What is the recommended dose of STEMetil (Prochlorperazine)?

Recommended Dosage of Prochlorperazine (STEMetil)

The recommended dose of prochlorperazine (STEMetil) is 5-10 mg orally every 6-8 hours or 5-10 mg IV every 6-8 hours, with a maximum daily dose of 40 mg. 1

Dosage Forms and Routes of Administration

Oral Administration

• Standard dose: 10 mg every 6 hours as needed 2, 1
• Daily maximum: 40 mg 2

Intravenous Administration

• Standard dose: 5-10 mg IV every 6-8 hours 1
• For rapid control: 2.5-5 mg IV provides faster relief than oral administration 1, 3
• IV administration achieves approximately 100% bioavailability with plasma concentrations more than twice as high as oral administration 1

Rectal Administration

• Standard dose: 25 mg suppository every 12 hours 2

Indications and Clinical Applications

Antiemetic Therapy

• Effective for nausea and vomiting in various settings:
  • Low emetogenic risk chemotherapy 2
  • Breakthrough treatment for chemotherapy-induced nausea/vomiting 2
  • Acute dizziness with associated nausea and vomiting 4
  • Cyclic vomiting syndrome (CVS) 2

Specific Clinical Scenarios

• Acute migraine: Effective in pediatric emergency department settings when combined with diphenhydramine to prevent akathisia 5
• Acute myocardial infarction: 2.5 mg IV has been shown to effectively relieve nausea and vomiting without causing symptomatic hypotension 3

Monitoring and Adverse Effects

Common Adverse Effects

• CNS depression
• Anticholinergic effects
• Extrapyramidal symptoms
• Drug-induced leukopenia or neutropenia (rare)
• Neuroleptic malignant syndrome (rare) 2

Special Precautions

• Monitor for dystonic reactions: Use diphenhydramine 25-50 mg PO or IV every 4-6 hours for dystonic reactions 2
• If allergic to diphenhydramine, use benztropine 1-2 mg IV or IM for one dose, followed by oral dose of 1-2 mg daily or BID if needed 2
• Peripheral IV administration: Can cause tissue injury, including gangrene or thrombophlebitis 2
• Use with caution in patients with:
  • History of leukopenia or neutropenia
  • Dementia
  • Glaucoma
  • Seizure disorder 2

Drug Interactions

• Prochlorperazine can interact with dofetilide and should be avoided in combination 2
• May cause QT prolongation when used with other QT-prolonging medications 2

Efficacy Data

• In a real-world study, prochlorperazine at a mean dose of 14.9 mg/day for a mean duration of 7.2 days was well-tolerated and effective for acute dizziness 4
• Only 0.006% of patients reported adverse drug reactions (headache, asthenia, somnolence) which were mild and resolved completely 4

Clinical Pearl

When administering prochlorperazine IV for rapid control of severe nausea and vomiting, consider starting with a lower dose of 2.5 mg in hemodynamically vulnerable patients (such as those with acute myocardial infarction), as this has been shown to be effective while minimizing the risk of hypotension 3.