Recommended Dosage of Prochlorperazine (Compazine) for Chemotherapy Patients
For chemotherapy patients experiencing nausea and vomiting, the recommended dosage of prochlorperazine (Compazine) is 10 mg orally every 4-6 hours as needed, or 25 mg rectally every 12 hours for breakthrough treatment. 1, 2
Dosing Guidelines by Route of Administration
Oral Administration
- 10 mg PO every 4-6 hours as needed for nausea and vomiting 1, 2
- Maximum daily oral dose should not exceed 40 mg 3
- Can be used as part of low emetic risk chemotherapy regimens 2
Rectal Administration
- 25 mg suppository PR every 12 hours for breakthrough treatment of chemotherapy-induced nausea/vomiting 2
- Particularly useful when oral administration is not feasible due to ongoing vomiting 1
Intravenous Administration
- 5-10 mg IV every 4-6 hours as needed 3
- Should be administered by slow IV injection or infusion at a rate not exceeding 5 mg per minute 3
- Maximum daily IV dose should not exceed 40 mg 3
- Do not use bolus injection due to risk of hypotension 3
Dosing Based on Chemotherapy Emetogenic Potential
Low Emetogenic Potential Chemotherapy
- Prochlorperazine 10 mg PO or IV every 4-6 hours as needed 1, 4
- Can be used as monotherapy or with dexamethasone 12 mg PO/IV daily 1
Moderate to High Emetogenic Potential Chemotherapy
- Prochlorperazine alone is insufficient for highly emetogenic chemotherapy regimens 4
- For these patients, prochlorperazine should be part of a multi-drug regimen including 5-HT3 receptor antagonists (e.g., ondansetron, granisetron) and dexamethasone 1
Management of Breakthrough Nausea and Vomiting
- For breakthrough symptoms, add prochlorperazine 10 mg PO/IV every 4-6 hours or 25 mg PR every 12 hours 1, 2
- Consider around-the-clock administration rather than PRN dosing for persistent symptoms 1, 2
- The general principle of breakthrough treatment is to add an agent from a different drug class to the current regimen 1
Special Considerations
- Monitor for dystonic reactions; use diphenhydramine 25-50 mg PO or IV every 4-6 hours if dystonic reactions occur 1, 2
- Use with caution in elderly patients who may be more susceptible to hypotension and neuromuscular reactions 3
- Subcutaneous administration is not recommended due to local irritation 3
- Prochlorperazine should not be used in pediatric patients under 20 pounds in weight or under two years of age 3
Comparative Efficacy
- Prochlorperazine and metoclopramide have shown similar efficacy in controlling chemotherapy-induced nausea and vomiting, with prochlorperazine offering more consistent control after the first day of treatment 5
- High-dose prochlorperazine (0.8 mg/kg IV) has demonstrated comparable efficacy to high-dose metoclopramide for emetogenic chemotherapy, with prochlorperazine being more cost-effective 6
- In studies comparing prochlorperazine with ondansetron and dexamethasone for delayed CINV, patients receiving prochlorperazine reported the lowest average nausea scores 7
Common Pitfalls and Caveats
- Prochlorperazine alone is insufficient for highly emetogenic chemotherapy regimens 4
- Repeated doses can prolong QT interval and potentially precipitate torsades de pointes 2
- CNS depression, anticholinergic effects, and extrapyramidal symptoms are potential adverse effects 2
- Assess for other causes of nausea before initiating therapy 4
- Use with caution in patients with cardiovascular disease due to potential hypotensive effects 4, 3