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Chlorpromazine was the first medicine specifically developed to treat psychoses as it helps people to feel less anxious, tense or angry. This review systematically examines the evidence to see how effective chlorpromazine is at reducing aggression or agitation due to psychosis. From the evidence available, we are unable to draw any firm conclusion about using this medicine for this purpose. We found that chlorpromazine was just as effective at reducing aggression or agitation due to psychosis as similar medicines, but that it may be associated with more side effects than other medicines. Further research is needed to clarify whether chlorpromazine is effective at reducing psychosis induced aggression or agitation. Such research would be best carried out using carefully designed clinical trials.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

The course of schizophrenia can be varied with some people experiencing a single episode of psychosis while others suffer repeated episodes. Often people with schizophrenia want to stop treatment with chlorpromazine once symptoms have subsided. This review highlights the risks of stopping chlorpromazine for those with established illness. Halting medication with chlorpromazine increases the risk of relapse over all time periods. Relapses are damaging and can be dangerous.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

The aim of this review was to find good quality evidence for comparing the efficacy of chlorpromazine versus metiapine for schizophrenia.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: March 25, 2017

People with schizophrenia often hear voices or see things (hallucinations) and have strange beliefs (delusions). The main treatment for people with these symptoms of schizophrenia is antipsychotic drugs. Chlorpromazine was one of the first drugs discovered to be effective for treating people with schizophrenia. It remains one of the most commonly used and inexpensive treatments. However, being an older drug (typical or first generation) it also has serious side effects, including blurred vision, a dry mouth, tremors or uncontrollable shaking, depression, muscle stiffness and restlessness.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Schizophrenia can be a long‐term, chronic illness with a worldwide lifetime prevalence of about one per cent. The most common treatment of this condition is using antipsychotics. In the developed world there is a large choice of antipsychotics including some that are quite expensive, whereas in the developing world the older and cheaper drugs such as haloperidol and chlorpromazine are still used for the majority of the people. In addition, most new medications are tested for their effectiveness against haloperidol or chlorpromazine. This review looks at clinical trials comparing people with schizophrenia who have been treated with either chlorpromazine or haloperidol, in tablet form or as injection into muscle but not by long acting injection. There were 14 trials identified containing a total of 794 people. The trials varied in length from ‘several hours’ to 36 weeks but only two were six months or longer. The most recent trial was published in 1994, and the earliest 1962. As diagnosis of schizophrenia has changed over the years, some people in the early trials may have diagnoses other than schizophrenia by today’s criteria.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Is there historical evidence that the very first antipsychotic drug (reserpine) ‐ which is now very rarely used ‐ is effective compared with an antipsychotic drug that has stayed in use for over 60 years (chlorpromazine).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

For previous plain language summary please see Appendix 3.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

The aim of this review was to find good quality evidence comparing the efficacy of chlorpromazine versus clotiapine for schizophrenia.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: April 7, 2017

This review looks at the best dose of chlorpromazine for treating people with schizophrenia.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: April 13, 2017

Flupenthixol was first made available in the UK in 1965 and it has been used to treat schizophrenia for nearly five decades. It is available both as a tablet and a long‐acting injection. Having been investigated in numerous studies, flupenthixol was found to be effective and well tolerated by people with schizophrenia. The main side effects are shaking, restlessness or the inability to sit still, a dry mouth and some weight gain. Although this drug has been available for decades, few systematic reviews exist on flupenthixol. The effects of this drug in helping people cope with the symptoms of schizophrenia are not currently measured, quantified and known. The review could include only one small study, which was limited and 13 years old. The number as well as the quality of the study was low; for the main outcomes of interest the authors could not rate the quality of evidence at all, as the study did not report on the outcomes of interest for the 'Summary of findings' table. Flupenthixol was compared with chlorpromazine. There was no clear difference in efficacy, nor was there clear information on: increasing their use of services; people’s satisfaction with treatment; quality of life; or costs and cost effectiveness. Flupenthixol is widely available and inexpensive. It is perhaps understandable that it remains one of many drugs used for treating people with serious mental illnesses. This is because the use of flupenthixol is based more on clinical experience, and the decisions of psychiatrists are based on large scale research studies and evidence‐based information. The effectiveness and benefits of flupenthixol over chlorpromazine remain largely unknown and incomplete. Large randomised trials could be helpful in increasing knowledge about this drug.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Schizophrenia is a profoundly disabling mental illness affecting thoughts, emotions and behaviour. It has a life time prevalence of about 1%. Antipsychotic medications still remain as the mainstay of treatment for schizophrenia. Antipsychotic medications are classified into typical and atypical subtypes. First generation or typical antipsychotic medications have been the mainstay of treatment for schizophrenia for decades and have been effective in reducing the positive symptoms of schizophrenia, but negative symptoms have been fairly resistant to treatment. With the advent of atypical antipsychotics there has been a surge in prescriptions of the atypical antipsychotic medications in recent years. Levomepromazine is one among these 'older' typical antipsychotic medications. We systematically reviewed the effects of levomepromazine in comparison to other typical and atypical antipsychotic medications for people with schizophrenia and schizophrenia‐like disorders. We were able to include four studies in our systematic review.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Magnesium sulphate performs better than lytic cocktail in preventing maternal deaths, further fits, respiratory depression, coma and pneumonia for pregnant women with eclampsia.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

There are only a few good quality studies comparing the acute treatment of early episode schizophrenia with an antipsychotic medication compared to placebo or psychosocial treatment. It appears that initial medication treatment reduces the study attrition rates while also increasing the risk for medication‐induced side effects. Data are too limited to assess the effects of initial antipsychotic medication treatment on outcomes for individuals with an early episode of schizophrenia.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

There is limited evidence from clinical trials on the role of drug therapy for the treatment of delirium in terminally ill patients. The key feature of delirium is a decreased level of consciousness (awareness). People may experience impaired memory, thinking and judgement, and become disorientated. They may experience distressing hallucinations or delusions. It occurs frequently in patients with terminal illness, and may be caused by the illness itself or occur as a side effect of drug treatments for symptom management. Our search of the international literature for trials of drug therapies for the treatment of delirium in patients with terminal illness yielded one small study, and therefore it was not possible to assess the effectiveness of drug treatment options. It is hoped that this review will provide an incentive for further research.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

When a sedative is needed to ameliorate symptoms in newborn infants with opiate withdrawal due to maternal opiate use in pregnancy, phenobarbitone is preferred. Use of opiates (commonly prescribed methadone or illicit heroin) by pregnant women may result in a withdrawal syndrome in their newborn infants. This may result in disruption of the mother‐infant relationship, sleeping and feeding difficulties, weight loss and seizures. Treatments for newborn infants used to ameliorate these symptoms and reduce complications include opiates, sedatives (phenobarbitone or diazepam) and supportive treatments (swaddling, settling, massage, relaxation baths, pacifiers or waterbeds). Trials of sedatives have generally been of poor quality. Individual studies have reported that use of phenobarbitone compared to supportive care alone reduces the amount time an infant needs supportive care, is better than diazepam at preventing treatment failure and reduces the severity of withdrawal in infants treated with a opiate. In infants treated with an opiate, the addition of a sedative (phenobarbitone or clonidine) may reduce withdrawal severity, although safety and efficacy need confirming. The long term effects of use of phenobarbitone on an infant's development have not been determined.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

As many as three‐quarters of people who receive chemotherapy experience nausea (feeling sick) and vomiting (being sick), which many find distressing. While conventional anti‐sickness medicines are effective, they do not work for everyone, all of the time. Therapeutic drugs based on the active ingredient of cannabis, known as THC (delta‐9‐tetrahydrocannabinol), have been approved for use as anti‐sickness medicines in some countries.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

It is one of the major psychiatric dogmas that the efficacy of all antipsychotic drugs is same. This statement originated from old, narrative reviews on first-generation antipsychotics, but this old literature has never been meta-analysed. We therefore conducted a meta-analysis of randomised controlled trials on the efficacy of chlorpromazine versus any other antipsychotic in the treatment of schizophrenia. If the benchmark drug chlorpromazine were significantly more or less effective than other antipsychotics, the notion of equal efficacy would have to be rejected. We searched the Cochrane Schizophrenia Group׳s specialized register, MEDLINE, EMBASE, PsychInfo and reference lists of relevant articles. The primary outcome was response to treatment. We also analyzed mean values of schizophrenia rating scales at endpoint and drop-out rates. 128, mostly small, RCTs with 10667 participants were included. Chlorpromazine was compared with 43 other antipsychotics and was more efficacious than four (butaperazine, mepazine, oxypertine and reserpine) and less efficacious than other four antipsychotics (clomacran, clozapine, olanzapine and zotepine) in the primary outcome. There were no statistically significant efficacy differences between chlorpromazine and the remaining 28 antipsychotics. The most important finding was that, due to low numbers of participants (median 50, range 8-692), most comparisons were underpowered. Thus we infer that the old antipsychotic drug literature was inconclusive and the claim for equal efficacy of antipsychotics was never evidence-based. Recent meta-analyses on second-generation antipsychotics were in a better position to address this question and small, but consistent differences between drugs were found.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Contemporary analyses demonstrate an early response to antipsychotic treatment in non-refractory schizophrenia. The profile of response to clozapine is unknown. We used meta-analytic and statistical procedures to examine the response profile to clozapine. We identified 19 unique, randomized, double-blind controlled clinical trials with suitable time course data, representing 1745 subjects. Individual subject data were available for 419 subjects, obtained from two industry-sponsored trials. Symptom severity scores from the BPRS or the PANSS were entered into regression analyses to estimate linear and quadratic coefficients of the rate of change of symptom severity over 4 weeks. Both linear and quadratic regression coefficients for clozapine, and for comparator antipsychotics differed significantly from zero (p ≤ 0.001), indicating early response profiles. Compared with other antipsychotic arms, for clozapine the treatment response was greater (d = -0.578, p = 0.021), and the linear coefficient was steeper (d = -0.502, p = 0.042); the quadratic coefficients indicating attenuation did not differ. Analyses of 6-week data and individual subject data from non-refractory and refractory trials were consistent with the primary findings. Somewhat surprisingly, clozapine shows an early response profile, similar in pattern but somewhat larger in magnitude than other antipsychotic drugs.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

To compare individual first-generation antipsychotics (FGAs) with individual second-generation antipsychotics (SGAs) in adults (18 to 64 years) with schizophrenia, schizophrenia-related psychoses, or bipolar disorder, with a focus on core illness symptoms, functional outcomes, health care system utilization, and adverse events.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: August 2012

Study found evidence that some treatments (ginger, vitamin B6, antihistamines, metoclopramide) were better than placebo for mild symptoms of nausea and vomiting in pregnancy (NVP), but there is little on the effectiveness of treatments in more severe NVP/hyperemesis gravidarum.

Health Technology Assessment - NIHR Journals Library.

Version: October 2016

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