From the Guidelines
Zofran (ondansetron) is generally preferred over Compazine (prochlorperazine) for chemotherapy-induced and postoperative nausea due to its targeted action on serotonin 5-HT3 receptors and favorable side effect profile. When considering the treatment of nausea and vomiting, it's essential to weigh the benefits and risks of each medication. Zofran is typically dosed at 4-8mg every 8-12 hours and is available in oral, dissolving tablet, and injectable forms 1. Compazine works by blocking dopamine receptors and is often used for general nausea, vertigo, and migraine-associated nausea, usually dosed at 5-10mg every 6-8 hours 1. However, Compazine carries more significant side effects, including sedation, extrapyramidal symptoms, and potential QT prolongation. In contrast, Zofran is generally better tolerated but more expensive. The choice between these medications depends on the cause of nausea, patient-specific factors, and cost considerations. For severe nausea, particularly with chemotherapy, Zofran is typically the first choice, while Compazine may be preferred for general nausea when cost is a concern or when a mild sedative effect is beneficial. Some key points to consider when choosing between Zofran and Compazine include:
- Efficacy in controlling acute and delayed nausea and vomiting
- Safety profiles, including the risk of sedation, extrapyramidal symptoms, and QT prolongation
- Cost and availability of the medications
- Patient-specific factors, such as medical history and concurrent medications. It's also important to note that the addition of dexamethasone can improve the efficacy of antiemetic regimens containing 5-HT3 antagonists, but it's associated with side effects like insomnia 1. Ultimately, the decision between Zofran and Compazine should be based on the individual patient's needs and circumstances.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Comparison of Compazine and Zofran
- Compazine, also known as prochlorperazine, and Zofran, also known as ondansetron, are two antiemetic medications used to treat nausea and vomiting.
- According to a study published in 2011 2, prochlorperazine and ondansetron appear to be equally effective at treating vomiting in the emergency department.
- However, the same study found that prochlorperazine had better control of nausea at 31-60 and 61-120 minutes after administration.
Mechanism of Action
- Ondansetron is a selective 5-HT3 receptor antagonist, which means it works by blocking the action of serotonin in the body 3, 4.
- Prochlorperazine, on the other hand, is a dopamine antagonist, which means it works by blocking the action of dopamine in the body.
- The 5-HT3 receptor antagonists, including ondansetron, have been shown to be more effective than metoclopramide in controlling nausea and vomiting induced by highly emetogenic chemotherapy regimens 5.
Efficacy and Safety
- Ondansetron has been shown to be effective in controlling nausea and vomiting associated with emetogenic chemotherapy, with a superior efficacy, safety, and pharmacoeconomic profile compared to other antiemetics 4.
- Prochlorperazine has also been shown to be effective in controlling nausea and vomiting, but its efficacy and safety profile may not be as favorable as ondansetron in certain situations 2.
- Both medications have been associated with adverse effects, including headache, sedation, and gastrointestinal effects 6, 2, 3.