Prochlorperazine

Prochlorperazine is a prescription medication used to treat Severe Nausea and Vomiting including Intraoperative Nausea and Vomiting, and Psychosis. 

• Prochlorperazine is available under the following different brand names: Compazine, Compazine Spansules, Prochlorperazine edisylate, Prochlorperazine Mesylate

Adult and pediatric dosage

Tablet

• 5mg
• 10mg

Suppository

Adult dosage

• 25mg

Pediatric dosage

• 2.5 mg 
• 5 mg
• 25 mg

Injectable solution

• 5mg/mL

Severe Nausea and Vomiting

Adult dosage

• Orally: Immediate-release, 5-10 mg every 6-8 hours; extended-release, 10 mg every 12 hours or 15 mg every morning
• Suppository: 25 mg every 12 hours
• IM: 5-10 mg every 3-4 hours; not to exceed 40 mg/day
• IV: 2.5-10 mg every 3-4 hours; not to exceed 10 mg/dose or 40 mg/day

Pediatric dosage

• Children younger than 2 years of age: Not recommended
• Children 2 years or older (9-13 kg): 2.5 mg orally daily or every 12 hours; not to exceed 7.5 mg/day
• Children 2 years or older (13.1-18 kg): 2.5 mg orally every 8-12 hours; not to exceed 10 mg/day
• Children 2 years or older (18.1-37 kg): 2.5 mg orally every 8 hours or 5 mg orally every 12 hours; not to exceed 15 mg/day

Severe Intraoperative Nausea and Vomiting

Adult dosage

Prophylaxis

• IM: 5-10 mg administered 1-2 hours before induction of anesthesia; may be repeated once 30 minutes after the initial dose
• IV: 5-10 mg administered 15-30 minutes before induction of anesthesia, repeated once before the procedure if desired, or 20 mg/L administered 15-30 minutes before induction; not to exceed 30 mg/day

Psychosis

Adult dosage

• 5-10 mg orally every 6-8 hours; slowly titrate dose every 2-3 days; not to exceed 150 mg/day
• 10-20 mg IM every 2-4 hours to gain control; 3-4 doses rarely needed

Pediatric dosage

• Children younger than 2 years of age: Not recommended
• Children 2-6 years: 2.5 mg orally or rectally daily every 8- 12 hours initially; not to exceed 20 mg/day; not to exceed 10 mg on the first day
• Children 6-12 years: 2.5 mg orally or rectally daily every 8-12 hours initially; not to exceed 25 mg/day; not to exceed 10 mg on the first day

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”.

Common side effects of Prochlorperazine include:

• headache, 
• dizziness, 
• drowsiness, 
• dry mouth, 
• stuffy nose, 
• nausea, 
• constipation, 
• increased appetite, 
• weight gain, 
• blurred vision, 
• agitation, 
• feeling jittery, 
• trouble sleeping, 
• skin redness, 
• itching, 
• rash, 
• missed periods, 
• impotence, and
• abnormal ejaculation

Serious side effects of Prochlorperazine include:

• hives, 
• difficulty breathing, 
• swelling of the face, lips, tongue, or throat, 
• uncontrolled muscle movements in the arms and legs, or the face (chewing, lip-smacking, frowning, tongue movement, blinking or eye movement), 
• trouble speaking or swallowing, 
• stiffness or muscle spasms in the neck, 
• tremors, 
• any new or unusual muscle movements that they cannot control, 
• extreme drowsiness, 
• lightheadedness, 
• little or no urination, 
• agitation, 
• restlessness, 
• severe constipation, 
• stomach pain, 
• bloating, 
• yellowing of the skin or eyes (jaundice), 
• fever, 
• chills, 
• sore throat, 
• cough, 
• mouth sores, 
• skin sores, 
• pale skin, 
• easy bruising, 
• unusual bleeding, 
• muscle or joint pain, 
• flu symptoms, 
• chest pain, 
• rash or patchy skin color that worsens in sunlight, 
• very stiff (rigid) muscles, 
• high fever, 
• sweating, 
• confusion, and
• fast or uneven heartbeats

Rare side effects of Prochlorperazine include:

• none 

This is not a complete list of side effects and other serious side effects or health problems may occur as a result of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first

• Prochlorperazine has severe interactions with the following drugs:
  • disopyramide
  • ibutilide
  • indapamide
  • metrizamide
  • pentamidine
  • pimozide
  • procainamide
  • quinidine
  • sotalol
• Prochlorperazine has serious interactions with at least 63 other drugs.
• Prochlorperazine has moderate interactions with at least 276 other drugs.
• Prochlorperazine has minor interactions with at least 60 other drugs.

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this drug, tell your doctor or pharmacist of all the drugs you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

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 younger than 2 years of age or weighing less than 9 kg

Effects of drug abuse

• None

Short-Term Effects

See “What Are Side Effects Associated with Using Prochlorperazine?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Prochlorperazine?”

Cautions

• Avoid using in children with suspected Reye syndrome
• Use caution in severe hypertension, severe cardiovascular disease
• Use with caution in glaucoma, prostatic hypertrophy, stenosing peptic ulcer disease, history of the 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 the 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, especially in prolonged therapy
• May cause sedation and impair the ability to perform tasks that 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 the extended-release product
• Avoid SC administration (may cause irritation)
• Antiemetic effects may obscure the toxicity of chemotherapeutic drugs
• Use may be associated with neuroleptic malignant syndrome; monitor muscle rigidity, 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

Pregnancy and Lactation

• Use with caution if the benefits outweigh the risks during pregnancy. 
• Phenothiazines may be excreted in breast milk; do not nurse.