prochlorperazine

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.

Availability ⬆ ⬇

(Generic available)

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

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.
Rect (Adults ): 25 mg twice daily.
Rect (Children 18–39 kg): 2.5 mg 3 times daily or 5 mg twice daily (not to exceed 15 mg/day).
Rect (Children 14–17 kg): 2.5 mg 2–3 times daily (not to exceed 10 mg/day).
Rect (Children 9–13 kg): 2.5 mg 1–2 times daily (not to exceed 7.5 mg/day).

US Brand Names ⬆ ⬇

~~Compazine,~~ Compro

Action ⬆ ⬇

Alters the effects of dopamine in the CNS.
Possesses significant anticholinergic and alpha-adrenergic blocking activity.
Depresses the chemoreceptor trigger zone in the CNS.

Therapeutic effects:

Diminished nausea and vomiting.

Classifications ⬆ ⬇

Therapeutic Classification: antiemetics, antipsychotics

Pharmacologic Classification: phenothiazines

Pharmacokinetics ⬆ ⬇

Absorption: Absorption from tablet is variable; may be better with oral liquid formulations. Well absorbed after IM administration.

Distribution: Widely distributed, high concentrations in the CNS.

Protein Binding: ≥90%.

Metabolism/Excretion: Highly metabolized by the liver and GI mucosa.

Half-Life: Unknown.

Canadian Brand Names ⬆ ⬇

Time/Action Profile ⬆ ⬇

(antiemetic effect)

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

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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Indications ⬇

Contraind./Precautions ⬆ ⬇