Talk:Chlorpromazine/GA1
GA Review
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Reviewer: Casliber (talk · contribs) 21:39, 6 July 2010 (UTC)
Dang, I meant to improve this article myself sometime. Nevermind, I'll review it. I'll make straightforward changes as I go and try and give it a shove towards FA while I'm at it. I'll jot queries below: Casliber (talk · contribs) 21:39, 6 July 2010 (UTC)
We call it largactil in oz. maybe it is called that elsewhere outside US so would be better in lead?
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Subcutaneous injection is not advised..- intramuscular is a more common way of giving injections like this - we don't do it anyway as it has a highly unpredictable uptake (I am a psychiatrist BTW :))
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Over 100 million people were treated but the popularity of the drug fell from the late 1960s as the severe extrapyramidal side effects and tardive dyskinesia became more of a concern.- issues (1) extrapyramidal side effects and tardive dyskinesia of CPZ are less than other typical antipsychotics, so I am not sure that 'severe' is a good adjective to add. (2) I am not sure whether it was the side effects, but being parlty superseded by thioridazine and later olanzapine were more the issue, and I am not sure if it was the 1960s when its use declined. In any case, this needs checking, citing and expanding. I am intrigued and will look into it if I get a chance. Casliber (talk · contribs) 10:06, 7 July 2010 (UTC)
- I changed this because I don't think it's right. There were several drugs that came shortly after that had worse side effects, like haloperidol, I believe. I think its use declined because other more efficacious drugs were developed. MacDaid (talk) 18:05, 7 July 2010 (UTC)
From chlorpromazine a number of other similar antipsychotics were developed such as triflupromazine and trifluoperazine.- as per previous, needs checking, citing and expanding. Not sure if these are the correct drugs or the only drugs.
- I am not having much luck in finding citations for this or other information that doesn't come from a drug site. MacDaid (talk) 18:05, 7 July 2010 (UTC)
- Have added some [citation needed] tags.
- I have either found citations or removed information that didn't seem supported anywhere. MacDaid (talk) 20:10, 7 July 2010 (UTC)
- The Interactions section has some repetition of material which needs to be streamlined. It is also a bit choppy.
- the Dosage and administration section needs referencing.
- As above, except for drug sites and repeated references to Goodman and Gilman (which a hard-to-read copy is online), there don't seem to be many sources. PMID etc have mostly articles on rats, and old ones at that. I get the feeling this is not a current area of active research. MacDaid (talk) 18:05, 7 July 2010 (UTC)
- The inline refs which use drugs.com need replacing with a proper Review Paper. Some are dubious or misworded - eg. some cases of impaired glucose tolerance may have been reported but this is very rare, especially when compared with some other agents.
- Removed the refs which use drugs.com. Not having luck with replacement citations. Will keep trying. MacDaid (talk) 18:05, 7 July 2010 (UTC)
- Question
Since you are a psychiatrist, perhaps you can comment on some of the specialized sections, such as "Dosage and administration" and "Pharmacology" sections. Some information is sourced to Drugs and behavior: an introduction to behavioral pharmacology and may be general information not specific to chlorpromazine. Is chlorpromazine ever used as a depot medication? (I wouldn't think so, but I don't know.) I removed some information that seemed too general, such as how to dissolve chlorpromazine in oil to prepare it for IM administration. What do you think? MacDaid (talk) 17:55, 8 July 2010 (UTC)
- I have to run but google "CPZE" (I might do this myself a bit later today if I get time) and look at 3rd entry (I can't get up the url as it flicks up into acrobat reader in pdf fromat) - there are some papers detailing the usage of the term -look at the reference section of that paper. Important as CPZ used as scale for other anitpsychotics. Casliber (talk · contribs) 01:47, 9 July 2010 (UTC)
- This:http://pb.rcpsych.org/cgi/reprint/24/4/130.pdf seems to pertain to chlorpromazine equivalents for evaluation of depot antipsychotics rather than to the use of chlorpromazine as a depot medicine itself. Used as a "benchmark". MacDaid (talk) 12:57, 9 July 2010 (UTC)
Update - sorry about delay, got sidetracked. Will look at sections tongiht. Casliber (talk · contribs) 11:51, 16 July 2010 (UTC)
- Chlorpromazine is never used as a depot. The intramuscular injection is highly unreliable and can vary considerably in its potency (as well as being painful), and is almost never used. Intravenous administration can cause a big drop in blood pressure, so never done either. It is often administered as a syrup in hospital as it works a little quicker than tablets and patients can't spit it out as easily (the same issue has been tackled differently by the makers of risperidone and olanzapine, both of which come in wafers which dissolve on the tongue.) Casliber (talk · contribs) 14:12, 17 July 2010 (UTC)
- The dosage section needs rejigging - generally 25 mg is used for hiccups or anxiety. It is usually ineffectual in psychosis though, where people will be on anywhere from 100 mg nocte upwards. In the acutely agitated inpatient, it is often given early on twice or three times daily to take advantage of calming effect through the day, and it may also be used as a PRN medication for agitation (50-100 mg). Once a patient is more settled, one can shift the dosing to all at night before bed, to take advantage of the sedation to get to sleep and minimise its impact on daytime alertness. Higher doses, up to 1200 mg daily or higher were used 30 years ago. Nowadays the dosing is much lower. Need to find a ref for maximum but is rare to see someone above 300 mg daily. Casliber (talk · contribs) 14:28, 17 July 2010 (UTC)
- this is the article needed! I will see if I can get fulltext at work/library. Casliber (talk · contribs) 15:08, 17 July 2010 (UTC)
- adverse effects: not specific to chlopromazine but the cardiovascular risk associated with weight gain might be worth mentioning? http://jap.sagepub.com/content/16/1/21.abstract Richiez (talk) 17:16, 31 July 2010 (UTC)
Additional reviewer
I will let the primary reviewer lead the review.
Compared to the information available elsewhere, this article fails as a good article. Compared with other Wikipedia articles, the standard is lower so it could pass. I caution others not to pat ourselves on the back and be too quick to call this GA. This pains me because I generally like to be positive in Wikipedia. One helpful thing to have would be a review by a pharmacologist. Otherwise it is amateurs reviewing things written by amateurs.
One of many problems is that there is a negative bent to the article. In government package inserts, the possible side effects are near the end. Here, it is in the beginning and also near the end. There is also a lot of negative emphasis. This could be partly fixed by moving sections around but complete repair requires major re-writing.
It is not my intention to oppose GA even though I have doubts about this article. As far as length, though, it's not short. Suomi Finland 2009 (talk) 17:34, 31 July 2010 (UTC)
- I agree with the above. I had ferreted out a couple of papers I am going to add. I have been busy elsewhere. But will work on it too, as well as list out more specific issues. Casliber (talk · contribs) 22:29, 31 July 2010 (UTC)
- Since the article's main editor has since been indefblocked, it is best to fail the article, which I'm going to do. It can be re-nommed after all the issues are fixed, since it looks like it'll be a while until that happens based on the above. Wizardman Operation Big Bear 18:36, 8 August 2010 (UTC)