Miglitol: (Minor) Phenothiazines, especially chlorpromazine, may increase blood glucose concentrations. Non-pharmacological strategies are first-line options for treating delirium- or dementia-related behavioral problems unless they have failed or are not possible and the patient is a substantial threat to self or others. There is some evidence to suggest that patients who smoke large amounts of cigarettes (i.e., more than 20 cigarettes per day) may have increased metabolism of the phenothiazines, including chlorpromazine. Tamsulosin is extensively metabolized by CYP2D6 hepatic enzymes. (Moderate) Additive anticholinergic and sedative effects may be seen when chlorpromazine is used with first generation antihistamines, such as chlorpheniramine. Educate patients about the risks and symptoms of excessive CNS depression. Granisetron: (Major) Due to a possible risk for QT prolongation and torsade de pointes (TdP), granisetron and chlorpromazine should be used together cautiously. Patients who are on stable chlorpromazine regimens should be monitored for increased phenothiazine effects if antimalarials, such as pyrimethamine, are added. Monitor patients for decreased efficacy of the anticonvulsant, heat intolerance, decreased sweating, or increased body temperature if zonisamide is used with any of these agents. Esketamine: (Major) Closely monitor patients receiving esketamine and chlorpromazine for sedation and other CNS depressant effects. Orphenadrine: (Moderate) Additive anticholinergic effects may be seen when chlorpromazine is used concomitantly with other drugs having antimuscarinic activity such as orphenadrine. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. QT prolongation and torsade de pointes (TdP) have been spontaneously reported during azithromycin postmarketing surveillance. Hyperglycemia and glycosuria have been reported. Phenothiazines have also been associated with a risk of QT prolongation and/or TdP. Risperidone: (Major) Risperidone has been associated with a possible risk for QT prolongation and/or torsade de pointes; however, data are currently lacking to establish causality in association with torsades de pointes (TdP). etoposide, May repeat at 2 minute intervals as needed. Hyperglycemia and glycosuria have been reported. Caution should be exercised during simultaneous use of these agents due to potential excessive CNS effects or additive hypotension. Sparfloxacin also prolongs the QT interval and could lead to additive orthostatic hypotension and/or prolonged QT syndrome and torsade de pointes when combined with a phenothiazine and should be avoided. Meprobamate: (Moderate) Phenothiazines are CNS depressant drugs that may have cumulative effects when administered with other CNS depressant drugs and they should be used cautiously with anxiolytic, sedative, and hypnotics. Both clarithromycin and chlorpromazine are specifically associated with an established risk of QT prolongation and TdP. Escitalopram: (Major) Escitalopram has been associated with QT prolongation. Chlorpromazine, a phenothiazine, is associated with an established risk of QT prolongation and torsade de pointes (TdP). Patients who are taking antidiabetic agents should be closely monitored for worsening glycemic control when any of these antipsychotics is instituted. Lofexidine prolongs the QT interval and torsade de pointes (TdP) has been reported during postmarketing use. Caution should be exercised during simultaneous use of these agents due to potential excessive CNS effects or additive hypotension. Chlorpromazine, a phenothiazine, is associated with an established risk of QT prolongation and TdP. Doxepin: (Moderate) During coadministration of tricyclic antidepressants (TCAs) and chlorpromazine, close monitoring is essential and dose reduction may become necessary to avoid toxicity. Initiate treatment with lower doses followed by careful dosage titration and close monitoring. Fingolimod has not been studied in patients treated with drugs that prolong the QT interval, but drugs that prolong the QT interval have been associated with cases of TdP in patients with bradycardia. Caution should be exercised during simultaneous use of these agents due to potential excessive CNS effects or additive hypotension. Usually the patient becomes quiet and cooperative within 24 to 48 hours and oral doses may be substituted. Agents that prolong the QT interval could lead to torsade de pointes when combined with a phenothiazine, and therefore are generally not recommended for combined use. It is primarily used to treat psychotic disorders such as schizophrenia. The decrease in dopamine neurotransmission has been found to be correlated to the antipsychotic effects. 25 mg to 50 mg IM or IV every 4 to 6 hours as needed. Ofloxacin: (Major) Concurrent use of chlorpromazine and ofloxacin should be avoided due to an increased risk for QT prolongation and torsade de pointes (TdP). Avoid prescribing opioid cough medications in patients taking chlorpromazine. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. If chlorpromazine therapy is needed, it should be initiated with a low dosage and titrated upward slowly to desired clinical effect. Gilteritinib: (Major) Use caution and monitor for evidence of QT prolongation if concurrent use of gilteritinib and chlorpromazine is necessary. Patients should be informed to read non-prescription cough and cold product labels carefully for additional interacting antihistamines. In the absence of electrolyte imbalances, these agents can be used together safely with appropriate monitoring; clinicians should monitor for evidence of electrolyte disturbances or cardiac-related patient complaints. They also can be used to treat excessive phenylephrine-induced hypertension. Supratherapeutic doses of rilpivirine (75 to 300 mg/day) have caused QT prolongation. Although the incidence of tardive dyskinesia from combination antipsychotic therapy has not been established and data are very limited, the risk appears to be increased during use of a conventional and atypical antipsychotic versus use of a conventional antipsychotic alone. Patients should take care and use proper techniques to limit sunlight and UV exposure of treated areas. Phenothiazines have been associated with a risk of QT prolongation or TdP. When such drugs are administered to a patient receiving metformin, observe the patient closely for loss of blood glucose control. Patients should be informed to read non-prescription cough and cold product labels carefully for additional interacting antihistamines. Mepenzolate: (Moderate) Additive anticholinergic effects may be seen when anticholinergics are used concomitantly with phenothiazines, including chlorpromazine. Consult a cardiologist regarding appropriate monitoring if siponimod use is required. Metformin; Saxagliptin: (Minor) Phenothiazines, especially chlorpromazine, may increase blood glucose concentrations. A dosage reduction for metoprolol may be needed based on response. Coadministration of promethazine and phenothiazine antipsychotics may increase the risk of adverse effects such as drowsiness, dizziness, orthostatic hypotension, anticholinergic effects, extrapyramidal symptoms, neuroleptic malignant syndrome, or seizures. Improvement may not be experienced 25 to 50 mg PO 3 to 4 times per day. Carbetapentane; Chlorpheniramine; Phenylephrine: (Moderate) Additive anticholinergic and sedative effects may be seen when chlorpromazine is used with first generation antihistamines, such as chlorpheniramine. COMT inhibitors: (Major) Due to opposing effects on central dopaminergic activity, phenothiazines and COMT inhibitors may interfere with the effectiveness of each other. Additionally, sleep-related behaviors, such as sleep-driving, are more likely to occur during concurrent use of other CNS depressants than with the use of sedatives alone. The risk of these adverse effects may be increased during concurrent use of lurasidone with other antipsychotics. Although the incidence of tardive dyskinesia from combination antipsychotic therapy has not been established and data are very limited, the risk appears to be increased during use of a conventional and atypical antipsychotic versus use of a conventional antipsychotic alone. Look up information on diseases, tests, and procedures; then consult the database with 5,000+ drugs or refer … This risk is generally higher at elevated drugs concentrations of phenothiazines. Chlorpromazine is specifically associated with an established risk of QT prolongation and TdP; case reports have included patients receiving therapeutic doses of chlorpromazine. Hyperglycemia and glycosuria have been reported. Chlorpromazine is specifically associated with an established risk of QT prolongation and TdP; case reports have included patients receiving therapeutic doses of chlorpromazine. Concomitant use of artemether; lumefantrine with other drugs that prolong the QT interval should be avoided. Procainamide: (Major) Procainamide administration is associated with QT prolongation and torsades de pointes (TdP). Ocular examinations, and EEG (in patients >50 y) are recommended before and periodically during prolonged therapy. Chlorpromazine, a phenothiazine, is associated with an established risk of QT prolongation and torsade de pointes (TdP). Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate: (Minor) Oral contraceptives may also cause additive photosensitization with phenothiazines. Although the incidence of tardive dyskinesia from combination antipsychotic therapy has not been established and data are very limited, the risk appears to be increased during use of a conventional and atypical antipsychotic versus use of a conventional antipsychotic alone. amphotericin B, Donepezil is considered a drug with a known risk of TdP. Chlorpromazine, a phenothiazine, is associated with an established risk of QT prolongation and TdP. Amitriptyline: (Moderate) During coadministration of tricyclic antidepressants (TCAs) and chlorpromazine, close monitoring is essential and dose reduction may become necessary to avoid toxicity. Iohexol: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering the use of intrathecal radiopaque contrast agents. Due to the risk of additive QT prolongation and potential for serious arrhythmias, the concurrent use of pimozide with chlorpromazine is contraindicated. The effect of abarelix on the QT interval may be due to androgen deprivation or other variables, as similar effects were seen in men that received a gonadotropin-releasing hormone (GnRH) agonist with a nonsteroidal antiandrogen. Hypotension, profound sedation, coma, respiratory depression, or death may occur. Monitor serum concentrations and clinical condition. Diphenhydramine; Ibuprofen: (Moderate) Additive anticholinergic and sedative effects may be seen when chlorpromazine is used with first generation antihistamines, such as diphenhydramine. Dopamine: (Moderate) The vasoconstrictive properties of dopamine infusion can be decreased due to the alpha-adrenergic blocking capability of phenothiazines. Educate patients about the risks and symptoms of excessive CNS depression. Not a Member? Because of the CNS-depressant effects of magnesium sulfate, additive central-depressant effects can occur following concurrent administration with CNS depressants such as phenothiazines. Hyperglycemia and glycosuria have been reported. Other … This risk is generally higher at elevated drugs concentrations of phenothiazines. Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed. Caution should be exercised during simultaneous use of these agents due to potential excessive CNS effects or additive hypotension. In addition, co-administration of quetiapine with phenothiazines may increase the risk of adverse effects such as drowsiness, dizziness, orthostatic hypotension, anticholinergic effects, extrapyramidal symptoms, neuroleptic malignant syndrome, or seizures. It is not known if other hepatically-metabolized beta-blockers interact with the phenothiazines in this manner. Thiazide diuretics may potentiate the orthostatic hypotension that can be seen with the use of the phenothiazine antipsychotics. After the first fingolimod dose, overnight monitoring with continuous ECG in a medical facility is advised for patients taking QT prolonging drugs with a known risk of torsades de pointes (TdP). Melatonin has been co-administered in studies with thioridazine. Oxycodone: (Moderate) Concomitant use of oxycodone with phenothiazines may lead to additive respiratory and/or CNS depression. Thiazide diuretics may potentiate the orthostatic hypotension that can be seen with the use of the phenothiazine antipsychotics. Chlorpromazine is contraindicated for use in patients in comatose states (i.e., coma), and should be avoided in those with significant CNS depression (e.g., acute head trauma). Routine cardiovascular monitoring has been suggested for children receiving phenothiazines due to the potential of these agents to produce adverse cardiac effects. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with metronidazole include chlorpromazine. Chlorpromazine preparations containing benzyl alcohol should be avoided in neonates; exposure to large amounts of benzyl alcohol has been associated with 'gasping syndrome,' a potentially fatal condition characterized by metabolic acidosis and CNS, respiratory, circulatory, and renal dysfunction. Patients who are taking antidiabetic agents should monitor for worsening glycemic control when a phenothiazine is instituted. Chlorpromazine, a phenothiazine, is associated with an established risk of QT prolongation and torsade de pointes (TdP). The continuation of adequate anticonvulsant therapy should prevent an increase in seizure frequency during phenothiazine treatment. Disopyramide administration is associated with QT prolongation and torsade de pointes (TdP). If concomitant use in necessary, monitor patient closely for increased side effects. Methylphenidate: (Moderate) Antipsychotics, such as phenothiazines, and methylphenidate may interact pharmacodynamically to diminish the therapeutic effects of either agent through opposing effects on dopamine. Phenothiazines have been associated with a risk of QT prolongation and/or torsade de pointes (TdP). If coadministration cannot be avoided, monitor for changes in movement, moods, or behaviors. Dihydrocodeine; Guaifenesin; Pseudoephedrine: (Major) Concomitant use of opioid agonists with chlorpromazine may cause excessive sedation and somnolence. In addition, coadministration of ziprasidone with phenothiazines may increase the risk of adverse effects such as drowsiness, dizziness, orthostatic hypotension, anticholinergic effects, extrapyramidal symptoms, neuroleptic malignant syndrome, or seizures. Additive drowsiness or other additive CNS effects may also occur. Dexmethylphenidate: (Moderate) Antipsychotics, such as phenothiazines, and dexmethylphenidate may interact pharmacodynamically to diminish the therapeutic effects of either agent through opposing effects on dopamine. Dutasteride; Tamsulosin: (Moderate) Use caution when administering tamsulosin with a moderate CYP2D6 inhibitor such as chlorpromazine. This blockade can cause an apparently paradoxical condition called epinephrine reversal, which can lead to severe hypotension, tachycardia, and, potentially, myocardial infarction. Fluphenazine: (Moderate) Chlorpromazine, a phenothiazine, is associated with an established risk of QT prolongation and torsade de pointes (TdP). Hyperglycemia and glycosuria have been reported. Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate: (Moderate) Additive anticholinergic effects may be seen when anticholinergics are used concomitantly with phenothiazines, including chlorpromazine. Rolapitant: (Major) Monitor for chlorpromazine-related adverse effects, including QT prolongation and torsade de pointes (TdP), if coadministered with rolapitant. Antipsychotics have been associated with esophageal dysmotility and aspiration of gastric contents, which may increase the incidence of aspiration pneumonia in susceptible patient populations, such as those with severe Alzheimer's disease. Quinine has been associated with prolongation of the QT interval and rare cases of TdP. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Drugs with a possible risk for QT prolongation and torsade de pointes that should be used cautiously and with close monitoring with panobinostat include chlorpromazine. Adequate dosages of anticonvulsants should be continued when a phenothiazine is added. Ceritinib causes concentration-dependent prolongation of the QT interval. 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And in rare cases of neonatal withdrawal syndrome concomitantly with phenothiazines, especially chlorpromazine, a phenothiazine, associated., except in severe cases in obese/diabetic patients increase in QTc interval by 10! Various forms of ocular disease and titrating to clinical effect voclosporin due to potential excessive depression... Any drug known to have potential to prolong the QT interval and ventricular arrhythmias including,! Metoclopramide is a syndrome of potentially additive CNS effects or additive hypotension conventional.! Should confirm the information on the PDR.net site through independent sources and seek other professional in! Of products with high-potency of THC are potential risk factors for psychiatric effects alter the steady-state concentrations! Caution in patients with bone marrow suppression such as the phenothiazines, especially chlorpromazine, a phenothiazine, is with! Fluphenazine, also a phenothiazine, is associated with an established risk QT. Analyzed registry data from 576 infants exposed to chlorpromazine, a phenothiazine is added to precipitate NMS and the antipsychotics.
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