Can prochlorperazine be given to children?

Prochlorperazine Use in Children

Prochlorperazine should not be used in children under 2 years of age or weighing less than 20 pounds, and should be used with caution in older children due to increased risk of extrapyramidal symptoms compared to adults. 1

Dosing Guidelines for Children

• Prochlorperazine is FDA-approved for children ≥2 years of age and weighing ≥20 pounds for severe nausea and vomiting, with weight-based dosing 1:

  • 20-29 lbs: 2.5 mg 1-2 times daily (maximum 7.5 mg/day)
  • 30-39 lbs: 2.5 mg 2-3 times daily (maximum 10 mg/day)
  • 40-85 lbs: 2.5 mg 3 times daily or 5 mg twice daily (maximum 15 mg/day)

• For children with schizophrenia (2-12 years), starting dosage is 2.5 mg 2-3 times daily with maximum daily dosage of 1:

  • Ages 2-5: 20 mg total daily
  • Ages 6-12: 25 mg total daily

Safety Concerns in Children

• Children are more prone to developing extrapyramidal reactions than adults, even at moderate doses 1, 2

• The most common adverse effects in children receiving prochlorperazine include 2:

  • Sedation (10% in multiple-dose studies)
  • Extrapyramidal symptoms (9% in single-dose studies, 4% in multiple-dose studies)

• Serious adverse events have been reported, though rarely 2:

  • Seizures
  • Neuroleptic malignant syndrome
  • Autonomic collapse
  • Tardive dyskinesia
  • Fatalities (5 cases reported)

• Neurological side effects appear to be predominantly independent of dosage and include 3:

  • Impaired consciousness
  • Dyskinesia (most frequent)
  • Pyramidal signs
  • Hypertonus

Clinical Considerations

• In oncology settings, prochlorperazine is listed as a rescue therapy option for low-emetic-risk radiation therapy in adults, but pediatric-specific recommendations are different 4

• For pediatric patients receiving chemotherapy, the American Society of Clinical Oncology (ASCO) recommends specific antiemetic combinations based on emetic risk level 4:

  • For high-emetic-risk: a three-drug combination of 5-HT3 receptor antagonist, dexamethasone, and aprepitant
  • No specific mention of prochlorperazine in the pediatric chemotherapy recommendations

• A pharmacokinetic study in children (ages 1-9 years) receiving cancer chemotherapy showed substantial interpatient variability in prochlorperazine pharmacokinetics, suggesting that dose requirements may differ among patients 5

Important Precautions

• Take particular precaution when administering prochlorperazine to children with acute illnesses or dehydration due to increased risk of dystonias 1

• Parents should be instructed not to exceed prescribed dosage, as the possibility of adverse reactions increases with higher doses 1

• If signs of restlessness and excitement occur, additional doses should not be administered 1

• Extrapyramidal symptoms typically resolve after discontinuation of the drug 3

• Formulation matters: A case report showed significant harm when converting from prochlorperazine mesilate liquid to crushed prochlorperazine maleate tablets, suggesting these forms should not be treated as equivalent 6

Alternative Antiemetics for Children

• Metoclopramide is another antiemetic option for children, but it also carries risks of extrapyramidal symptoms (9%), diarrhea (6%), and sedation (6%) 7

• Drug regulatory agencies in Canada and the EU have contraindicated metoclopramide use in children <1 year and caution against its use in children <5 years 7

In summary, while prochlorperazine can be given to children ≥2 years of age and weighing ≥20 pounds, it should be used with caution due to the increased risk of extrapyramidal symptoms in the pediatric population. Close monitoring is essential, and the lowest effective dosage should be used.