What is the interaction between Prochlorperazine (PCP) and Busulfan?

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From the Guidelines

Procloprazine and busulfan should not be used together due to a potentially dangerous interaction, as evidenced by the emetogenic potential of busulfan being classified as minimal [ 1 ], which may not directly imply a significant interaction but considering the potential for increased toxicity, caution is advised. When combined, procloprazine (a phenothiazine antipsychotic) can potentially decrease the metabolism of busulfan (an alkylating chemotherapy agent), leading to increased busulfan blood levels and toxicity. This interaction can result in severe side effects including bone marrow suppression, liver damage, and seizures.

If a patient requires both medications, alternative antipsychotics with less interaction potential should be considered. For patients on busulfan therapy who need antipsychotic treatment, medications from different classes such as atypical antipsychotics may be safer options. The interaction occurs because procloprazine may inhibit the cytochrome P450 enzymes responsible for busulfan metabolism. Healthcare providers should perform more frequent blood monitoring for busulfan levels and signs of toxicity if no alternative medications can be used.

According to the guidelines [ 1 ], busulfan is classified as having a minimal emetic potential, but the concern lies in its potential interaction with procloprazine. The guidelines also recommend antiemetic prophylaxis for busulfan when the dose is ≥ 4 mg/d [ 1 ], which may indirectly suggest a need for careful management of its side effects, including potential interactions with other medications like procloprazine.

Given the potential risks, it is crucial to prioritize the safety of the patient and avoid the combination of procloprazine and busulfan whenever possible, opting for alternative treatments that minimize the risk of adverse interactions and prioritize morbidity, mortality, and quality of life outcomes.

From the Research

Procloprazine and Busulfan Interaction

  • There are no research papers to assist in answering this question as the provided studies do not mention the interaction between Procloprazine and Busulfan.
  • The studies provided focus on the use of Busulfan in cancer therapy, its pharmacokinetics, and its interactions with other drugs, but do not mention Procloprazine 2, 3, 4, 5, 6.
  • Busulfan is a chemotherapeutic agent used in the treatment of certain types of cancer, and its interactions with other drugs are important to consider in order to minimize adverse effects and optimize treatment outcomes.
  • However, without specific information on the interaction between Procloprazine and Busulfan, it is not possible to provide a detailed answer to this question.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Therapeutic Dose Monitoring of Busulfan Is Associated with Reduced Risk of Relapse in Non-Hodgkin Lymphoma Patients Undergoing Autologous Stem Cell Transplantation.

Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation, 2020

Research

Busulfan.

The Annals of pharmacotherapy, 1994

Research

Managing Drug Interactions in Cancer Therapy: A Guide for the Advanced Practitioner.

Journal of the advanced practitioner in oncology, 2017

Research

Maximally tolerated busulfan systemic exposure in combination with fludarabine as conditioning before allogeneic hematopoietic cell transplantation.

Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation, 2012

Research

[Busulfan-induced pneumopathy].

Revue des maladies respiratoires, 1987

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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