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Aminazine (Chlorpromazinum, Chlorpromazine) - hypotensive, antihistaminic, neuroleptic, antiemetic.
Does central adrenergic and dopaminergic interneuron contacts, providing hypothermic effect.
Aminazin is one of the main representatives of neuroleptics (medicines that have an inhibitory effect on the central nervous system and cause sedative effects at normal doses). Despite the emergence of many new neuroleptic drugs, it continues to be widely used in medical practice.
One of the main features of chlorpromazine action on the central nervous system is relatively strong sedative effect (sedative effect on the central nervous system). Increases with increasing doses of chlorpromazine general sedation is accompanied by inhibition of the conditioned reflex activity, and above all the motor-defensive reflexes, decreased spontaneous motor activity and some relaxation of skeletal muscles; comes the state of reduced reactivity to endogenous (internal) and exogenous (external) stimuli; mind, however, remains.
Action anticonvulsants under the influence of chlorpromazine increases, but in some cases, chlorpromazine can cause convulsive effects.
The main features are its antipsychotic chlorpromazine action and ability to influence the emotional sphere of man. With chlorpromazine unable to stop (remove) a different kind of agitation, reduce or completely to stop delusions and hallucinations (delirium, vision, acquiring the nature of reality), to reduce or remove the fear, anxiety, stress in patients with psychoses and neuroses.
An important property of chlorpromazine javjaletsja its blocking effect on central adrenergic and dopaminergic receptors. It reduces or even completely eliminates the increase in blood pressure and other effects caused by adrenaline and Adrenomimeticalkie substances. Hyperglycemic effect of epinephrine (increased blood sugar levels under the influence of adrenaline) chlorpromazine is not removed. Strongly expressed adrenoliticheskoe central action. Blocking effect on the cholinergic receptors expressed relatively weak.
The drug has a strong antiemetic effect and calms the hiccups.
Chlorpromazine has hypothermic (reducing body temperature) effect, especially when artificial cooling of the body. In some cases, patients with parenteral (bypassing the digestive tract) administration of the drug the body temperature rises, due to the influence on the thermoregulatory centers and partly with the local irritant.
The drug also has mild anti-inflammatory properties, reduces the permeability of blood vessels, reduces the activity of kinins and hyaluronidase. It has weak antihistamine effect.
Chlorpromazine increases the effects of hypnotics, narcotic analgesics (pain relievers), mestnoanesteziruyushih substances. It inhibits various interoceptive reflexes.
In psychiatric practice chlorpromazine is used in various states of agitation in patients with schizophrenia (hallucinatory-delusional, hebephrenic, catatonic syndrome), chronic paranoid and hallucinatory-paronoidnyh states, manic excitation in patients with manic-depressive psychosis (psychosis with alternating excitation and depressed mood) , with psychotic disorders in patients with epilepsy, with agitated depression (motor excitation at alarm background and fear) in patients presinilnym (stracheskim), manic-depressive psychosis, as well as other psychiatric disorders and neuroses, accompanied by excitement, fear, insomnia, stress, acute alcoholic psychosis.
Chlorpromazine can be used both independently and in conjunction with other psychotropic drugs (antidepressants, butyrophenone derivatives, etc.).
A feature of the action of chlorpromazine in states of excitation as compared to other antipsychotics (triftazin, haloperidol, etc..) Is pronounced sedative (calming) effect.
In neurological practice chlorpromazine also appointed in cases involving increased muscle tone (after a stroke, and others.). Sometimes it is used for the relief of status epilepticus (after failure of other treatments). Enter it for this purpose, intravenously or intramuscularly. It should be borne in mind that in patients with epilepsy chlorpromazine can cause increased frequency of seizures, but it is usually in the appointment at the same time it enhances the anticonvulsant action of the latter.
Effective use of chlorpromazine combined with analgesics for persistent pain, including in causalgia (burning pain during intense peripheral nerve damage), and with drugs and tranquillizers (sedatives) with persistent insomnia.
As an antiemetic used chlorpromazine sometimes vomiting during pregnancy, Meniere's disease (disease of the inner ear), in oncology practice - in the treatment of derivatives of bis (beta-chloroethyl) amine and other chemotherapeutic agents, radiation therapy. In the clinic of skin diseases with itching dermatosis (skin diseases) and other diseases.
Aminazin is contraindicated in patients with lesions of the liver (cirrhosis, hepatitis, hemolytic jaundice, etc..), Kidneys (nephritis); violation of blood-forming organs function, myxedema (a sharp decrease in the function of the thyroid gland, accompanied by edema), progressive systemic diseases of the brain and spinal cord, decompensated heart diseases, thromboembolic disease (blockage of blood vessels clot). Relative contraindications are cholelithiasis, urolithiasis, acute pyelitis (inflammation of the renal pelvis), rheumatic fever, rheumatic heart disease. In gastric ulcer and duodenal ulcers should not be administered chlorpromazine administration (intramuscular injection). Not prescribed chlorpromazine persons in a comatose (unconscious) state, including in cases related to the reception of barbiturates, alcohol, drugs. It is necessary to monitor blood picture, including the determination of the prothrombin index, examine the liver and kidneys. Do not use chlorpromazine to treat agitation in acute brain injury. Do not assign pregnant chlorpromazine.
Assign chlorpromazine inside (in the form of pills), intramuscularly or intravenously (as a 2.5% solution). For parenteral (bypassing the digestive tract) the introduction of the effect is faster and more pronounced. Inside the drug recommended for use after meals (to reduce the irritant effect on the gastric mucosa). If intramuscular administration of chlorpromazine to the required amount of solution was added 5.2 ml of 0.25% -0.5% solution of novocaine or isotonic sodium chloride solution. The solution is injected deep into the muscle (in the upper outer quadrant of the buttock or thigh naruzhnobokovuyu). Intramuscular injection produced no more than 3 times a day. For intravenous required amount of chlorpromazine solution diluted in 10-20 ml of a 5% (sometimes 20-40%) glucose solution or isotonic sodium chloride solution administered slowly (over 5 min).
Chlorpromazine doses depend on the method of administration, the indication and the age and condition of the patient. The most convenient and widespread yaatyaetsya receiving chlorpromazine inside.
In the treatment of mental disorders the initial dose is typically 0,025-0,075 g per day (reception 1-2-3), and then gradually increased to a daily dose of 0.3-0.6 g in some cases, the daily dose received inside reaches 0 , 7-1 g (especially in patients with chronic disease and psychomotor agitation). The daily dose in the treatment of large doses divided into 4 parts (reception in the morning, afternoon, evening and night). Duration of treatment with high doses should not exceed 1-1.5 months., with little effect it is advisable to go to the treatment of other drugs. Prolonged treatment with chlorpromazine one currently held relatively rare. Often combined with chlorpromazine triftazinom, haloperidol and other drugs.
When should not normally be administered intramuscularly daily dose of chlorpromazine than 0.6 is reached, the effect on the admission of the drug inside.
By the end of chlorpromazine treatment, which can last from 3-4 weeks. up to 3-4 months. or longer, the dose is gradually reduced to 0,025-0.075 grams per day. Patients with chronic diseases prescribed long-term maintenance therapy.
When states expressed agitation initial dose by intramuscular administration is generally 0.1-015 g for emergency relief of acute excitement chlorpromazine may be administered into a vein. For this purpose, 1 or 2 ml of 2.5% solution (25-50 mg) chlorpromazine diluted in 20 ml of 5% or 40% glucose solution. If necessary to increase the dosage of chlorpromazine 4 ml of 2.5% solution (in 40 ml of glucose solution). Enter slowly.
In acute alcoholic psychosis appoint 0.2-0.4 g per day of chlorpromazine intramuscularly and inside. If the effect is insufficient, intravenous 0,05-0,075 g (often in conjunction with Tisercinum).
Higher doses for adults inside: single - 0.3 grams daily - 1,5 g; intramuscularly: single - 0.15 g daily - 1 g; IV: single - 0.1 g daily - 0.25 g
Babies chlorpromazine administered in smaller doses: depending on the age of 0.15-0.2 to 0.01-0.02 g per day. Weak and elderly patients -up to 0.3 grams per day.
For the treatment of diseases of the internal organs, skin and other diseases chlorpromazine administered in lower doses than in psychiatric practice (0.025 g, 3-4 times a day for adults, children older - 0.01 g per dose).
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