Orzine
Orzine (Chlorpromazine 10/100 mg) — first-generation phenothiazine for schizophrenia, severe agitation, intractable hiccups. first antipsychotic ever (1952) — useful niche FGA.
✓ Medically reviewed by Morgan Ellis — Pharmacy Researcher · 8 years experience · Last reviewed: May 2026
⚡ Quick Answer
Orzine (Chlorpromazine 10 / 100 mg) is a first-generation phenothiazine antipsychotic. Used for schizophrenia, severe agitation, intractable hiccups, severe nausea/vomiting, and pre-anaesthetic sedation. Typicals (FGAs) are now generally second-line behind atypicals.
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What Orzine is and how it works
Orzine is a Chlorpromazine tablet supplied by Sun Pharma. Available strengths: 10 / 100 mg.
Chlorpromazine was the first antipsychotic (1952) and remains useful for severe agitation, intractable hiccups, and acute psychosis. The original phenothiazine — strong sedation, strong anticholinergic action, strong α1 blockade, and meaningful EPS / tardive dyskinesia risk.
Indications and dosing
| Indication | Starting | Target | Max |
|---|---|---|---|
| Schizophrenia (adult) | 25–50 mg TID | 200–800 mg/day | 1000 mg |
| Severe agitation (IM) | 25–50 mg IM | — | 3 doses/24h |
| Intractable hiccups | 25–50 mg TID–QID PO | — | 50 mg QID |
| Severe nausea/vomiting | 10–25 mg q4–6h PO | — | — |
| Older adults / dementia (off-label, last-resort) | 10 mg HS | 10–25 mg/day | by tolerability |
Important safety considerations
Like atypicals, all antipsychotics carry the dementia-related psychosis mortality warning.
Chlorpromazine prolongs QT (less than thioridazine). EPS and tardive dyskinesia are more common than with atypicals. Cumulative TD risk is approximately 5%/year of exposure.
All phenothiazines have meaningful anticholinergic, antihistamine, and α1-blocking activity. Particularly problematic in older adults — falls, delirium, urinary retention, and constipation are common. Avoid in dementia, BPH, narrow-angle glaucoma, severe hepatic disease.
Phenothiazines cause photosensitivity (severe sunburns) and, with long-term use, blue-grey skin pigmentation, and rare lens / corneal pigmentation (chlorpromazine particularly). Sun protection mandatory.
Common side effects
- Sedation — universal.
- Orthostatic hypotension — strong α1 blockade.
- Anticholinergic — dry mouth, constipation, urinary hesitancy, blurred vision.
- EPS / tardive dyskinesia — meaningful.
- Hyperprolactinaemia — strong.
- Weight gain — moderate.
- QT prolongation — present in both, severe in thioridazine.
- Photosensitivity — universal.
- Cholestatic hepatitis (rare, idiosyncratic) — chlorpromazine particularly.
Drug interactions
- Other QT-prolonging drugs — additive risk; avoid combinations.
- Strong CYP2D6 inhibitors (paroxetine, fluoxetine, bupropion, quinidine) — raise levels substantially; absolute contraindication for thioridazine.
- Antihypertensives — strong additive hypotension.
- Anticholinergics — additive burden.
- CNS depressants — additive sedation.
- Levodopa — antagonism; avoid in Parkinson’s.
Pregnancy, breastfeeding, paediatric
Pregnancy: limited data; chlorpromazine has historically been used in hyperemesis with caution. Breastfeeding: passes into milk; usually avoided. Paediatric: not first-line; chlorpromazine occasionally used at low doses for severe paediatric agitation under specialist input.
Storage
Store at 15–30 °C, away from light, in original packaging.
Frequently Asked Questions
Why is chlorpromazine considered second-line now?
Chlorpromazine was the first effective antipsychotic and remains useful, but atypicals (olanzapine, risperidone, aripiprazole, lurasidone, quetiapine) generally have lower EPS / TD rates and similar efficacy for positive symptoms. Chlorpromazine retains a clinical niche in severe acute agitation, intractable hiccups, and severe nausea/vomiting.
Is chlorpromazine safe in older adults?
Generally not preferred — anticholinergic burden, falls, orthostasis, and TD risk all rise with age. The Beers Criteria flag both as potentially inappropriate medications in older adults. If used, start at a low dose and review weekly.
Will chlorpromazine cause tardive dyskinesia?
Cumulative TD risk for typical antipsychotics is approximately 5%/year of exposure (atypicals approximately 1%/year). After 5 years of typical antipsychotic exposure, roughly 25% of patients develop some TD signs. Risk is higher with age and female sex. TD can be irreversible — switch to clozapine or a low-EPS atypical at the first signs.
Why does chlorpromazine cause sun sensitivity?
Phenothiazines deposit in skin and undergo photochemical damage on UV exposure — producing severe sunburns and, with long-term use, blue-grey pigmentation. Sunscreen, protective clothing, and limited UV exposure are mandatory.
Can chlorpromazine be stopped abruptly?
Taper over 2–4 weeks. Abrupt cessation produces cholinergic rebound (nausea, sweating, insomnia) and antipsychotic relapse. Withdrawal dyskinesia can also unmask TD that was suppressed by the medication.
Will chlorpromazine interact with my other medications?
Several important interactions: (1) other QT-prolonging drugs (additive); (2) strong CYP2D6 inhibitors like paroxetine and fluoxetine (raise levels substantially); (3) antihypertensives (additive orthostasis). Always review the full medication list with the prescriber.
Why chlorpromazine for hiccups?
Chlorpromazine is the only FDA-approved drug for intractable hiccups. The mechanism is uncertain — likely a combination of central anticholinergic and dopamine-blocking action on the hiccup reflex arc. 25–50 mg TID–QID PO is the typical dose; usually time-limited.
How long until chlorpromazine works?
Calming and sedating effect within hours. Antipsychotic effect over 1–2 weeks for positive symptoms. Full effect at 4–6 weeks.
Can chlorpromazine be used for short-term severe agitation?
Yes — IM chlorpromazine is sometimes used for severe acute agitation in psychiatric emergencies. Newer atypicals (IM olanzapine, IM ziprasidone, IM aripiprazole) and IM benzodiazepines have largely replaced chlorpromazine for this indication in modern practice.
Will chlorpromazine affect my driving?
Strong sedation in the first 1–2 weeks. Most patients on stable doses drive normally but the orthostatic hypotension and sedation can persist.
Other Mental Health Medications
- Aripicon (Aripiprazole — atypical, low EPS)
- Risdone (Risperidone)
- Olanzap (Olanzapine)
- Sulpitac (Amisulpride)
- Skizoril (Clozapine — refractory disease)
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