From the FDA Drug Label
Dosage should be tailored to the individual, response carefully monitored and dosage adjusted accordingly. Oral Dosage-Tablets: Usually one 5mg or 10mg tablet 3 or 4 times daily. Daily dosages above 40 mgs should be used only in resistant cases.
The recommended oral dose of prochlorperazine is 5mg or 10mg tablet, 3 or 4 times daily. However, the FDA drug label does not specifically address the dosage for recurrent BPPV.
- The dosage may need to be adjusted based on individual response and severity of symptoms.
- Daily dosages above 40mg should be used only in resistant cases 1.
From the Research
Prochlorperazine is not typically recommended as a first-line treatment for recurrent benign paroxysmal positional vertigo (BPPV), and its use should be limited to short-term management of severe vertigo symptoms. The standard treatment for BPPV involves canalith repositioning procedures such as the Epley maneuver, which physically moves the displaced calcium crystals back to their proper location in the inner ear 2. When medications are needed for symptomatic relief of vertigo in BPPV, a typical oral dose of prochlorperazine would be 5-10 mg taken 3-4 times daily as needed for severe vertigo symptoms, with a maximum daily dose of 40 mg. However, this medication should only be used for short-term management (generally less than 7 days) due to the risk of side effects, including sedation, hypotension, and extrapyramidal symptoms.
Some key points to consider when treating BPPV include:
- The recurrence rate of BPPV is 27%, and relapse largely occurs in the first 6 months 3
- The most effective treatment method of BPPV is repositioning maneuver, and addition of betahistine or dimenhydrinate pharmacotherapy to repositioning maneuver did not show superiority to treatment with repositioning maneuvers alone 4
- Betahistine alleviates BPPV through inducing production of multiple CTRP family members and activating the ERK1/2-AKT/PPARy pathway 5
- Repeated testing and treatment of BPPV within the same session is promoted as a safe and effective approach to the management of BPPV with a low risk of canal conversion 2
It's essential to note that while prochlorperazine may help control symptoms temporarily, it does not address the underlying cause of BPPV and should be used as an adjunct to proper repositioning maneuvers rather than as a standalone treatment. For elderly patients, a lower starting dose of 5 mg is recommended. Prochlorperazine works by blocking dopamine receptors in the chemoreceptor trigger zone and has antiemetic and antipsychotic properties.