Intervention Review

Cessation of medication for people with schizophrenia already stable on chlorpromazine

  1. Muhammad Qutayba Almerie1,*,
  2. Hassan Alkhateeb2,
  3. Adib Essali3,
  4. Hosam E Matar4,
  5. Emtithal Rezk5

Editorial Group: Cochrane Schizophrenia Group

Published Online: 24 JAN 2007

Assessed as up-to-date: 26 JUN 2009

DOI: 10.1002/14651858.CD006329


How to Cite

Almerie MQ, Alkhateeb H, Essali A, Matar HE, Rezk E. Cessation of medication for people with schizophrenia already stable on chlorpromazine. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD006329. DOI: 10.1002/14651858.CD006329.

Author Information

  1. 1

    Leeds Teaching Hospitals NHS Trust, Department of General Surgery, Leeds, UK

  2. 2

    Damascus University, Damascus, Syrian Arab Republic

  3. 3

    Modern Psychiatry Hospital, Psychiatry Centre, Damascus, Syrian Arab Republic

  4. 4

    Northern General Hospital, Department of Trauma and Orthopaedics, Sheffield, UK

  5. 5

    Al-Mowasat Hospital, Infectious Diseases Department, Damascus, Syrian Arab Republic

*Muhammad Qutayba Almerie, Department of General Surgery, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK. qalmerie@doctors.org.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 24 JAN 2007

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary

Background

Chlorpromazine, one of the first generation of antipsychotic drugs, is effective in the treatment of schizophrenia. For most people schizophrenia is a life-long disorder but about a quarter of those who have a first psychotic breakdown do not go on to experience further breakdowns. Most people with schizophrenia are prescribed antipsychotic drugs, although use is often intermittent. The effects of stopping medication are not well researched in the context of systematic reviews.

Objectives

To quantify the effects of stopping chlorpromazine for people with schizophrenia stable on this drug.

Search methods

We supplemented an electronic search of the Cochrane Schizophrenia Group Trials Register (March 2006 and July 2012) with reference searching of all identified studies.

Selection criteria

We included all relevant randomised clinical trials.

Data collection and analysis

We independently inspected citations and abstracts, ordered papers and re-inspected and quality assessed these. We independently extracted data and resolved disputes during regular meetings. We analysed dichotomous data using fixed effects relative risk (RR) and the 95% confidence interval (CI). For continuous data, where possible, we calculated the weighted mean difference (WMD). We excluded the data where more than 40% of people were lost to follow up.

Main results

We included ten trials involving 1042 people with schizophrenia stable on chlorpromazine. Even in the short term, those who remained on chlorpromazine were less likely to experience a relapse compared to people who stopped taking chlorpromazine (n=376, 3 RCTs, RR 6.76 CI 3.37 to 13.54, NNH NNH 4 CI 2 to 8). Medium term (n=850, 6 RCTs, RR 4.04 CI 2.81 to 5.8, NNH 4 CI 3 to 7) and long term data were similar (n=510, 3 RCTs, RR 1.70 CI 1.44 to 2.01, NNH 4 CI 3 to 6). People allocated to chlorpromazine withdrawal were not significantly more likely to stay in the study compared with those continuing chlorpromazine treatment (n=374, 1 RCT, RR 1.14 CI 0.55 to 2.35). In sensitivity analyses, there was a significant difference in the 'relapse' outcome between trials for those diagnosed according to checklist criteria compared to those with a clinical diagnosis.

Authors' conclusions

This review confirms clinical experience and quantifies the risks of stopping chlorpromazine medication for a group of people with schizophrenia who are stable on this drug. With its moderate adverse effects, chlorpromazine is likely to remain one of the most widely prescribed treatments for schizophrenia.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary

Cessation of medication for people with schizophrenia already stable on chlorpromazine

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.