prochlorperazine

ROUTE	ONSET	PEAK	DURATION
PO	30–40 min	unknown	3–4 hr
Rect	60 min	unknown	3–4 hr
IM	10–20 min	10–30 min	3–4 hr
IV	rapid (min)	10–30 min	3–4 hr

Contraindicated in:

Hypersensitivity;
Cross-sensitivity with other phenothiazines may exist;
Angle-closure glaucoma;
Bone marrow depression;
Severe liver or cardiovascular disease;
Hypersensitivity to bisulfites or benzyl alcohol (some parenteral products);
Pedi: Children 2 yr or 9.1 kg.

Use Cautiously in:

Diabetes mellitus;
Respiratory disease;
Prostatic hypertrophy;
CNS tumors;
Seizure disorder;
Intestinal obstruction;
At risk for falls;
OB: Safety not established in pregnancy;
Lactation: Safety not established in breastfeeding;
Geri: Dose recommended; risk of mortality in older adults treated for dementia-related psychosis.

Adv. Reactions/Side Effects ⬆ ⬇

CV: ECG changes, hypotension, tachycardia

Derm: photosensitivity, pigment changes, rash

EENT: blurred vision, dry eyes, lens opacities

Endo: galactorrhea

GI: constipation, dry mouth, anorexia, hepatitis, ileus

GU: pink or reddish-brown discoloration of urine, urinary retention

Hemat: AGRANULOCYTOSIS, leukopenia

Metab: hyperthermia

Neuro: extrapyramidal reactions, NEUROLEPTIC MALIGNANT SYNDROME, sedation, tardive dyskinesia

Misc: allergic reactions

Interactions ⬆ ⬇

Drug-drug:

Additive hypotension with antihypertensives, nitrates, or acute ingestion of alcohol.
Additive CNS depression with other CNS depressants, including alcohol, antidepressants, antihistamines, opioid analgesics, sedative/hypnotics, or general anesthetics.
Additive anticholinergic effects with other drugs possessing anticholinergic properties, including antihistamines, some antidepressants, atropine, haloperidol, and other phenothiazines.
Lithium↑ risk of extrapyramidal reactions.
May mask early signs of lithium toxicity.
↑risk of agranulocytosis with antithyroid agents.
↓beneficial effects of levodopa.
Antacids may ↓ absorption.

Drug-Natural Products:

Concomitant use of kava-kava, valerian, chamomile, or hops can ↑ CNS depression.
↑anticholinergic effects with angel’s trumpet, jimson weed, and scopolia.

Route/Dosage ⬆ ⬇

Pediatric dose should not exceed 10 mg on the 1st day and then should not exceed 20 mg/day in children 2–5 yr or 25 mg/day in children 6–12 yr
PO (Adults and Children ≥12 yr): 5–10 mg 3–4 times daily (not to exceed 40 mg/day).
PO (Children 18–39 kg): 2.5 mg 3 times daily or 5 mg twice daily (not to exceed 15 mg/day).
PO (Children 14–17 kg): 2.5 mg 2–3 times daily (not to exceed 10 mg/day).
PO (Children 9–13 kg): 2.5 mg 1–2 times daily (not to exceed 7.5 mg/day).
IM (Adults and Children ≥12 yr): 5–10 mg every 3–4 hr as needed. Nausea/vomiting associated with surgery: 5–10 mg; may be repeated once.
IM (Children 2–12 yr): 132 mcg (0.132 mg)/kg; usually only 1 dose is required.
IV (Adults and Children ≥12 yr): 2.5–10 mg (not to exceed 40 mg/day). Nausea/vomiting associated with surgery: 5–10 mg; may be repeated once.
(Adults ): 25 mg twice daily.
(Children 18–39 kg): 2.5 mg 3 times daily or 5 mg twice daily (not to exceed 15 mg/day).
(Children 14–17 kg): 2.5 mg 2–3 times daily (not to exceed 10 mg/day).
(Children 9–13 kg): 2.5 mg 1–2 times daily (not to exceed 7.5 mg/day).

Availability ⬆ ⬇

(Generic available)

Tablets: 5 mg; 10 mg
Solution for injection: 5 mg/mL (edisylate)
Suppositories: 10 mg; 25 mg

Assessment ⬆ ⬇

Monitor BP (sitting, standing, lying down), ECG, pulse, and respiratory rate before and frequently during the period of dosage adjustment. May cause Q-wave and T-wave changes in ECG.
- Assess patient for level of sedation after administration.
- Monitor patient for onset of akathisia (restlessness or desire to keep moving) and extrapyramidal side effects (parkinsonian: difficulty speaking or swallowing, loss of balance control, pill rolling, mask-like face, shuffling gait, rigidity, tremors; and dystonic: muscle spasms, twisting motions, twitching, inability to move eyes, weakness of arms or legs) every 2 mo during therapy and 8–12 wk after therapy has been discontinued. Report these symptoms; reduction in dose or discontinuation may be necessary. Trihexyphenidyl or diphenhydramine may be used to control these symptoms.
- Monitor for tardive dyskinesia (uncontrolled rhythmic movement of mouth, face, and extremities; lip smacking or puckering; puffing of cheeks; uncontrolled chewing; rapid or worm-like movements of tongue). Report immediately; may be irreversible.
- Monitor for development of neuroleptic malignant syndrome (fever, respiratory distress, tachycardia, seizures, diaphoresis, hypertension or hypotension, pallor, tiredness, severe muscle stiffness, loss of bladder control). Notify health care professional immediately if these symptoms occur.
Assess for falls risk. Drowsiness, orthostatic hypotension, and motor and sensory instability increase risk. Institute prevention if indicated.
Antiemetic: Assess patient for nausea and vomiting before and 30–60 min after administration.

Lab Test Considerations:

CBC and liver function tests should be evaluated periodically during therapy. May cause blood dyscrasias, especially between wk 4 and 10 of therapy. Hepatotoxicity is more likely to occur between wk 2 and 4 of therapy. May recur if medication is restarted. Liver function abnormalities may require discontinuation of therapy.
- May cause false-positive or false-negative pregnancy test results and false-positive urine bilirubin test results.
- May cause ↑ serum prolactin levels.

Implementation ⬆ ⬇

To prevent contact dermatitis, avoid getting solution on hands.
- Phenothiazines should be discontinued 48 hr before and not resumed for 24 hr after myelography; they lower seizure threshold.
PO: Administer with food, milk, or a full glass of water to minimize gastric irritation.
IM: Do not inject SUBQ. Inject slowly, deep into well-developed muscle. Keep patient recumbent for at least 30 min after injection to minimize hypotensive effects. Slight yellow color will not alter potency. Do not administer solution that is markedly discolored or that contains a precipitate.

IV Administration:

Concentration: Dilute to a concentration of 1 mg/mL.
Rate: Administer at a rate of 1 mg/min; not to exceed 5 mg/min.
Intermittent Infusion: Diluent: Dilute 20 mg in up to 1 L dextrose, saline, Ringer’s or LR, dextrose/saline, dextrose/Ringer’s, or lactated Ringer’s combinations.
Has been used as infusion with 20 mg/L of compatible solution.

Patient/Family Teaching ⬆ ⬇

Instruct patient to take medication as directed, not to skip doses or double up on missed doses. Take missed doses as soon as remembered unless almost time for next dose. If more than 2 doses are scheduled each day, missed dose should be taken within about 1 hr of the ordered time. Abrupt withdrawal may lead to gastritis, nausea, vomiting, dizziness, headache, tachycardia, and insomnia.
Inform patient of possibility of extrapyramidal symptoms and tardive dyskinesia. Instruct patient to report these symptoms immediately to health care professional.
Advise patient to change positions slowly to minimize orthostatic hypotension. Protect from falls.
May cause drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
Caution patient to avoid alcohol and CNS depressants. Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications and alcohol.
Advise patient to use sunscreen and protective clothing when exposed to the sun to prevent photosensitivity reactions. Extremes in temperature should also be avoided, because this drug impairs body temperature regulation.
Instruct patient to use frequent mouth rinses, good oral hygiene, and sugarless gum or candy to minimize dry mouth. Consult health care professional if dry mouth continues for >2 wk.
Advise patient not to take prochlorperazine within 2 hr of antacids or antidiarrheal medication.
Advise patient that increasing bulk and fluids in the diet and exercise may help minimize the constipating effects of this medication.
Inform patient that this medication may turn urine pink to reddish-brown.
Advise patient to notify health care professional of medication regimen before treatment or surgery.
Instruct patient to notify health care professional promptly if sore throat, fever, unusual bleeding or bruising, skin rashes, weakness, tremors, visual disturbances, dark-colored urine, or clay-colored stools are noted.
Rep: Advise female patients to notify health care professional if pregnancy is planned or suspected or if breastfeeding. Maternal use of phenothiazines may cause jaundice or hyper- or hyporeflexia in newborn infants. Use during 3rd trimester may risk for abnormal muscle movements (extrapyramidal symptoms) and withdrawal symptoms in newborns following delivery; may include agitation, feeding disorder, hypertonia, hypotonia, respiratory distress, somnolence, and tremor; may be self-limiting or require hospitalization. Monitor infants breastfed by a mother taking prochlorperazine for drowsiness, skin reactions, and hypotension.
Emphasize the importance of routine follow-up exams to monitor response to medication and detect side effects. Periodic ocular exams are indicated. Encourage continued participation in psychotherapy as ordered by health care professional.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇