predose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias. . sodium sulfate/potassium sulfate/magnesium sulfate decreases levels of chlorpromazine by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Administer chlorpromazine at least 2 hr before and no less than 6 hr after each dose to avoid chelation with magnesium. .solifenacinMonitor Closely (3)solifenacin decreases levels of chlorpromazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. solifenacin decreases levels of chlorpromazine by pharmacodynamic antagonism. Use Caution/Monitor. chlorpromazine increases effects of solifenacin by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.Serious - Use Alternative (1)solifenacin and chlorpromazine both increase QTc interval. Avoid or Use Alternate Drug.sorafenibMonitor Closely (1)sorafenib and chlorpromazine both increase QTc interval. Use Caution/Monitor.sotalolContraindicated (1)chlorpromazine and sotalol both increase QTc interval. Contraindicated.stiripentolMonitor Closely (1)stiripentol, chlorpromazine. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.sufentanilMonitor Closely (1)sufentanil and chlorpromazine both increase sedation. Use Caution/Monitor.sulfamethoxazoleMonitor Closely (1)chlorpromazine and sulfamethoxazole both increase QTc interval. Modify Therapy/Monitor Closely.sunitinibSerious - Use Alternative (1)sunitinib and chlorpromazine both increase QTc interval. Avoid or Use Alternate Drug.tacrolimusSerious - Use Alternative (1)tacrolimus and chlorpromazine both increase QTc interval. Avoid or Use Alternate Drug.tamoxifenMonitor Closely (1)chlorpromazine, tamoxifen. affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. CYP2D6 inhibition decreases metabolism of tamoxifen to hydroxytamoxifen, and N-desmethyl tamoxifen to endoxifen (active metabolites with 100-fold greater affinity for estrogen receptor); decreased endoxifen levels may result in poor clinical outcome.tamsulosinMonitor Closely (1)chlorpromazine increases levels of tamsulosin by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.tapentadolMonitor Closely (1)tapentadol and chlorpromazine both increase sedation. Use Caution/Monitor.teduglutideMonitor Closely (1)teduglutide increases levels of chlorpromazine by Other (see comment). Use Caution/Monitor. Comment: Teduglutide may increase absorption of concomitant PO medications; caution with with drugs requiring titration or those with a narrow therapeutic index; dose adjustment may be necessary.telavancinMonitor Closely (1)chlorpromazine and telavancin both increase QTc interval. Modify Therapy/Monitor Closely.temazepamMonitor Closely (1)temazepam and chlorpromazine both increase sedation. Use Caution/Monitor.terbinafineMonitor Closely (1)terbinafine will increase the level or effect of chlorpromazine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.terbutalineMonitor Closely (1)chlorpromazine increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.tetrabenazineMonitor Closely (1)chlorpromazine and tetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)tetrabenazine and chlorpromazine both increase QTc interval. Avoid or Use Alternate Drug.thalidomideMonitor Closely (1)thalidomide increases effects of chlorpromazine by unspecified interaction mechanism. Use Caution/Monitor. Increased sedative effects.thioridazineMonitor Closely (2)chlorpromazine and thioridazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. chlorpromazine and thioridazine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)chlorpromazine and thioridazine both increase QTc interval. Avoid or Use Alternate Drug.Minor (1)thioridazine will increase the level or effect of chlorpromazine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.thiothixeneMonitor Closely (2)chlorpromazine and thiothixene both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. chlorpromazine and thiothixene both increase sedation. Use Caution/Monitor.tiotropiumMonitor Closely (3)tiotropium decreases levels of chlorpromazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. tiotropium decreases levels of chlorpromazine by pharmacodynamic antagonism. Use Caution/Monitor. chlorpromazine increases effects of tiotropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.tipranavirMinor (1)tipranavir will increase the level or effect of chlorpromazine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.tobacco useMonitor Closely (1)tobacco use decreases levels of chlorpromazine by increasing metabolism. Use Caution/Monitor. Interaction mainly seen w/chlorpromazine & thioridazine, but may occur w/other phenothiazines.tolterodineMonitor Closely (3)tolterodine decreases levels of chlorpromazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. tolterodine decreases levels of chlorpromazine by pharmacodynamic antagonism. Use Caution/Monitor. chlorpromazine increases effects of tolterodine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.topiramateMonitor Closely (1)chlorpromazine and topiramate both increase sedation. Modify Therapy/Monitor Closely.tramadolMonitor Closely (1)tramadol and chlorpromazine both increase sedation. Use Caution/Monitor.trandolaprilMinor (1)chlorpromazine increases effects of trandolapril by unspecified interaction mechanism. Minor/Significance Unknown.tranylcypromineMonitor Closely (1)tranylcypromine, chlorpromazine. Other (see comment). Use Caution/Monitor. Comment: Coadministration of MAOI and phenothiazines may lead to additive hypotensive effects.trazodoneMonitor Closely (1)chlorpromazine and trazodone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)chlorpromazine and trazodone both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)trazodone, chlorpromazine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive hypotensive effects. trazodone, chlorpromazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.tretinoinSerious - Use Alternative (1)chlorpromazine, tretinoin. Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased phototoxicity.tretinoin topicalSerious - Use Alternative (1)chlorpromazine, tretinoin topical. Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased phototoxicity.triazolamMonitor Closely (1)triazolam and chlorpromazine both increase sedation. Use Caution/Monitor.triclofosMonitor Closely (1)triclofos and chlorpromazine both increase sedation. Use Caution/Monitor.trifluoperazineMonitor Closely (2)chlorpromazine and trifluoperazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. chlorpromazine and trifluoperazine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)chlorpromazine and trifluoperazine both increase QTc interval. Avoid or Use Alternate Drug.trihexyphenidylMonitor Closely (2)trihexyphenidyl decreases levels of chlorpromazine by pharmacodynamic antagonism. Use Caution/Monitor. chlorpromazine increases effects of trihexyphenidyl by pharmacodynamic synergism. Use Caution/Monitor. Potential for additive anticholinergic effects.trimethoprimMonitor Closely (1)chlorpromazine and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.trimipramineMonitor Closely (1)chlorpromazine and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)chlorpromazine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)trimipramine, chlorpromazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects. trimipramine, chlorpromazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.triprolidineMonitor Closely (1)triprolidine and chlorpromazine both increase sedation. Use Caution/Monitor.triptorelinMonitor Closely (1)triptorelin increases toxicity of chlorpromazine by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.tropisetronMonitor Closely (1)chlorpromazine and tropisetron both increase QTc interval. Modify Therapy/Monitor Closely.trospium chlorideMonitor Closely (3)trospium chloride decreases levels of chlorpromazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. trospium chloride decreases levels of chlorpromazine by pharmacodynamic antagonism. Use Caution/Monitor. chlorpromazine increases effects of trospium chloride by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.umeclidinium bromide/vilanterol inhaledSerious - Use Alternative (1)chlorpromazine increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.valbenazineMonitor Closely (2)chlorpromazine will increase the level or effect of valbenazine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Consider reducing valbenazine dose based on tolerability if coadministered with a strong CYP2D6 inhibitor. valbenazine and chlorpromazine both increase QTc interval. Use Caution/Monitor.valoctocogene roxaparvovecMonitor Closely (1)chlorpromazine and valoctocogene roxaparvovec both increase Other (see comment). Use Caution/Monitor. Medications that may cause hepatotoxicity when combined with valoctogene roxaparvovec may potentiate the risk of elevated liver enzymes. Closely monitor these medications and consider alternative medications in case of potential drug interactions.vandetanibSerious - Use Alternative (1)chlorpromazine, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.vecuroniumMonitor Closely (3)vecuronium decreases levels of chlorpromazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. vecuronium decreases levels of chlorpromazine by pharmacodynamic antagonism. Use Caution/Monitor. chlorpromazine increases effects of vecuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.vemurafenibSerious - Use Alternative (1)vemurafenib and chlorpromazine both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.venlafaxineMonitor Closely (2)chlorpromazine and venlafaxine both increase QTc interval. Modify Therapy/Monitor Closely. venlafaxine will increase the level or effect of chlorpromazine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.vilanterol/fluticasone furoate inhaledSerious - Use Alternative (1)chlorpromazine increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.voclosporinMonitor Closely (1)voclosporin, chlorpromazine. Either increases effects of the other by QTc interval. Use Caution/Monitor.voriconazoleMonitor Closely (1)chlorpromazine and voriconazole both increase QTc interval. Modify Therapy/Monitor Closely.vorinostatSerious - Use Alternative (1)vorinostat and chlorpromazine both increase QTc interval. Avoid or Use Alternate Drug.vortioxetineSerious - Use Alternative (1)chlorpromazine increases levels of vortioxetine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Decrease vortioxetine dose by 50% when coadministered with strong CYP2D6 inhibitors.xylometazolineMonitor Closely (2)chlorpromazine, xylometazoline. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only. chlorpromazine increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.yohimbeSerious - Use Alternative (1)yohimbe decreases effects of chlorpromazine by pharmacodynamic antagonism. Contraindicated.yohimbineMonitor Closely (2)chlorpromazine, yohimbine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only. chlorpromazine increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.ziconotideMonitor Closely (1)chlorpromazine and ziconotide both increase sedation. Use Caution/Monitor.ziprasidoneMonitor Closely (2)chlorpromazine and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. chlorpromazine and ziprasidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)chlorpromazine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.zolpidemMonitor Closely (1)chlorpromazine will increase the level or effect of zolpidem by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Additive effect of decreased alertness and psychomotor performancezotepineMonitor Closely (2)chlorpromazine and zotepine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. chlorpromazine and zotepine both increase sedation. Use Caution/Monitor. Frequency Not Defined Extrapyramidal symptoms Akathisia Dystonia Muscle stiffness Neuroleptic malignant syndrome (NMS; infrequent but serious) Parkinsonism Tardive dyskinesia Common Anticholinergic effects Sedation Weight gain Erectile dysfunction Oligomenorrhea or amenorrhea Less common Cerebral edema, orthostatic hypotension (after IM injection), tachycardia Agitation, anxiety, depression, dizziness, euphoria, headache, insomnia, poikilothermia, restlessness, weakness Anorexia, constipation, dyspepsia, ileus Lens opacities (prolonged use) Uncommon ECG changes Photosensitivity Pruritus Galactorrhea Ejaculatory disorder Diarrhea Blood dyscrasia Rare Seizure Priapism Cholestatic jaundice Black Box Warnings Patients with dementia-related psychosis who are treated with antipsychotic drugs are at increased risk for death, as shown in short-term controlled trials; deaths in these trials appeared to be either cardiovascular (eg, heart failure, sudden death) or infectious (eg, pneumonia) in nature This drug is not approved for treatment of patients with dementia-related psychosisContraindications Hypersensitivity to phenothiazines Coma, severe hypotension, severe central nervous system (CNS) depression, concurrent administration of large amounts of CNS depressants, subcortical brain damage, poorly controlled seizure disorder Severe cardiovascular disease Lactation Cautions Avoid using in children with suspected Reye syndrome Use caution in glaucoma, prostatic hypertrophy, stenosing peptic ulcer disease (PUD), history of NMS, Parkinson disease, hypocalcemia, renal or hepatic impairment, history of severe reaction to insulin or electroconvulsive therapy (ECT), history of seizures, asthma, respiratory tract infection, cardiovascular disease, myelosuppression Risk of extrapyramidal symptoms (EPS), NMS, hypotension Significant hypotension may occur, especially with parenteral administration; hypotension may be particularly severe in patients with pheochromocytoma or mitral insufficiency; in case of severe hypotension, treat with norepinephrine or phenylepinephrine, and do not use epinephrine or dopamine May alter cardiac conduction; life threatening arrhythmias reported with therapeutic doses of phenothiazines; may cause QT prolongation and subsequent torsade de pointes; avoid use in patients diagnosed or suspected congenital long QT syndrome May cause anticholinergic effects; use caution in patients with paralytic ileus, gastrointestinal motility, urinary retention, xerostomia, or visual problems Agranulocytosis, leukopenia, and neutropenia reported with antipsychotic use; periodic blood count assessment recommended in patients with history of risk factors, including history of drug-induced leuko/neutropenia or preexisting low WBC Esophageal dysmotility and aspiration reported with antipsychotic use; use caution in patients at risk of pneumonia May cause extrapyramidal symptoms, including akathisia, acute dystonic reactions, and pseudoparkinsonism, and tardive dyskinesia; risk of dystonia greater with increased doses Therapy is associated with increased prolactin levels; significance unknown May cause pigmentary retinopathy, and lenticular and corneal deposits with prolonged therapy May cause orthostatic hypotension; use caution in patients with risk factors, including patients who do not tolerate transient hypotensive episodes such as hypovolemia, cerebrovascular disease, cardiovascular disease, or medicatioin predisposing to hypotension/bradycardia May impair physical or mental abilities due to sedating properties;