From the Guidelines
Compazine (prochlorperazine) can be used in pregnant women, particularly for hyperemesis gravidarum, as it is considered compatible in all trimesters, according to the most recent guidelines. The European Association for the Study of the Liver Clinical Practice Guidelines on the management of liver diseases in pregnancy, published in 2023 1, lists prochlorperazine as a compatible medication in all trimesters, including the first trimester, for the management of hyperemesis gravidarum. This guideline is based on a systematic review of the literature and rated according to the Oxford Centre for Evidence-Based Medicine guidelines.
When considering the use of prochlorperazine in pregnancy, it's essential to weigh the potential benefits against the risks. The medication is classified as FDA pregnancy category C, indicating that animal studies have shown adverse effects on the fetus, but there are no adequate well-controlled studies in humans. However, the recent guideline suggests that prochlorperazine can be used when the potential benefits outweigh the risks.
Some key points to consider when using prochlorperazine in pregnant women include:
- Potential risks of extrapyramidal symptoms in the newborn if used near delivery
- Possible long-term neurobehavioral effects, though the evidence is limited
- Safer first-line alternatives for pregnancy-related nausea include vitamin B6 (pyridoxine), ginger, and antihistamines like doxylamine
- The typical dose for nausea is 5-10 mg orally every 6-8 hours or 25 mg rectally twice daily
The American Gastroenterological Association (AGA) also provides guidance on the management of pregnancy-related gastrointestinal and liver disease, including the use of prochlorperazine for hyperemesis gravidarum 1. However, the most recent and highest-quality study, as per the guideline from the European Association for the Study of the Liver 1, should be prioritized when making a definitive recommendation.
In clinical practice, the decision to use prochlorperazine in a pregnant woman should involve a careful discussion between the patient and healthcare provider about the risk-benefit profile for the individual situation.
From the FDA Drug Label
Safety for the use of prochlorperazine during pregnancy has not been established Therefore, prochlorperazine is not recommended for use in pregnant patients except in cases of severe nausea and vomiting that are so serious and intractable that, in the judgment of the physician, drug intervention is required and potential benefits outweigh possible hazards Prochlorperazine Maleate should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
Prochlorperazine is not recommended for use in pregnant women unless the potential benefits outweigh the possible hazards, such as in cases of severe nausea and vomiting. The decision to use prochlorperazine in pregnant women should be made with caution and under the judgment of a physician, considering the potential risks to the fetus 2.
- Key considerations:
- Safety for use during pregnancy has not been established
- Potential benefits must outweigh possible hazards
- Risk of extrapyramidal and/or withdrawal symptoms in newborns
- Risk of prolonged jaundice, extrapyramidal signs, hyperreflexia or hyporeflexia in newborn infants
From the Research
Safety of Compazine in Pregnancy
- There is limited information available on the safety of Compazine (prochlorperazine) in pregnant women 3.
- Prochlorperazine is a first-generation antipsychotic, and according to a study, no definitive association has been found between the use of antipsychotics during pregnancy and an increased risk of birth defects or other adverse outcomes 3.
- However, it is essential to note that there is a lack of large, well-designed, prospective comparative studies on the safety of antipsychotics, including prochlorperazine, during pregnancy 3.
- The decision to use Compazine in pregnant women should be made after discussing the risks and benefits with a physician, as the potential harms to both the mother and fetus must be outweighed by the potential benefits 4, 3.
Comparison with Other Medications
- Unlike some other medications, such as nonsteroidal anti-inflammatory drugs, which are generally not recommended in pregnancy, especially during organogenesis and in the third trimester 5, prochlorperazine may be considered for use in pregnant women under certain circumstances.
- However, it is crucial to weigh the potential benefits against the potential risks, as with any medication used during pregnancy 4, 3.