Is Compazine (prochlorperazine) available in an intravenous (IV) form?

Is Compazine Available in IV Form?

Yes, Compazine (prochlorperazine) is available in an intravenous formulation and is FDA-approved for IV administration. 1

FDA-Approved IV Formulation

• Prochlorperazine edisylate injection is specifically formulated as a sterile solution for both intramuscular and intravenous administration, containing 5 mg of prochlorperazine per mL. 1

• The solution is supplied at a pH of 4.2-6.2 and should be protected from light, though slight yellowish discoloration does not alter potency. 1

IV Dosing Guidelines

For Severe Nausea and Vomiting

• The recommended IV dose is 2.5 mg to 10 mg administered by slow IV injection or infusion at a rate not exceeding 5 mg per minute. 1

• A single IV dose should not exceed 10 mg, and total daily IV dosage should not exceed 40 mg per day. 1

• The medication may be administered either undiluted or diluted in isotonic solution. 1

• Bolus injection should be avoided due to risk of hypotension. 1

Clinical Context from Guidelines

• NCCN guidelines recommend prochlorperazine 10 mg PO/IV every 6 hours as breakthrough treatment for chemotherapy-induced nausea and vomiting. 2

• For palliative care settings, prochlorperazine can be administered via continuous IV or subcutaneous infusion for intractable nausea and vomiting. 2

• In postoperative pain management, prochlorperazine is recommended via IV route for managing nausea and vomiting targeting dopaminergic pathways. 2

Clinical Efficacy of IV Administration

• IV prochlorperazine 2.5 mg achieves cessation of vomiting in a mean time of 8.5 minutes, significantly faster than the 35 minutes required for IM administration (P < 0.05). 3

• In comparative trials, IV prochlorperazine 10 mg demonstrated superior efficacy to promethazine 25 mg IV for uncomplicated nausea and vomiting, with significantly better symptom relief at 30 and 60 minutes (P = 0.004 and P < 0.001). 4

• Treatment failure rates are significantly lower with IV prochlorperazine (9.5%) compared to promethazine (31%), with a difference of 21% (95% CI: 5-38%). 4

Critical Safety Considerations

Hypotension Risk

• Hypotension is a documented risk when prochlorperazine is administered IV, particularly with bolus injection or rapid infusion. 1

• The rate of IV administration must not exceed 5 mg per minute to minimize this risk. 1

Akathisia

• Akathisia develops in 44% of patients within 1 hour of receiving a single 10 mg IV dose of prochlorperazine (95% CI: 34-54%). 5

• The akathisia can be graded as mild (14%), moderate (22%), or severe (8%). 5

• Delayed akathisia symptoms may develop within 48 hours in approximately 3% of patients. 5

• Decreasing the infusion rate can reduce akathisia incidence, and acute symptoms can be treated with IV diphenhydramine. 6

QT Prolongation

• Repeated doses of prochlorperazine can potentially prolong QT interval. 7, 8

Contraindications for IV Use

• Subcutaneous administration is not advisable due to local irritation. 1

• Bolus injection should not be used due to hypotension risk. 1

Common Pitfalls to Avoid

• Do not exceed 5 mg per minute infusion rate, as faster administration increases hypotension and akathisia risk. 1

• Do not mix prochlorperazine with other agents in the syringe, as compatibility has not been established. 1

• Monitor elderly patients closely as they are more susceptible to hypotension and neuromuscular reactions; use lower dosages in this population. 1

• Prochlorperazine causes significantly less sedation (38%) compared to promethazine (71%), which may be advantageous when sedation is undesirable. 4