Chlorpromazine for schizophrenia: a Cochrane systematic review of 50 years of randomised controlled trialsReport as inadecuate

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BMC Medicine

, 3:15

First Online: 17 October 2005Received: 16 May 2005Accepted: 17 October 2005DOI: 10.1186-1741-7015-3-15

Cite this article as: Adams, C.E., Rathbone, J., Thornley, B. et al. BMC Med 2005 3: 15. doi:10.1186-1741-7015-3-15


BackgroundChlorpromazine CPZ remains one of the most common drugs used for people with schizophrenia worldwide, and a benchmark against which other treatments can be evaluated. Quantitative reviews are rare; this one evaluates the effects of chlorpromazine in the treatment of schizophrenia in comparison with placebo.

MethodsWe sought all relevant randomised controlled trials RCT comparing chlorpromazine to placebo by electronic and reference searching, and by contacting trial authors and the pharmaceutical industry. Data were extracted from selected trials and, where possible, synthesised and random effects relative risk RR, the number needed to treat NNT and their 95% confidence intervals CI calculated.

ResultsFifty RCTs from 1955–2000 were included with 5276 people randomised to CPZ or placebo. They constitute 2008 person-years spent in trials. Meta-analysis of these trials showed that chlorpromazine promotes a global improvement n = 1121, 13 RCTs, RR 0.76 CI 0.7 to 0.9, NNT 7 CI 5 to 10, although a considerable placebo response is also seen. People allocated to chlorpromazine tended not to leave trials early in both the short n = 945, 16 RCTs, RR 0.74 CI 0.5 to 1.1 and medium term n = 1861, 25 RCTs, RR 0.79 CI 0.6 to 1.1. There were, however, many adverse effects. Chlorpromazine is sedating n = 1242, 18 RCTs, RR 2.3 CI 1.7 to 3.1, NNH 6 CI 5 to 8, increases a person-s chances of experiencing acute movement disorders, Parkinsonism and causes low blood pressure with dizziness and dry mouth.

ConclusionIt is understandable why the World Health Organization WHO have endorsed and included chlorpromazine in their list of essential drugs for use in schizophrenia. Low- and middle-income countries may have more complete evidence upon which to base their practice compared with richer nations using recent innovations.

Electronic supplementary materialThe online version of this article doi:10.1186-1741-7015-3-15 contains supplementary material, which is available to authorized users.

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Author: Clive Elliott Adams - John Rathbone - Ben Thornley - Mike Clarke - Jo Borrill - Kristian Wahlbeck - A George Awad


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