What is the recommended dosage of Stemitil (Prochlorperazine) for treating nausea and vomiting?

Recommended Dosage of Stemitil (Prochlorperazine) for Nausea and Vomiting

For adults with nausea and vomiting, the recommended dosage of Stemitil (Prochlorperazine) is 5-10 mg orally 3-4 times daily, with a maximum daily dose of 40 mg for resistant cases. 1, 2

Adult Dosing

Oral Administration

• For most adults: 5-10 mg 3-4 times daily 2
• Daily dosages above 40 mg should only be used in resistant cases 2
• For chemotherapy-induced nausea and vomiting: 10-20 mg 3-4 times daily 1
• Frequency of administration should be adjusted according to the severity of symptoms and patient response 2

Intravenous Administration

• For rapid control of vomiting in emergency settings: 2.5-5 mg IV 3
• IV administration has shown a mean time to cessation of vomiting of 8.5 minutes compared to 35 minutes for IM administration 3

Special Populations

Elderly Patients

• Lower dosages are generally sufficient for most elderly patients 2
• Start with the lowest recommended dosage and increase gradually 2
• Elderly patients should be observed closely as they appear more susceptible to hypotension and neuromuscular reactions 2

Debilitated or Emaciated Patients

• Dosage should be increased more gradually in these patients 2

Pediatric Dosing

Prochlorperazine should not be used in:

• Children under 20 pounds in weight 2
• Children under 2 years of age 2

For children with severe nausea and vomiting:

• 20-29 lbs: 2.5 mg 1-2 times daily (not to exceed 7.5 mg/day) 2
• 30-39 lbs: 2.5 mg 2-3 times daily (not to exceed 10 mg/day) 2
• 40-85 lbs: 2.5 mg 3 times daily or 5 mg twice daily (not to exceed 15 mg/day) 2

Clinical Considerations

Efficacy

• Prochlorperazine works by inhibiting dopamine receptors in the brain's chemoreceptor trigger zone 1
• In comparative studies, prochlorperazine has demonstrated superior efficacy compared to promethazine for uncomplicated nausea and vomiting 4
• When combined with oxycodone in cancer patients, prochlorperazine (5 mg) reduced the incidence of nausea to 18.1% 5

Administration Timing

• For chemotherapy-induced nausea and vomiting, prochlorperazine should be administered 3-4 times daily 1
• For refractory gastroparesis symptoms, prochlorperazine can be administered at 5-10 mg four times daily 1

Route of Administration

• Oral administration is recommended for routine use 1
• Intravenous administration may be preferred for rapid control of symptoms in emergency settings 3, 6
• Buccal formulations achieve higher plasma concentrations by direct absorption into systemic circulation and have shown faster onset of effect compared to oral administration 7

Potential Side Effects and Monitoring

• Monitor for extrapyramidal reactions, especially in children who seem more prone to develop these reactions even on moderate doses 2
• Watch for signs of restlessness and excitement; if these occur, do not administer additional doses 2
• Take particular precaution when administering to children with acute illnesses or dehydration 2
• Less drowsiness and sedation have been reported with buccal compared to oral administration 7

Combination Therapy

• For refractory nausea and vomiting, prochlorperazine can be combined with serotonin antagonists (e.g., ondansetron) and corticosteroids 1
• In postoperative settings, prochlorperazine can be part of a multimodal approach to control nausea and vomiting 1

Remember that prochlorperazine is one of several antiemetic options, and selection should be based on the specific clinical situation, with consideration of patient factors and the underlying cause of nausea and vomiting 1.