From the Guidelines
Compazine (prochlorperazine) is considered compatible with use during pregnancy, including the first trimester, 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, list prochlorperazine as a compatible medication for use during pregnancy, including the first trimester. This guideline is based on a systematic review of the literature and expert consensus, providing a high level of evidence for the safety of prochlorperazine during pregnancy.
When considering the use of Compazine during pregnancy, it's essential to weigh the potential benefits against the risks. While there are no definitive human birth defects conclusively linked to prochlorperazine, the medication should be used cautiously, especially during the first trimester when organ formation occurs. If prescribed during pregnancy, it's typically used at the lowest effective dose for the shortest duration necessary to control symptoms like severe nausea and vomiting.
Pregnant women with hyperemesis gravidarum (severe pregnancy nausea) who haven't responded to other treatments may be candidates for Compazine. The medication crosses the placental barrier, and there have been reports of extrapyramidal symptoms in newborns whose mothers received phenothiazines (the drug class of prochlorperazine) during pregnancy. However, the most recent guidelines suggest that the benefits of using prochlorperazine during pregnancy may outweigh the risks, especially when used under the guidance of a healthcare provider.
Some key points to consider when using Compazine during pregnancy include:
- The medication should be used at the lowest effective dose for the shortest duration necessary to control symptoms.
- Pregnant women should be closely monitored for any adverse effects, including extrapyramidal symptoms in the newborn.
- The benefits and risks of using Compazine during pregnancy should be carefully weighed, taking into account the individual patient's situation and medical history.
- Healthcare providers should consult the most recent guidelines and expert recommendations when making decisions about the use of Compazine during pregnancy.
Overall, while there are potential risks associated with the use of Compazine during pregnancy, the most recent guidelines suggest that the medication can be safely used when clearly needed and under the guidance of a healthcare provider 1.
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 There have been reported instances of prolonged jaundice, extrapyramidal signs, hyperreflexia or hyporeflexia in newborn infants whose mothers received phenothiazines. Prochlorperazine Maleate should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
Compazine (prochlorperazine) is not recommended for use during pregnancy unless the benefits outweigh the potential risks, such as in cases of severe nausea and vomiting. The use of prochlorperazine during pregnancy may pose a risk to the fetus, including extrapyramidal signs, hyperreflexia, hyporeflexia, and prolonged jaundice in newborn infants. 2
From the Research
Safety of Compazine (Prochlorperazine) During Pregnancy
- Compazine, also known as prochlorperazine, is a medication used to treat nausea and vomiting, including hyperemesis gravidarum, a condition characterized by severe nausea and vomiting during pregnancy 3.
- According to the Australian Family Physician study, prochlorperazine is classified as a category C medication, which means that it should be used with caution during pregnancy, as there is limited data available on its safety 3.
- A study published in the Journal of Obstetric Medicine reported a case of akathisia and oculogyric crisis in a patient with hyperemesis gravidarum who was treated with parenteral prochlorperazine, highlighting the potential risks associated with its use 4.
- Another study published in the Journal of Family Practice noted that prochlorperazine is one of the options for pharmacologic management of nausea and vomiting of pregnancy, but it is not recommended as a first-line treatment due to its potential side effects 5.
- A review of the safety of drugs for the treatment of nausea and vomiting of pregnancy published in Expert Opinion on Drug Safety found that most antiemetics, including prochlorperazine, appear to be safe to use in pregnancy, but it is essential to weigh the benefits and risks of each medication 6.
- The use of prochlorperazine during pregnancy has been increasing over time, according to a retrospective cohort study published in BMC Pregnancy and Childbirth, which found that the use of prochlorperazine, as well as other antiemetics, increased between 2002 and 2019 7.