Answer:
Plain language
summary
Research evidence suggests that chlorpromazine is an effective
treatment in reducing symptoms of schizophrenia and increasing
patient functioning. However the studies included were of low
quality. Higher quality and more current research trials need to be
carried out in order to adequately assess the effectiveness of
chlorpromazine.
Clinical and research
implications
Evidence form one well conducted systematic review suggests that
chlorpromazine is an effective treatment for people with
schizophrenia, reducing relapse rates and improving global measures
of symptoms and functioning. However, it should be noted that the
review found that chlorpromazine had no significant effect on
measures of behavioural disturbance and was associated with a
substantial adverse event profile.
As noted by the authors of the review, its reliability is
limited by the quality of the included studies, which was generally
low; most studies were published before 1990. Large, high quality
trials are needed to adequately assess the effectiveness of
chlorpromazine and these should focus on key outcomes such as
quality of life, levels of satisfaction, relapse, hospital
discharge or admission and number of violent incidents.
What do guidelines say?
SIGN guidelines states in service users with an acute
exacerbation or recurrence of schizophrenia prescribers should
consider amisulpride, olanzapine or risperidone as the preferred
medications with chlorpromazine and other low-potency
first-generation antipsychotics providing suitable alternatives.
Consideration should be given to previous response to individual
antipsychotic medications and relative adverse effect profiles.
For maintenance treatment, prescribers should consider
amisulpride, olanzapine or risperidone as the preferred medications
with chlorpromazine and other low-potency first-generation
antipsychotics providing suitable alternatives.
Individuals with schizophrenia, which is in remission, should be
offered maintenance treatment with antipsychotic medication at low
to moderate regular dosing of around 300-400 mg of chlorpromazine,
4-6 mg of risperidone, or their equivalents daily.
NICE guidance says that if prescribing chlorpromazine, warn of
its potential to cause skin photosensitivity. Advise using
sunscreen if necessary.
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