Maximum Recommended Daily Dose of Compazine (Prochlorperazine)
The maximum recommended daily dose of prochlorperazine (Compazine) is 40 mg per day for adults when used for severe nausea and vomiting. 1
Dosing Guidelines by Indication
For Nausea and Vomiting
- Standard oral dosing: 5-10 mg 3-4 times daily 2, 1
- Daily dosages above 40 mg should only be used in resistant cases 1
- For chemotherapy-induced nausea and vomiting, prochlorperazine is typically administered at 10-20 mg orally 3-4 times daily 2
For Psychiatric Disorders
- Non-psychotic anxiety: Maximum 20 mg per day, not to exceed 12 weeks of treatment 1
- Psychotic disorders including schizophrenia:
Special Populations
Pediatric Dosing
- Not recommended for children under 20 pounds or under 2 years of age 1
- Weight-based dosing for children with severe nausea and vomiting:
- For children with schizophrenia:
Elderly Patients
- Dosage should be increased more gradually in elderly patients 1
- Lower starting doses are recommended due to increased risk of side effects 1
Safety Considerations
Common Side Effects
- Sedation is common (10% in multiple-dose studies) 3
- Extrapyramidal symptoms (EPS) occur in approximately 4-9% of patients 3
- Higher doses increase risk of hypotension and extrapyramidal reactions 4
Serious Adverse Events
- Repeated doses can potentially prolong QT interval 5
- Rare but serious adverse events include seizures, neuroleptic malignant syndrome, and tardive dyskinesia 3
- Fatal outcomes have been reported in pediatric patients, though rarely 3
Clinical Pearls
- When treating refractory nausea, consider adding a serotonin antagonist (e.g., ondansetron) if prochlorperazine alone is insufficient 2, 5
- For persistent symptoms, consider opioid rotation or adding another agent class 2
- Intravenous administration (2.5-5 mg) has been shown to control vomiting in approximately 8.5 minutes, faster than intramuscular administration 6
- The maximum tolerated dose in cancer chemotherapy studies was found to be 1.2 mg/kg IV, with dose-limiting toxicity being hypotension 4
Monitoring Recommendations
- Monitor for extrapyramidal symptoms, particularly with higher doses 3, 4
- Watch for signs of sedation, which may affect patient safety 3
- Be vigilant for hypotension, especially with intravenous administration 4
Remember that while the absolute maximum daily dose can be higher for psychiatric indications, the standard maximum for nausea and vomiting is 40 mg per day, with careful monitoring required if exceeding this dose 1.