Recommended Dosage of IV Compazine (Prochlorperazine) for Nausea
For adult patients with nausea, the recommended IV dose of prochlorperazine is 2.5 mg to 10 mg administered by slow IV injection or infusion at a rate not exceeding 5 mg per minute. 1
Dosing Guidelines
- IV prochlorperazine should be administered either undiluted or diluted in isotonic solution 1
- A single dose should not exceed 10 mg 1
- Total IV dosage should not exceed 40 mg per day 1
- Do not use bolus injection due to risk of hypotension 1
- For most patients, 5-10 mg is an effective dose for controlling nausea and vomiting 1, 2
Administration Technique
- Administer by slow IV injection or infusion at a rate not exceeding 5 mg per minute 1
- When rapid control of vomiting is needed, lower doses of 2.5 mg IV have shown effectiveness with a mean time to cessation of vomiting of 8.5 minutes 3
- If necessary, the dose may be repeated every 3 or 4 hours as needed 1
Special Populations
- For elderly patients, use dosages in the lower range (2.5-5 mg) as they appear more susceptible to hypotension and neuromuscular reactions 1
- Dosage should be increased more gradually in debilitated or emaciated patients 1
Efficacy
- Prochlorperazine has been shown to be significantly more effective than promethazine for relieving nausea and vomiting more quickly and completely in emergency department patients 2
- Studies show prochlorperazine has fewer treatment failures (9.5% vs 31%) compared to promethazine 2
- However, for chemotherapy-induced nausea and vomiting, high-dose metoclopramide has shown superior antiemetic efficacy compared to prochlorperazine 4
Potential Side Effects and Precautions
- Monitor for hypotension, which is a possibility with IV administration 1
- Watch for extrapyramidal reactions, which may occur even with moderate doses 1
- Repeated doses can prolong QT interval and potentially precipitate torsades de pointes 5
- Prochlorperazine causes significantly less sedation compared to some other antiemetics (38% vs 71% for promethazine) 2
Alternative Options
- For patients with persistent nausea despite prochlorperazine, consider adding a serotonin antagonist such as ondansetron or granisetron 5
- For chemotherapy-induced nausea, a combination approach with dexamethasone may be more effective 5
- For patients with gastroparesis-associated refractory nausea not responding to conventional antiemetics including prochlorperazine, aprepitant may be considered 6
Remember that IV prochlorperazine should be administered with careful monitoring, especially for hypotension and extrapyramidal symptoms, which are the most common serious adverse effects.