Prochlorperazine

A to Z Drug Facts

(pro-klor-PURR-uh-zeen)

Compazine,  Stemetil Suppositories

Class: Antipsychotic/Phenothiazine; Antiemetic

 Action Effects apparently related to dopamine receptor blocking in CNS. Antiemetic activity may be caused by direct inhibition on medullary chemoreceptor trigger zone.

 Indications Management of psychotic disorders; short-term treatment of generalized nonpsychotic anxiety; control of severe nausea and vomiting. Unlabeled use(s): Treatment of severe vascular or tension headaches (IV), Tourette's syndrome, acute agitation in elderly patients and some symptoms of dementia.

 Contraindications Coma or severely depressed states; allergy to any phenothiazine; presence of large amounts of other CNS depressants; bone marrow depression or blood dyscrasias; liver damage; cerebral arteriosclerosis; coronary artery disease; severe hypotension or hypertension; subcortical brain damage; surgery in pediatric patients.

 Route/Dosage

Individualize dosage. SC administration is not advised because of local irritation.

Psychiatric

ADULTS: PO 20 to 150 mg/day, usually in divided doses. IM 10 to 20 mg. May repeat every 2 to 4 hr.

Nonpsychotic Anxiety

ADULTS: PO 5 mg tid to qid; 15 mg (sustained-release formulation) in morning or 10 mg (sustained-release formation) q 12 hr. Do not exceed 20 mg/day or give for longer than 12 wk. CHILDREN 2 to 12 YR: PO/PR 2.5 mg bid to tid. CHILDREN 2 to 5 YR: Do not exceed 20 mg/day. CHILDREN 6 to 12 YR: Do not exceed 25 mg/day. CHILDREN < 12 YR: IM 0.03 mg/kg by deep injection.

Nausea and Vomiting

ADULTS: PO 5 or 10 mg tablet tid to qid; 15 mg (sustained-release formulation) on arising or 10 mg q 12 hr. PR 25 mg bid. IM 5 to 10 mg. May repeat q 3 to 4 hr. Do not exceed 40 mg/day. CHILDREN: Adjust according to patient response and severity of symptoms. CHILDREN 40 to 85 LB: 2.5 mg tid or 5 mg bid; do not exceed 15 mg/day. IM 0.03 mg/kg given by deep IM injection. CHILDREN 30 to 39 LB: PO/PR 2.5 mg given bid to tid; do not exceed 10 mg/day. CHILDREN 20 to 29 LB: PO/PR 2.5 mg given once or twice daily; do not exceed 7.5 mg/day.

Nausea and Vomiting (Surgery)

ADULTS: IM 5 to 10 mg 1 to 2 hr prior to induction of anesthesia (may repeat once in 30 min) or to control acute symptoms during and after surgery (may repeat once). IV 2.5 to 10 mg by slow IV injection or infusion, at rate not to exceed 5 mg/min. Single dose should not exceed 10 mg. Daily dose IV should not exceed 40 mg. IV injection 5 to 10 mg 15 to 30 min before induction of anesthesia or to control acute symptoms during or after surgery. Repeat once if necessary. IV infusion 20 mg/L of isotonic solution. Add to IV infusion 15 to 30 min before induction of anesthesia.

 Interactions

Alcohol: May result in increased CNS depression and may precipitate dystonic reactions. Anticholinergics: May reduce therapeutic effects of prochlorperazine and worsen anticholinergic effects. Barbiturate anesthetics: Frequency and severity of neuromuscular excitation and hypotension may be increased. Guanethidine: Hypotensive action of guanethidine may be inhibited. Metrizamide: Possibility of seizure may be increased when subarachnoid metrizamide injection is used. INCOMPATIBILITIES: Do not mix prochlorperazine injection with other agents in syringe. Do not dilute with any diluent containing parabens as preservative.

 Lab Test Interferences May discolor urine pink to redbrown. False-positive pregnancy tests may occur but are less likely to occur with serum test. Increases in protein-bound iodine have been reported.

 Adverse Reactions

CV: Orthostatic hypotension; hypertension; tachycardia; bradycardia, syncope; cardiac arrest; circulatory collapse; lightheadedness; faintness; dizziness; ECG changes. CNS: Pseudoparkinsonism; dystonia; dyskinesia; motor restlessness; oculogyric crises; opisthotonos; hyperreflexia; tardive dyskinesia; drowsiness; headache; weakness; tremor; fatigue; slurring of speech; insomnia; vertigo; abnormalities of CSF proteins; paradoxical excitement or exacerbation of psychotic symptoms; catatonic-like states; paranoid reactions; lethargy; seizures; hyperactivity; nocturnal confusion; bizarre dreams. DERM: Photosensitivity; skin pigmentation; dry skin; pruritus; exfoliative dermatitis; urticarial rash; maculopapular hypersensitivity reaction; seborrhea; eczema. EENT: Pigmentary retinopathy; glaucoma; photophobia; blurred vision; mydriasis; glaucoma; dry mouth or throat; nasal congestion. GI: Nausea; vomiting; dyspepsia, adynamic ileus (which may result in death); constipation. GU: Urinary hesitancy or retention; impotence, sexual dysfunction; menstrual irregularities. HEPA: Jaundice. HEMA: Agranulocytosis; eosinophilia; leukopenia; hemolytic anemia; thrombocytopenic purpura. META: Hyperglycemia; hypoglycemia; increased cholesterol levels. RESP: Laryngospasm; bronchospasm; dyspnea. OTHER: Increases in appetite and weight; polydipsia; breast enlargement; galactorrhea; increased prolactin levels; heat stroke.

 Precautions

Pregnancy: Safety not established. Lactation: Safety not established. Children: Do not give to children < 20 lb or < 2 yr. Do not use in pediatric surgery. Extrapyramidal side effects may develop even at moderate doses. Use lowest effective dose. Some children respond with restlessness and excitement; do not give additional doses. Use with caution in children with acute illnesses or dehydration. Elderly: More susceptible to effects; consider lower dose. Special-risk patients: Use caution in patients with cardiovascular disease or mitral insufficiency, history of glaucoma, EEG abnormalities or seizure disorders, prior brain damage, hepatic, or renal impairment. Aspiration: As result of suppression of cough reflex, aspiration of vomitus possible. CNS effects: May impair mental or physical abilities, especially during first few days of therapy. Hepatic effects: Jaundice usually occurs between weeks 2 and 4 of treatment; considered hypersensitivity reaction. Usually reversible. Neuroleptic malignant syndrome: Has occurred with agents in this class; is potentially fatal. Signs and symptoms are hyperpyrexia, muscle rigidity, altered mental status, irregular pulse, fluctuating blood pressure, tachycardia, and diaphoresis. Pulmonary: Cases of bronchopneumonia, some fatal, have occurred. Sudden death: Has been reported; predisposing factors may be seizures or previous brain damage. Flare ups of psychotic behavior may precede death. Sulfite sensitivity: Some parenteral products contain sulfites. Tardive dyskinesia: Syndrome of potentially irreversible involuntary body and facial movements may develop. Prevalence highest in elderly, especially women. Use smallest effective doses for shortest possible time.

 Administration/Storage

• Give sustained-release forms whole; do not crush, and do not allow patient to bite or chew.
• Double-check pediatric dosage for suppositories (2.5 mg) to avoid confusion with adult dose (25 mg).
• Give IM deeply in upper outer quadrant of buttock; do not administer SC.
• Do not mix injectable form with other drugs in syringe and do not dilute with any diluent containing parabens.
• Give IV injection at rate not to exceed 5 mg/min. May be administered undiluted or diluted in isotonic solution. May be given undiluted at 5 mg/min or diluted at rate of 5 mg/ml/min. Do not give as bolus and do not give more than 10 mg/dose.
• Prepare IV infusion by adding 20 mg to no less than 1 L of isotonic solution.
• Total daily parenteral dose should not exceed 40 mg.
• Store oral and injectable dosage forms at room temperature and protect from light.
• Store suppositories at room temperature.
• Avoid freezing solution or injectable products.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Carefully position patient to prevent aspiration of vomitus after surgery.
• Report possible side effects to physician: Extrapyramidal reactions (eg, pseudoparkinsonism, dystonia, dyskinesia), urinary retention or hesitancy, jaundice, orthostatic hypotension, dizziness, drowsiness, dry mouth or throat, drooling, blurry vision, increases in weight or appetite or breast enlargement.
• Immediately report to physician symptoms of possible neuroleptic malignant syndrome, including hyperpyrexia, muscle rigidity, altered mental status, irregular pulse or blood pressure, tachycardia, and diaphoresis.
• In patients chronically treated with this drug, observe for signs of tardive dyskinesia (eg, rhythmical involuntary movements of tongue, face, mouth or jaw) and report to physician.
• Notify physician of possible allergic reaction.

 Patient/Family Education

• Explain potential problems during long-term treatment with this drug, and identify signs of tardive dyskinesia.
• Explain that urine may turn reddish-brown color.
• Advise patient to use caution in hot weather because of increased possibility of heat stroke.
• Instruct patient to report the following symptoms to physician: Pseudoparkinsonism (eg, dystonia, dyskinesia, akathisia), urinary retention or hesitancy, jaundice, orthostatic hypotension, dizziness, drowsiness, dry mouth or throat, drooling, blurry vision, increases in weight or appetite, fever, skin rash, breast enlargement.
• Caution patient to sudden position changes to minimize problems with dizziness or light headedness.
• Instruct patient to avoid intake of alcoholic beverages or other CNS depressants.
• Advise patient that drug may cause drowsiness or dizziness and to use caution while driving or performing other tasks requiring mental alertness.
• Caution patient to avoid exposure to sunlight or to use sunscreen or wear protective clothing.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts