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Orzine

Orzine (Chlorpromazine 10/100 mg) — first-generation phenothiazine for schizophrenia, severe agitation, intractable hiccups. first antipsychotic ever (1952) — useful niche FGA.

Medisch beoordeeld door Morgan Ellis — Apotheekonderzoeker · 8 jaar ervaring  · Laatst beoordeeld: mei 2026

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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.

Indicaties en dosering

IndicatieStartdoseringStreefdoseringMaximaal
Schizophrenia (adult)25–50 mg TID200–800 mg/day1000 mg
Severe agitation (IM)25–50 mg IM3 doses/24h
Intractable hiccups25–50 mg TID–QID PO50 mg QID
Severe nausea/vomiting10–25 mg q4–6h PO
Older adults / dementia (off-label, last-resort)10 mg HS10–25 mg/dayby tolerability

Belangrijke veiligheidsoverwegingen

FDA dementia black-box

Like atypicals, all antipsychotics carry the dementia-related psychosis mortality warning.

QT prolongation, EPS, tardive dyskinesia

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.

Anticholinergic burden, sedation, orthostatic hypotension

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.

Photosensitivity and skin pigmentation

Phenothiazines cause photosensitivity (severe sunburns) and, with long-term use, blue-grey skin pigmentation, and rare lens / corneal pigmentation (chlorpromazine particularly). Sun protection mandatory.

Veelvoorkomende bijwerkingen

  • Sedation — universal.
  • Orthostatic hypotension — strong α1 blockade.
  • Anticholinergic — dry mouth, constipation, urinary hesitancy, blurred vision.
  • EPS / tardive dyskinesia — meaningful.
  • Hyperprolactinemie — strong.
  • Gewichtstoename — moderate.
  • QT-verlenging — present in both, severe in thioridazine.
  • Fotosensitiviteit — universal.
  • Cholestatic hepatitis (rare, idiosyncratic) — chlorpromazine particularly.

Geneesmiddelinteracties

  • Andere QT-verlengende geneesmiddelen — additive risk; avoid combinations.
  • Strong CYP2D6 inhibitors (paroxetine, fluoxetine, bupropion, quinidine) — raise levels substantially; absolute contraindication for thioridazine.
  • Antihypertensiva — strong additive hypotension.
  • Anticholinergics — additive burden.
  • CNS depressants — additive sedation.
  • Levodopa — antagonism; avoid in Parkinson’s.

Zwangerschap, borstvoeding, pediatrie

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.

Opslag

Store at 15–30 °C, away from light, in original packaging.

Veelgestelde vragen

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.

Andere medicijnen voor geestelijke gezondheid

Medisch disclaimer. Deze pagina is educatief en geen vervanging voor persoonlijk medisch advies. Farmacotherapie voor geestelijke gezondheid dient te worden gestart, gecontroleerd en aangepast onder begeleiding van een gekwalificeerde clinicus. Als u of iemand die u kent in een suïcidale crisis verkeert, neem dan onmiddellijk contact op met de plaatselijke hulpdiensten, of bel de suïcidepreventielijn van uw land (VS/Canada: 988; VK: Samaritans 116 123; internationale lijst: findahelpline.com).

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50 mg, 100 mg

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