What is the typical duration of treatment with Stemitil (prochlorperazine) for nausea and vomiting?

Duration of Treatment with Prochlorperazine (Stemitil) for Nausea and Vomiting

Prochlorperazine (Stemitil) should typically be administered at 5-10 mg four times daily for short-term use, generally not exceeding 12 weeks due to the risk of persistent tardive dyskinesia that may prove irreversible. 1

Recommended Dosing and Duration

• Standard dosing: 5-10 mg four times daily 2
• Maximum duration: Should not exceed 12 weeks when used for non-psychotic conditions 1
• Administration routes:
  • Oral tablets
  • Intravenous (for acute settings)
  • Suppositories (alternative route)

Duration Based on Clinical Context

Acute Nausea and Vomiting

• Uncomplicated gastritis/gastroenteritis: Short course of 1-3 days typically sufficient 3
• Chemotherapy-induced nausea: Used for 2-3 days during the risk period 2
• Opioid-induced nausea: Short-term use (usually 5-7 days) while tolerance to opioid-induced nausea develops 4

Breakthrough or Persistent Nausea

• For persistent symptoms, treatment may be extended but should be regularly reassessed
• Consider switching to alternative antiemetics if response is inadequate after 48-72 hours

Important Considerations and Cautions

Side Effect Monitoring

• Extrapyramidal symptoms (EPS): Particularly akathisia, which can occur within the first week of treatment 4
  • Studies show 14% incidence of akathisia with prochlorperazine compared to 0% with newer agents 4
  • Most EPS occur early in treatment, highlighting the importance of short-term use

Risk Factors for Adverse Effects

• Prolonged use: Increases risk of tardive dyskinesia
• Higher doses: Greater than 20 mg/day increases side effect risk 1
• Patient factors: Elderly patients, those with renal impairment, and patients with cardiac disease require closer monitoring

Efficacy Considerations

• Prochlorperazine works rapidly, with mean time to cessation of vomiting around 8.5 minutes when given intravenously 5
• In studies of acute dizziness with nausea, a mean duration of 7.2 days at 15 mg/day showed good efficacy with minimal side effects 6

Treatment Algorithm

1. Initial treatment: Start with 5-10 mg four times daily
2. Assess response: Within 24-48 hours
3. If effective with no side effects: Continue for shortest duration needed (typically 3-7 days for most causes)
4. If inadequate response: Consider increasing dose (not exceeding 20 mg/day) or switching to alternative antiemetic
5. If side effects occur: Reduce dose or discontinue and switch to alternative agent
6. Maximum duration: Do not exceed 12 weeks regardless of indication

Remember that prochlorperazine should be used for the shortest duration possible to control symptoms while minimizing the risk of serious adverse effects, particularly tardive dyskinesia, which can be irreversible.