Prochlorperazine (Compazine) Dosing for a 48 kg 16-Year-Old
The recommended starting dose of prochlorperazine (Compazine) for a 16-year-old patient weighing 48 kg is 5 mg orally 2-3 times daily, not to exceed 15 mg per day. 1
Dosage Considerations
The FDA-approved labeling for prochlorperazine provides specific guidance for pediatric dosing based on weight and age:
- For children 40-85 lbs (18-38.5 kg): 2.5 mg 3 times daily or 5 mg 2 times daily, not to exceed 15 mg per day 1
- For adolescents 12-16 years: Total daily dosage usually does not exceed 25 mg 1
Since this 16-year-old patient weighs 48 kg (approximately 106 lbs), they fall into the adolescent category but should still receive careful dosing due to their relatively low weight.
Route of Administration
- Oral administration is appropriate for outpatient management of nausea and vomiting
- For severe nausea and vomiting requiring rapid control, intravenous administration may be considered at a lower dose (2.5-5 mg) 2
Important Safety Considerations
Extrapyramidal symptoms (EPS): Children and adolescents are more prone to developing EPS, even at moderate doses 1. Studies show EPS occurs in approximately 9% of children after single doses and 4% with multiple doses 3.
Akathisia: This is a common adverse effect, occurring in up to 44% of patients receiving intravenous prochlorperazine 4. Monitor for symptoms of restlessness, inability to sit still, or pacing.
Sedation: This is reported in about 10% of children receiving multiple doses 3.
Serious adverse events: Though rare, serious complications can include seizures, neuroleptic malignant syndrome, and tardive dyskinesia 3.
Monitoring Recommendations
- Observe the patient for at least 30-60 minutes after administration for signs of acute adverse reactions
- Monitor for:
- Extrapyramidal symptoms (muscle stiffness, tremor, restlessness)
- Excessive sedation
- Hypotension
- Akathisia (subjective feeling of restlessness)
Alternative Antiemetics to Consider
If prochlorperazine is contraindicated or not tolerated, ondansetron may be considered as an alternative:
- Recommended dose: 0.15 mg/kg IV (maximum 8 mg) 5
- Ondansetron has a better safety profile in pediatric patients with fewer extrapyramidal side effects 5
Precautions
- Do not exceed the recommended dosage as the risk of adverse reactions increases with higher doses 1
- Use caution in patients with acute illnesses or dehydration 1
- If signs of restlessness or excitement occur, do not administer additional doses 1
- Prochlorperazine should not be used in pediatric surgery 1
By following these guidelines, prochlorperazine can be safely administered to manage nausea and vomiting in this 16-year-old patient while minimizing the risk of adverse effects.