II. Indications
- Nausea or Vomiting
-
Motion Sickness or Vertigo
- Other agents are preferred (e.g. Dimenhydrinate)
III. Mechanism
- Phenothiazine Antiemetic
-
Dopamine 2 Antagonist
- Active at the ChemoreceptorTrigger Zone in the Medulla of the Brainstem
- Similar to other DopamineAntagonist Antipsychotic agents
IV. Contraindications
- Do not use under age 2 years
V. Adverse Effects
- Respiratory Depression
- Apnea and death have occurred in children
- Severe tissue injury risk on Parenteral Injection
- Do not use Subcutaneous Injection
- Hypotension with rapid IV injection
- Extrapyramidal Side Effects (with high IV dose)
- Anticholinergic effects (e.g. sedation, Dry Mouth)
VI. Safety
- Pregnancy Category C
- Avoid in Lactation
VII. Precautions
VIII. Dosing: Adults
-
Nausea or Vomiting
- PO/PR/IM: 12.5 to 25 mg PO/Deep IM/PR every 4 to 6 hours
- IV (not FDA labeled, see adverse effects): 12.5 to 25 mg IV every 4 hours as needed
-
Motion Sickness
- PO/PR: 25 mg orally or PR 30 to 60 minutes prior to departure and every 12 hours as needed
IX. Dosing: Children (over age 2 years only)
- Children
- PO/PR/IM: 0.25 to 0.5 mg/kg (up to 25 mg/dose) PO/deep IM/PR every 4 to 6 hours
- IV (not FDA labeled, see adverse effects): 0.25 mg/kg/dose (up to 25 mg) IV every 4 hours as needed
-
Motion Sickness
- PO/PR: 0.5 mg/kg (up to 25 mg/dose) PO/PR 30 to 60 minutes prior to departure and every 12 hours as needed
X. Efficacy
- Less effective Antiemetic than Prochlorperazine (Compazine) in ER patients
- Sedation may delay Emergency Department discharge
XI. Resources
XII. References
- Johnson (1993) Harriet Lane, Mosby, p. 521
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
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