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prochlorperazine (Rx)Brand and Other Names:Compazine, Compazine Spansules, more...prochlorperazine edisylate, prochlorperazine mesylate

 
 
 

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet

  • 5mg
  • 10mg

suppository

  • 25mg

injectable solution

  • 5mg/mL
more...

Severe Nausea & Vomiting

PO: Immediate-release, 5-10 mg q6-8hr; extended-release, 10 mg q12hr or 15 mg every morning

Suppository: 25 mg q12hr

IM: 5-10 mg q3-4hr; not to exceed 40 mg/day

IV: 2.5-10 mg q3-4hr; not to exceed 10 mg/dose or 40 mg/day

Severe Intraoperative Nausea & Vomiting

Prophylaxis

IM: 5-10 mg administered 1-2 hours before induction of anesthesia; may be repeated once 30 minutes after initial dose

IV: 5-10 mg administered 15-30 minutes before induction of anesthesia, repeated once before procedure if desired, or 20 mg/L administered 15-30 minutes before induction; not to exceed 30 mg/day

Psychosis

5-10 mg PO q6-8hr; slowly titrate dose q2-3days; not to exceed 150 mg/day

10-20 mg IM q2-4hr to gain control; 3-4 doses rarely needed

Dosage Forms & Strengths

tablet

  • 5mg
  • 10mg

suppository

  • 2.5mg
  • 5mg
  • 25mg

injectable solution

  • 5mg/mL
more...

Psychotic Disorder

<2 years: Not recommended

2-6 years: 2.5 mg PO/PR q8-12hr initially; not to exceed 20 mg/day; not to exceed 10 mg on the first day

6-12 years: 2.5 mg PO/PR q8-12hr initially; not to exceed 25 mg/day; not to exceed 10 mg on the first day

Severe Nausea & Vomiting

<2 years: Not recommended

≥2 years (9-13 kg): 2.5 mg PO daily or q12hr; not to exceed 7.5 mg/day 

≥2 years (13.1-18 kg): 2.5 mg PO q8-12hr; not to exceed 10 mg/day

≥2 years (18.1-37 kg): 2.5 mg PO q8hr or 5 mg PO q12hr; not to exceed 15 mg/day

Not drug of choice in elderly, because of extrapyramidal symptoms

Nonpsychotic Dementia Behavior (Off-label)

Lower initial dose and adjust gradually; 2.5-5 mg/day PO; dosing interval may be increased to q8-12hr PRN; not to exceed 75 mg/day

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Interactions

Interaction Checker

prochlorperazine and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            <1%

            Insomnia

            Restlessness (immediate restlessness or agitation may be treated with diphenhydramine 25 mg IV push)

            Dizziness

            Anxiety

            Euphoria

            Agitation

            Depression

            Weakness

            Headache

            Cerebral edema

            Poikilothermia

            Orthostatic hypotension (after IM injection)

            Tachycardia

            ECG changes

            Anorexia

            Dyspepsia

            Constipation

            Diarrhea

            Ileus

            Blood dyscrasia

            Galactorrhea

            Gynecomastia

            Ejaculatory disorder

            Lens opacities (with prolonged use)

            Photosensitivity

            Pruritus

            Frequency Not Defined

            Akathisia

            Sedation

            Anticholinergic effects

            Weight gain

            Oligomenorrhea or amenorrhea

            Erectile dysfunction

            Extrapyramidal symptoms (muscle stiffness, dystonia, parkinsonism, tardive dyskinesia)

            Neuroleptic malignant syndrome (infrequent but serious)

            Seizure

            Decreased gag reflex

            Confusion

            Hypotension

            Hypertension

            Leukopenia

            Agranulocytosis

            Cholestatic jaundice

            Photosensitivity reaction

            Priapism

            Hepatotoxicity

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            Warnings

            Black Box Warnings

            Patients with dementia-related psychosis who are treated with antipsychotic drugs are at an increased risk of death, as shown in short-term controlled trials; the deaths appeared to be either cardiovascular (eg, heart failure, sudden death) or infectious (eg, pneumonia) in nature

            This drug is not approved for treatment of patients with dementia-related psychosis

            Contraindications

            Documented hypersensitivity to phenothiazines

            Coma, severe CNS depression, concurrent use of large amounts of CNS depressants, poorly controlled seizure disorder, subcortical brain damage

            Postoperative management of nausea/vomiting following pediatric surgery

            Children <2 years or weighing <9 kg

            Cautions

            Avoid using in children with suspected Reye syndrome

            Use caution in evere hypertension, severe cardiovascular disease

            Use with caution in glaucoma, prostatic hypertrophy, stenosing peptic ulcer disease, history of neuroleptic malignant syndrome, Parkinson disease, hypocalcemia, renal/hepatic impairment, history of severe reactions to insulin or electroconvulsive therapy, history of seizures, asthma, respiratory tract infections, cardiovascular disease, myelosuppression

            Blood dyscrasias including neutropenia, agranulocytosis, and leukopenia reported with use; discontinue therapy at first sign of blood dyscrasias

            Risk of extrapyramidal symptoms, neuroleptic malignant syndrome, hypotension (may be particularly severe in patients with pheochromocytoma or mitral insufficiency)

            Esophageal dysmotility/aspiration may occur; use with caution in patients at risk of pneumonia

            Depresses hypothalamic thermoregulatory mechanism; exposure to extreme temperatures may cause hypo- or hyperthermia

            May alter cardiac conduction; life-threatening arrhythmias reported with therapeutic doses

            May cause anticholinergic effects (constipation, xerostomia, urinary retention, blurred vision); use caution in patients with decreased gastrointestinal motility, paralytic ileus, urinary retention, BPH, xerostomia, visual problems

            May cause pigmentary retinopathy and lenticular and corneal deposits, espcially in prolonged therapy

            May cause sedation and impair ability to perform tasks which require mental alertness, including operating heavy machinery

            Use associated with increased prolactin levels

            In case of severe hypotension, use norepinephrine or phenylepinephrine; do not use epinephrine or dopamine

            Do not crush extended-release product

            Avoid SC administration (may cause irritation)

            Antiemetic effect may obscure toxicity of chemotherapeutic drugs

            Use may be associated with neuroleptic malignant syndrome; monitor muscle ritidity, mental status changes, fever, autonomic instability

            May need anticholinergic antiparkinsonian agent to counter extrapyramidal symptoms

            May impair core body temperature regulation

            FDA warning regarding off-label use for dementia in elderly

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            Pregnancy & Lactation

            Pregnancy category: C

            Lactation: Phenothiazines may be excreted in breast milk; do not nurse

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Antiemetic: Antidopaminergic effect, blocking dopamine receptors in the brain, blocking vagus nerve in GI tract

            Antipsychotic: Blocking mesolimbic dopamine receptors, and blocking alpha-adrenergic receptors (D1 and D2) in brain

            Absorption

            Bioavailability: 12.5%

            Onset: 10-20 min (IM); 30-40 min (PO); 60 min (PR)

            Duration: 3-4 hr (PO); 3-12hr (PR); extended-release, 10-12 hr

            Distribution

            Vd: 1400-1548 L

            Metabolism

            Metabolized by liver

            Metabolites: N-desmethyl prochlorperazine (active)

            Elimination

            Half-life: 6.8-9 hr (PO); 6-10 hr (IV)

            Dialyzable: No

            Excretion: Feces (primarily)

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            Administration

            IV Compatibilities

            Solution: Compatible with most common solvents

            Additive: Amikacin, ascorbic acid injection, dexamethasone, dimenhydrinate, erythromycin, ethacrynate, lidocaine, nafcillin, penicillin G potassium (incompatible at higher concentrations), sodium bicarbonate, vitamins B and C

            Syringe (partial list): Atropine, chlorpromazine, cimetidine, diphenhydramine, fentanyl, glycopyrrolate, hydroxyzine, meperidine, metoclopramide, morphine sulfate (incompatible if phenol present)(?)

            Y-site (partial list): Calcium gluconate, cisplatin, cladribine, clarithromycin, cyclophosphamide, cytarabine, docetaxel, doxorubicin, doxorubicin liposomal, heparin, linezolid, melphalan, methotrexate, potassium chloride, propofol, teniposide, thiotepa, topotecan, vitamins B and C

            IV Incompatibilities

            Additive: Aminophylline, amphotericin B, ampicillin, calcium gluconate(?), chloramphenicol, chlorothiazide, floxacillin, furosemide, hydrocortisone, methohexital, penicillin G sodium, phenobarbital, thiopental

            Syringe: Dimenhydrinate, hydromorphone(?), ketorolac, midazolam, morphine tartate, pentobarbital, thiopental

            Y-site: Aldesleukin, allopurinol, amifostine, amphotericin B, aztreonam, bivalirudin, cefepime, etoposide phosphate, fenoldopam, filgrastim, fludarabine, foscarnet, gemcitabine, piperacillin/tazobactam

            IV Administration

            Avoid bolus

            IV push rate should not exceed 5 mg/min

            For infusion, dilute 20 mg in 1 L of compatible solution; may infuse over 30 minutes

            Storage

            Store at room temperature, and protect from light

            Solution is clear or slightly yellow

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            Images

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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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