This patient had received antihypertensive therapy, which was followed by severe acute hypertension (300/260 mmHg), due to inadequate ventilation after anesthesia. Acute hypertensive treatment was performed successfully by lowering blood pressure with chlorpromazine, 25 mg and valium, 10 mg by intravenous injection, with intermittent positive pressure breathing.
Anesthesia ; Blood Pressure ; Chlorpromazine ; Diazepam ; Humans ; Hypertension ; Injections, Intravenous ; Intermittent Positive-Pressure Breathing ; Postoperative Period* ; Ventilation

In a placebo-controlled trial, we have studied the vasodilator properties of bolus dose of nitroglycerin, isosorbide dinitrate and chlorpromazine in 38 patients during cardiopulmonary bypass with a constant pump flow. Mean arterial pressure and blood volume of the venous reservoir were recorded for 10 min after drug administration to detect changes in arteriolar resistance and venous capacitance, respectively. Nitroglycerin, 2.5 ug/kg, decreased arterial pressure, but the effect lasted for 3 minutes. Chlorpromazine, 0.1 mg/kg, decreased arterial pressure for 9 minutes. Isosorbide dinitrate, 20 ug/kg, had no significant change on arterial pressure. The venous capacitance-increasing effects of nitroglycerin and chlorpromazine were significant for 4 minutes after the bolus. Thereafter the effect of nitroglycerin began to decline, while that of chlorpromazine significantly continued. Isosorbide dinitrate had no significant change on venous reservoir level. The SVR reduction effects of nitroglycerin was significant for 3 minutes, chlorpromazine decreased SVR for over 10 minutes. In conclusion chlorpromazine effect on arterial pressure and venous capacitance was more potent and longer than nitroglycerin and isosorbide dinitrate. Nitroglycerin and chlorpromazine effect on preload and afterload were significant after bolus dose.
Arterial Pressure ; Blood Volume ; Cardiopulmonary Bypass ; Chlorpromazine* ; Humans ; Isosorbide Dinitrate* ; Isosorbide* ; Nitroglycerin* ; Vascular Access Devices

OBJECTIVE: To develop a method to measure trihexyphenidyl, chlorpromazine and clozapine in human blood with GC-MS. METHODS: The specimens were alkalized (pH > 10) and extracted with V (benzene):V(ethyl acetate) = 1:1, and qualitatively analyzed using GC-MS-Full Scan with internal standard SKF525A. The specimens were alkalized (pH > 10) and extracted with V(benzene):V(ethyl acetate) = 1:1, and quantitatively analyzed using GC-MS-SIM with internal standard diazepam-d5. RESULTS: The lowest detection limits of trihexyphenidyl, chlorpromazine and clozapine were 0.3, 0.3 and 0.7 ng/mL (S/N > or = 3) respectively. The calibration curve in 20-10 000 ng/mL showed a good linear distribution. The recovery rate was 79.9% to 85.5%. The RSDs of intraday and interday were less than 5.1%. CONCLUSION The established method was simple, sensitive and accurate for simultaneous determination of trihexyphenidyl, chlorpromazine and clozapine in human blood, and can be applied in forensic toxicological cases.
Adult ; Antipsychotic Agents/poisoning* ; Chlorpromazine/blood* ; Clozapine/blood* ; Female ; Forensic Toxicology ; Gas Chromatography-Mass Spectrometry/methods* ; Humans ; Hydrogen-Ion Concentration ; Male ; Middle Aged ; Reproducibility of Results ; Sensitivity and Specificity ; Solvents/chemistry* ; Trihexyphenidyl/blood*

OBJECTIVE: Weight gain and DM can be serious side effects in the use of atypical antipsychotics (AAP), although conventional antipsychotics (CAP) have also been implicated. Also weight gain & DM are the adverse effects that are often associated with noncompliance and medical problems. The relationship between weight gain, dyslipidemia and DM is well established. Patients with schizophrenia are not only at risk of DM, but also taking antipsychotic medication further increases the chance of developing non-insulin-dependent hyperglycemia. Thus, this pilot study was conducted to investigate the risk of hyperlipidemia & DM in Korean patients taking antipsychotic medications. METHODS: After receiving informed consent, demographic data and history of medication were collected from medical records of 174 inpatients (92 male, 82 female). For the laboratory tests blood sampling was done at 7 A.M. before the meal and medication. RESULTS: For all subjects, the mean age was 41.10+/-9.56 years (range 14-65 years); 88% were diagnosed with schizophrenia. Of these, 55% were treated with antipsychotics alone (Monotherapy) and 45% were treated with combination therapy (such as antipsychotics plus a mood stabilizer). The mean age of onset of illness was 24.8+/-47.25 years old and mean duration of admission was 45.44+/-133.84 months. In the monotherapy group, the duration & dosage of each medications were 42.1+/-60.5 weeks and 12.2+/-8.22 mg/day of haloperidol (N=35), 6.95+/-9.52 weeks & 5.03+/-1.88 mg/day of risperidone (N=19), 9.1+/-11.1 weeks & 13.9+/-6.5 mg/day of olanzapine (N=8), 10.2+/-6.3 weeks and 287.6+/-62.9 mg/day of lodopine (N=4), 15.7+/-9.54 weeks and 335+/-172.8 mg/day of clozapine (N=5), 20+/-22.23 & 620+/-265.9 mg/day of chlorpromazine (CPZ; N=5). Mean weight gains of CAP group and AAP group, which was divided by the main therapeutic drug, were 0.18+/-5.99 and 2.18+/-6.38 kg in total subjects, however, there was no statistical significance between the groups. Moreover, there was no statistically significant difference in weight gain between groups when comparing each individual monotherapy (haloperidol, risperidone, olanzapine, lodopine, clozapine, CPZ: ANOVA; df=5, f=1.12, p=0.35). In the laboratory test results of total subjects abnormality of total cholesterol was 23.6%, triglyceride was 50.6%, fasting blood sugar (FBS) 1.7%, hemoglobin A1c (HbA1c) 27.6%, insulin 3.4%. There were statistical significances of correlations between HbA1c & FBS (r=0.489, p<0.01), total cholesterol (r=0.286, p<0.01), low density lipid (LDL; r=0.299, p<0.01) and triglyceride (TG; r=0.277, p<0.05), high density lipid (HDL; r= -0.192, p<0.05), original weight (r=0.154, p<0.05). With ANOVA for the evaluations of drug effect in monotherapy groups, the level of ALT (SGPT; p=0.04) was higher in olanzapine group, TG was higher in clozapine & CPZ group (p=0.03). HDL was lower in lodopine, clozapine & CPZ group (p=0.01). LDLwas highr in olanzapine & lodopine group (p=0.01). Abnormalities of ALT in olanzapine & clozapine group were 37.5% & 40%, those were statistically significant (p=0.02). Although there was no statistical significance (p=0.05), clozapine (60%), CPZ (60%) & olanzapine (37.5%) groups revealed more abundant abnormalities than haloperidol (11.4%) & risperidone (21%) groups in total cholesterol. CPZ (100%), clozapine (80%), lodopine (75%), olanzapine (75%) groups revealed more abundant abnormalities than haloperidol (48.6%) & risperidone (57.9%) groups in TG, however, there was no statistical significance. And the abnormality of HbA1c was 62.5% in olanzapine group and 40% in CPZ group, those were more abundant than other groups (20-25.1%), even though no statistical significance. CONCLUSION: In the cases of Korean patients taking antipsychotic medication, the tentative risk rate of hyperlipidemia might be 18.3% and hyperglycemia might be 27.6%. CPZ, clozapine and olanzapine, as compared with haloperidol and risperidone, may be associated with more adverse changes in total cholesterol and TG. Olanzapine and CPZ, as compared with haloperidol, risperidone and clozapine, may be more risky in the development of hyperglycemia. HbA1c may be an indicator to detect the risk of hyperlipidemia and hyperglycemia in patients taking antipsychotic medications.
Age of Onset ; Antipsychotic Agents* ; Blood Glucose ; Chlorpromazine ; Cholesterol ; Clozapine ; Dyslipidemias ; Fasting ; Haloperidol ; Humans ; Hyperglycemia* ; Hyperlipidemias* ; Informed Consent ; Inpatients ; Insulin ; Male ; Meals ; Medical Records ; Pilot Projects ; Prevalence* ; Risperidone ; Schizophrenia ; Triglycerides ; Weight Gain

Neuroleptic malignant syndrome (NMS), a potentially fatal adverse reaction to neuroleptics, is known to occur more often in the initial stage of antipsychotic treatment. We describe a patient with chronic schizophrenia who, in a few days after the addition of antituberculotic drugs to his antipsychotic regimen, developed probable NMS without pyrexia. We reasoned that rifampin, a strong hepatic enzyme inducer, decreased the plasma chlorpromazine concentration of the patient, with the result of cholinergic hyperactivity and finally, the symptoms of NMS. Therefore, physicians should be aware of drug interactions and the likelihood of NMS, and consider antipsychotic dose adjustment when prescribing drugs that may influence pharmacokinetic properties of antipsychotics in a patient with schizophrenia receiving long-term antipsychotic treatment.
Adult ; Antitubercular Agents/*adverse effects ; Chlorpromazine/*adverse effects ; Creatine Kinase/blood ; Drug Interactions ; Enzyme Induction/drug effects ; Humans ; Male ; Neuroleptic Malignant Syndrome/*etiology ; Rifampin/*adverse effects ; Schizophrenia/*drug therapy