevant. And the country of origin, just because I’m geeky like that. That’s about it. Depending on how you feel about Schrodinger, our privacy policy should either assuage or exacerbate your paranoia.
All brand names of the drugs listed in this site are the trademarks of the companies named on the PI/SPC sheet associated with the medication, sometimes on the pages about the drugs, even though those companies may have been acquired by other companies who may or may not be listed in this site by the time you read this. Or the rights to the drug were sold to another company. And any or all of the companies involved may have changed their names.
Crazy Meds is optimized for the browser you’re not using on the platform you wish you had. Between you and me, it all looks a lot cleaner using Firefox or Safari, which is what a plurality of visitors use. And I’m running Windows XP3. On a computer that sits on top of my desk. With a 23 inch monitor. Hey, at least you can make the text larger or smaller by clicking on the + or - buttons in the upper right hand corner. If you have Java enabled. Like 99% of the websites on the planet, Crazy Meds is hosted on domain running an open source operating system with a variety of open source applications, including the software used to display what you’ve been reading. As such Crazy Meds is not responsible for whatever weird shit your browser does or does not do when you read this site².
No neurologists, psychiatrists, therapists or pharmacists were harmed in the production of this website. Use only as directed. Void where prohibited. Contains nuts. Certain restrictions may apply. All data are subject to availability. Not available on all mobile devices or in all dimensions of reality.

‘Everything is true, nothing is permitted.’ - Jerod Poore

¹ While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.

² Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?
[begin rant] I rent a dedicated server for Crazy Meds. It’s sitting on a rack somewhere in Southern California along with a bunch of other servers that other people have rented. The hardware is identical, but no two machines have exactly the same operating systems. I don’t even need to see what is on any of the others to know this. If somebody got their server at the exact same time, with the exact same features as I did, I’m confident that there would be noticeable differences in some aspects of the operating systems. So what does this mean? For one thing it means that no two computers in the same office of a single company have the same operating system, and the techs can spend hours figuring out what the fuck the problem could be based on that alone. It also means that application software like IP board that runs the forum here has to have so many fucking user-configurable bells and whistles that even when I read the manual I can’t find every setting, or every location that every flag needs to be set in order for a feature to run the way I want it to run. And in the real world it means you can get an MBA not only with an emphasis on resource planning, but with an emphasis on using SAP - a piece of software so complex there are now college programs on how to use it. You might think, “But don’t people learn how to use Photoshop or Adobe Illustrator in college?” Sure, in order to create stuff. And in a way you’re creating stuff with SAP. But do you get a Bachelor of Fine Arts degree with an emphasis on Photoshop?
Back in the Big Iron Age the operating systems were proprietary, and every computer that took up an entire room with a raised floor and HVAC system, and had less storage and processing power than an iPhone, had the same operating system as every other one, give or take a release level. But when a company bought application software like SAP, they also got the source code, which was usually documented and written in a way to make it easy to modify the hell out of it. Why? Because accounting principles may be the same the world over, and tax laws the same across each country and state, but no two companies have the same format for their reports, invoices, purchase orders and so forth. Standards existed and were universally ignored. If something went wrong it went wrong the same way for everyone, and was easy to track down. People didn’t need to take a college course to learn how to use a piece of software.
I’m not against the open source concept entirely. Back then all the programmers read the same magazines, so we all had the same homebrew utilities. We even had the forerunner to QR Code to scan the longer source code. Software vendors and computer manufacturers sponsored conventions so we could, among other things, swap recipes for such add-ons and utilities. While those things would make our lives easier, they had nothing to do with critical functions of the operating system. Unless badly implemented they would rarely cause key application software to crash and burn. Whereas today, with open source everything, who the hell knows what could be responsible some part of a system failing. [/end rant]