Adult Dosing
Severe nausea and vomiting
- Intramuscular:
- 5-10 mg IM q3-4 hr
- Max: 10 mg/dose, 40 mg/day
- Intravenous:
- 2.5-10 mg IV q3-5 hr
- Max: 10 mg/dose, 40 mg/day
Prevention of postoperative nausea/vomiting
- Intramuscular:
- 5-10 mg IM x1; administer 1-2 hrs before induction of anesthesia or for controlling acute symptoms during and after surgery; may repeat q30 mins x1 if necessary
- Max: 10 mg/dose, 40 mg/day
- Intravenous:
- 5-10 mg IV x1; administer 15-30 mins before induction of anesthesia, or to control acute symptoms during or after surgery; may repeat once if necessary
- Max: 10 mg/dose, 40 mg/day
Schizophrenia
- Start: 5-10 mg IM; if needed, repeat q2-4 hrs for acute, severe agitation
- Max: 150 mg/day
- Dose of 10-20 mg q4-6 hrs may be seldom required
Pediatric Dosing
Severe nausea and vomiting
- <20 lbs, 2 yrs: Avoid use
- Calculate dose based on 0.06 mg/lb of body weight for IM use
Schizophrenia
- <12 yrs: Calculate each dose on the basis of 0.06 mg/lb of body weight for IM dose
Note: Switch the patient to an oral form of the drug at the same dosage level or higher on achieving control
[Outline]
- Elderly patients with dementia-related psychosis are at an increased risk of death when treated with antipsychotic drugs [US Black Box Warning]
- This drug is not approved for the treatment of patients with dementia-related psychosis [US Black Box Warning]
- Risk of developing irreversible tardive dyskinesia increases as the duration of treatment and the total cumulative dose of antipsychotic drugs administered to the patient increases. Elderly women are more prone to syndrome of potentially irreversible, involuntary, dyskinetic movements. Syndrome may remit, partially or completely, if antipsychotic treatment is withdrawn
- Prescribe this drug in a manner that is most likely to minimize the risk of tardive dyskinesia. Discontinue therapy on occurrence of signs and symptoms of tardive dyskinesia. Periodically reassessed need for continued treatment
- Orthostatic hypotension associated with dizziness, tachycardia, bradycardia, and in some patients syncope, has occurred, especially during initial dose titration
- A potentially fatal symptom complex sometimes referred to as neuroleptic malignant syndrome (NMS) has occurred in association with administration of antipsychotic drugs. Manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status, and evidence of autonomic instability. Additional signs including elevated creatinine phosphokinase, myoglobinuria (rhabdomyolysis), and acute renal failure have occurred
- Carefully evaluate patients for serious medical illness (e.g. pneumonia, systemic infection, etc.), untreated or inadequately treated extrapyramidal signs and symptoms, central anticholinergic toxicity, drug fever, and primary central nervous system pathology
- Immediately discontinue antipsychotic drugs and other drugs not essential for concomitant therapy, provide intensive symptomatic treatment, carefully monitor patients and provide treatment for concomitant serious medical problems for management of NMS
- Carefully consider potential reintroduction of drug therapy in patients recovered from NMS as recurrences of NMS can occur
- An encephalopathic syndrome may occur in patients treated with lithium plus an antipsychotic. In some instances, irreversible brain damage may follow this syndrome. Closely monitor patients receiving such combined therapy for early evidence of neurologic toxicity and promptly discontinue therapy if such signs appear
- Avoid administration of this drug in patients with bone marrow depression or in those who have previously demonstrated a hypersensitivity reaction unless in the judgment of the physician the potential benefits of treatment outweigh the possible hazards
- This drug may impair mental and/or physical abilities, especially during the first few days of therapy; caution patients about activities requiring alertness (e.g., operating vehicles or machinery)
- This drug is associated with intensifying or prolonging the action of CNS depressants (e.g., alcohol, anesthetics, narcotics
- Safety of the use of prochlorperazine during pregnancy has not been established
- The antiemetic action of this drug masks the signs and symptoms of overdosage of other drugs and obscures the diagnosis and treatment of other conditions such as intestinal obstruction, brain tumors and Reye’s syndrome
- On occurrence of hypotension, place the patient in head-low position with legs raised. Avoid using other pressor agents, including epinephrine as they may cause a paradoxical further lowering of blood pressure
- Aspiration of vomitus has occurred in a few postsurgical patients who have received prochlorperazine as an antiemetic
- Deep sleep, from which patients can be aroused, and coma may occur on overdosage
- Elevations of prolactin levels are associated with this drug. Galactorrhea, amenorrhea, gynecomastia and impotence have also occurred in patients
- Effect of oral anticoagulants may be diminished by the use of phenothiazines
- This drug can produce alpha-adrenergic blockade
- Thiazide diuretics accentuate the orthostatic hypotension that occurres due to phenothiazines
- Antihypertensive effects of guanethidine and related compounds are counteracted when phenothiazines are used concomitantly
- Periodically evaluate patients with a history of long-term therapy with prochlorperazine and/or other antipsychotics to decide whether the maintenance dosage could be lowered or drug therapy discontinued
- Children with acute illnesses (e.g., chickenpox, CNS infections, measles, gastroenteritis) or dehydration are more susceptible to neuromuscular reactions, particularly dystonias, then are adults. In such patients, use the drug only under close supervision
- Avoid using this drug with metrizamide
- Discontinue this drug at least 48 hrs before myelography, avoid resuming for at least 24 hrs post-procedure, and avoid using for the control of nausea and vomiting occurring either prior to myelography with metrizamide or post-procedure
- Leukopenia, neutropenia, and agranulocytosis have occurred with antipsychotics. Frequently monitor complete blood count (CBC) during the first few months of therapy in patients having a history of a clinically significant low white blood cell count (WBC) or drug-induced leukopenia/neutropenia. Consider discontinuation of therapy at the first sign of a clinically significant decline in WBC in the absence of other causative factors
Cautions: Use cautiously in
- Patients with dementia
- Seizure disorder
- Use of CNS depressants
- Cardiovascular disease
- Use of oral anticoagulants
- Glaucoma
- History of drug induced leukopenia or neutropenia
- Leukopenia
- High environmental temperature
- Pediatric patients
- Adolescent
- Elderly patients
Pregnancy Category:C
Breastfeeding: Based on minimal excretion of other phenothiazine derivatives, short term use for the treatment of nausea and vomiting poses little risk to breastfed infants. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 28 April 2011). Manufacturer advises caution.
US Trade Name(s)
US Availability
prochlorperazine (generic)
Canadian Trade Name(s)
Canadian Availability
prochlorperazine (generic)
UK Trade Name(s)
UK Availability
prochlorperazine (generic)
- INJ: 12.5 mg/mL (1, 2 mL amp)
Stemetil
Australian Trade Name(s)
Australian Availability
Stemetil
[Outline]