The use of chlorpromazine for symptom control in dying cancer patients

Terminal restlessness is a significant problem in deaths from advanced cancer, it is difficult not only for patients, but for family and health-care providers also. Chlorpromazine is an antipsychotic phenothiazine, safe at high doses and by many routes. It has also been used as an adjunct to morphine in advanced cancer. We have conducted a study using chlorpromazine in 20 patients, in which the drug was administered intravenously (i.v.) or rectally (PR) in inpatients and outpatients for terminal restlessness and dyspnea. The median PR dose was 25 mg every 4-12 hr. The median IV dose was 12.5 mg every 4-12 hr. Eighteen patients had complete relief and two had partial relief before death. We find chlorpromazine safe and effective for the relief of terminal restlessness and dyspnea in advanced cancer.