ORIGINAL ARTICLE   

Journal of Neurosurgical Sciences 2019 June;63(3):265-9

DOI: 10.23736/S0390-5616.19.04665-4

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Low dose concomitant treatment with chlorpromazine and promethazine is safe in acute ischemic stroke

Haomeng ZHU ^{1, 2}, Ankush CHANDRA ³, Xiaokun GENG ^{1, 2, 3} ✉, Zhe CHENG ^{1, 2}, Yanna TONG ^{1, 2}, Huishan DU ^{1, 2}, Yuchuan DING ^{3, 4}

¹ Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China; ² China-America Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical University, Beijing, China; ³ Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA; ⁴ John D. Dingell VA Medical Center, Detroit, MI, USA

BACKGROUND: Acute ischemic stroke (AIS) is associated with significant morbidity and mortality and has a very narrow window of treatment with fibrinolytics. We investigated the safety and efficacy of combined chlorpromazine and promethazine (C+P) treatment in AIS.
METHODS: A total of 64 consecutive patients diagnosed with AIS were selected and were randomly (double-blind) assigned into either the control group (standard of care [SOC] treatment) or the treatment group (SOC+C+P [12.5+12.5 mg BID or 25+25 mg BID]) which were treated for 2 weeks. The National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (mRS) were computed prior to and after treatment to evaluate neurological deficits and daily functional status.
RESULTS: In our study, 64 patients (males=81.3%) were divided into either the control (34 patients, 83.3% males, mean age=58.8±11.7 years) or the study group (30 patients, 79.4% males, mean age=62.3±9.1 years). While the NIHSS scores were not different between the control and treatment group at admission (P>0.05), a greater proportion of the cohort in both the groups (control group low NIHSS=79.4%, high NIHSS=20.6%, P<0.01) had a lower NIHSS at admission and (treatment group low NIHSS=83.3%, high NIHSS=16.7%, P<0.01). Interestingly, while both the control and treatment group had lower NIHSS and mRS scores at 90d post treatment compared to those at baseline, there were no significant differences in those scores between the two group (P>0.05) suggesting no improved benefit with C+P. Moreover, using C+P did not lead to any serious adverse effects when compared to the treatment group.
CONCLUSIONS: While the addition of low dose chlorpromazine and promethazine to standard of care for acute ischemic stroke did not have any significant improvement in functional outcomes, there were no serious adverse effects. Thus, the use of chlorpromazine and promethazine in the acute ischemic stroke setting and future studies using higher doses of C+P are justified.

KEY WORDS: Ischemia - Stroke - Chlorpromazine - Promethazine - Neuroprotective agents