Effects of mode of management on plasma chlorpromazine in psychiatric patients

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Abstract
Gas liquid chromatography (GLC) assay for plasma chlorpromazine was developed to maximize recovery, accuracy, sensitivity, and reproducibility. Plasma levels of chlorpromazine were monitored in psychiatric patients weekly for 6 weeks, at 0, 2, 3, and 4 hours after a prescribed dose of chlorpromazine. Weekly clinical evaluation was made with the Brief Psychiatric Rating Scale. The study suggests that schizophrenic patients with negligible plasma levels of chlorpromazine (less than 30 ng per milliliter) are not likely to improve clinically. Most patients who showed significant clinical improvement achieved high plasma levels (150 to 300 ng per milliliter or greater). Those who manifested toxiCity in the form of tremors and convulsicYns were shown to have very high plasma levels (750 to 1,000 ng per milliliter). A factor in patients who did not achieve adequate plasma levels despite moderate doses of chlorpromazine was the administration of trihexyphenidyl. Interpatient and intrapatient data suggest that trihexyphenidyl tends to lower plasma levels of chlorpromazine.

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