Prochlorperazine

Aka: Prochlorperazine, Compazine

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II. Indications

  1. Nausea or Vomiting
  2. Migraine Headache
  3. Motion Sickness
  4. Vertigo
  5. Hiccups

III. Mechanism

  1. Phenothiazine Antiemetic
  2. Dopamine 2 Antagonist
    1. Active at the ChemoreceptorTrigger Zone in the Medulla of the Brainstem
    2. Similar to other Dopamine antagonist Antipsychotic agents

IV. Adverse effects

  1. Orthostatic Hypotension (esp. IV dosing)
  2. Arrhythmia
  3. Sedation
  4. Constipation
  5. Dry Mouth
  6. Leukopenia
  7. Thrombocytopenia
  8. Hyperprolactinemia
  9. Extrapyramidal Reaction
    1. Precaution
      1. Reactions may be delayed up to 2 weeks after dose
      2. Slow injection over minutes reduces risk of Dystonic Reaction
    2. Reactions
      1. Akathisia (25-60% after single dose)
      2. Dystonic Reaction (4% after a single dose)
      3. Olsen (2000) Am J Emerg Med 18(5): 609-11 +PMID:10999579 [PubMed]
      4. Drotts (1999) Ann Emerg Med 34(4 Pt 1): 469-75 [PubMed]
    3. Concurrent Diphenhydramine (Benadryl) prevents Akathisia (NNT 5, ARR 22%)
      1. Diphenhydramine (Benadryl) 50 mg IV (adults) was the dose used in study
      2. Vinson (2001) Ann Emerg Med 37(2):125-31 +PMID:11174228 [PubMed]

V. Dosing: Nausea or Vomiting

  1. Adults
    1. Prochlorperazine 5-10 mg orally every 6 to 8 hours
    2. Prochlorperazine 5-10 mg IM or slow IV over 2 minutes every 3 to 4 hours as needed
    3. Prochlorperazine suppository 25 mg PR every 12 hours
    4. Sustained release Prochlorperazine 15 mg orally each morning or 10 mg orally twice daily
    5. Maximum PO/IV/IM/day: 40 mg
  2. Children (over age 2 years and >10 kg)
    1. Avoid IV dosing in children
    2. Prochlorperazine 0.1 mg/kg/dose PO/PR every 6-8 hours
    3. Prochlorperazine 0.1 to 0.15 mg IM q6-8 hours

VI. Dosing: Migraine Headaches (Adults)

  1. Give 10 mg IM or slow IV over 2 minutes, or 25 mg PR for single dose

VII. Precautions

  1. Pregnancy Category C
  2. Unknown Safety in Lactation
  3. IV dosing must be administered over 2 minutes or more
  4. Lowers Seizure threshold

VIII. Efficacy

  1. Better Antiemetic than Promethazine in ED patients
    1. Ernst (2000) Ann Emerg Med 36(2): 89-94 [PubMed]

IX. Resources

  1. Prochlorperazine (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=e913d678-7a5d-4e74-9e9c-1b9a3affd265

X. References

  1. Johnson (1993) Harriet Lane, Mosby, p. 521
  2. Hamilton (2020) Tarascon Pocket Pharmacopoeia
  3. Olsen (2000) Am J Emerg Med 18(5):609-11 [PubMed]
  4. Vinson (2001) Ann Emerg Med 37(2):125-31 [PubMed]

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Related Studies

Cost: Medications

prochlorperazine (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
PROCHLORPERAZINE 10 MG TAB Generic $0.43 each
PROCHLORPERAZINE 25 MG SUPP Generic $5.56 each
PROCHLORPERAZINE 5 MG TABLET Generic $0.30 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

Related Topics in Pharmacology

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