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Prochlorperazine

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Prochlorperazine, Compazine

  • Indications
  1. Nausea or Vomiting
  2. Migraine Headache
  3. Motion Sickness
  4. Vertigo
  5. Hiccups
  • Mechanism
  1. Phenothiazine Antiemetic
  2. Dopamine 2 Antagonist
  • Adverse effects
  1. Orthostatic Hypotension
  2. Extrapyramidal Reaction
    1. Precaution
      1. Reactions may be delayed up to 2 weeks after dose
    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]
  • Dosing
  1. Adults
    1. Compazine 5-10 mg PO/IV/IM q6-8 hours
    2. Compazine 25 mg PR q12 hours
    3. Sustained release Compazine 15 mg PO qam or 10 mg bid
  2. Children (over age 2 years or >10 kg)
    1. Compazine 0.1 mg/kg/dose PO/PR q6-8 hours
    2. Compazine 0.1 to 0.15 mg IM q6-8 hours
  • Precautions
  1. IV dosing must be administered over 2 minutes or more
  2. Lowers Seizure threshold
  • Efficacy
  1. Better Antiemetic than Phenergan in ER patients
    1. Ernst (2000) Ann Emerg Med 36(2): 89-94 [PubMed]
  • References
  1. Johnson (1993) Harriet Lane, Mosby, p. 521
  2. (2002) Tarascon Pocket Pharmacopoeia, p. 67
  3. Olsen (2000) Am J Emerg Med 18(5):609-11 [PubMed]
  4. Vinson (2001) Ann Emerg Med 37(2):125-31 [PubMed]