Can Stematil (prochlorperazine) be used for extrapyramidal side effects?

Stematil (Prochlorperazine) Should Not Be Used to Treat Extrapyramidal Side Effects

Stematil (prochlorperazine) should absolutely not be used to treat extrapyramidal side effects (EPS); in fact, it is a medication that commonly causes these side effects rather than treating them. 1, 2

Why Prochlorperazine Cannot Be Used for EPS

Prochlorperazine (Stematil) is an antiemetic medication that belongs to the phenothiazine class of antipsychotics. Rather than treating extrapyramidal symptoms, it actually:

• Acts as a dopamine antagonist that blocks D2 receptors in the basal ganglia 2
• Is known to cause extrapyramidal symptoms as a side effect 3
• Has been documented to cause akathisia (a form of EPS) within one week of administration 3

Medications Actually Recommended for EPS Management

According to clinical guidelines, the appropriate medications for managing extrapyramidal symptoms include:

1. For acute dystonic reactions:

   • Anticholinergic medications (first-line) 1, 4
   • Benztropine 1-2 mg daily (maximum 6 mg daily) 1, 4
   • Benzodiazepines (alternative option) 4

2. For pseudoparkinsonism:

   • Dose reduction of the offending antipsychotic 4
   • Addition of anticholinergic agents 1, 4
   • Amantadine as an alternative 4
   • Switching to a lower potency or atypical antipsychotic 1, 5

3. For akathisia:

   • Beta-blockers, particularly propranolol 10-30 mg two to three times daily 1, 4
   • Lorazepam 0.5-2 mg as needed (caution: risk of tolerance and dependence) 1
   • Anticholinergic agents (less effective for akathisia than for other EPS) 4

Risk Factors for Developing EPS

Certain populations have higher risk for developing EPS:

• Patients under 30 years of age 6
• Elderly patients 1
• Males 1
• Patients with previous history of tremors 1
• Previous use of antipsychotics 1
• Patients on polypharmacy 1
• Patients on higher doses of antipsychotics 1
• Patients with AIDS 6
• Patients with renal disease 6
• Oncology patients 6

Comparative EPS Risk Among Antipsychotics

If a patient is experiencing EPS from an antipsychotic and requires continued antipsychotic treatment, consider switching to an agent with lower EPS risk:

• Highest EPS risk: Conventional antipsychotics (like prochlorperazine) 1, 5
• Moderate EPS risk: Risperidone (among atypical antipsychotics) 1, 5
• Lowest EPS risk: Clozapine and quetiapine 1, 5

Important Clinical Considerations

• EPS can sometimes present as psychiatric symptoms (anxiety, depression, or catatonia), leading to misdiagnosis 6
• Regular assessment for abnormal movements using standardized scales like the Abnormal Involuntary Movement Scale (AIMS) is recommended every 3-6 months for patients on antipsychotics 1
• Anticholinergic medications should not be used routinely for EPS prevention but reserved for treatment of significant persistent symptoms 1

Common Pitfalls to Avoid

1. Misidentification of the cause: Prochlorperazine (Stematil) is a cause of EPS, not a treatment 3
2. Overlooking akathisia: This form of EPS can be easily missed or misdiagnosed as anxiety or agitation 3, 6
3. Prolonged anticholinergic use: Long-term prophylactic use of anticholinergics is controversial and may lead to additional side effects 4
4. Failure to consider medication interactions: When treating EPS, consider potential interactions with the patient's other medications 1