Chlorpromazine

chlorpromazine is a legend in the antipsychotics category. Known scientifically as chlorpromazine hydrochloride, this first-generation phenothiazine was the game-changer that launched modern psychopharmacology back in the 1950s. Whether you know it by its brand names—Thorazine in the US or Largactil in the UK—or its generic form, chlorpromazine remains a go-to for managing psychosis and more.

At its core, chlorpromazine works by blocking dopamine D2 receptors in the brain, taming the chaotic neurotransmitter activity that drives symptoms like hallucinations, delusions, and severe agitation. But it’s not a one-trick pony—its effects on histamine, serotonin, and muscarinic receptors give it a broad reach, from sedation to antiemetic properties. Available in strengths like chlorpromazine 25mg tablets, syrup, or injections, it’s a versatile tool we pharmacists still dispense today, guided by resources like the British National Formulary (BNF).

What Does Chlorpromazine Treat?
Here’s a quick rundown of its uses:

Schizophrenia: Calms acute psychotic episodes and agitation.
Bipolar Mania: Stabilizes extreme mood swings.
Severe Anxiety: Offers short-term relief with its sedative punch (chlorpromazine for anxiety).
Intractable Hiccups: A surprising but effective fix (chlorpromazine for hiccups).
Nausea/Vomiting: A staple in palliative care settings.
While it’s a heavy hitter in the antipsychotics category, chlorpromazine comes with a trade-off: side effects like drowsiness, low blood pressure, and extrapyramidal symptoms (EPS) mean it requires careful dosing and monitoring. Start at 25–100mg daily for adults, and we adjust from there—sometimes up to 1000mg in severe cases. It’s not as polished as newer antipsychotics, but its efficacy, affordability, and decades of proven results keep it relevant.