What are the contraindications for Compazine (prochlorperazine)?

Compazine (Prochlorperazine) Contraindications

Prochlorperazine is absolutely contraindicated in patients with bone marrow depression, prior hypersensitivity reactions to phenothiazines (including blood dyscrasias or jaundice), Parkinson's disease, and dementia with Lewy bodies. 1, 2

Absolute Contraindications

Hematologic Conditions

• Bone marrow depression - Prochlorperazine should not be administered to any patient with existing bone marrow suppression 1
• History of blood dyscrasias - Prior phenothiazine-induced blood disorders (leukopenia, neutropenia) represent an absolute contraindication unless potential benefits clearly outweigh risks in the physician's judgment 1, 2

Neurologic Conditions

• Parkinson's disease - Do not use due to high risk of extrapyramidal symptoms (EPS) 2
• Dementia with Lewy bodies - Contraindicated due to severe risk of EPS 2

Prior Hypersensitivity

• Previous phenothiazine hypersensitivity - Including jaundice or other allergic reactions to any phenothiazine compound 1

Strong Cautions (Relative Contraindications)

Neuropsychiatric Conditions

• History of seizure disorder - Use with extreme caution as prochlorperazine can lower seizure threshold 2
• Dementia - Exercise caution due to increased risk of adverse neurologic effects 2
• Glaucoma - Anticholinergic effects may worsen intraocular pressure 2

Hematologic Monitoring Required

• History of leukopenia or neutropenia - Prochlorperazine can cause drug-induced leukopenia or neutropenia; use only with careful monitoring 2

Cardiac Considerations

• QTc prolongation risk - While not an absolute contraindication, prochlorperazine may prolong QTc interval and carries risk of neuroleptic malignant syndrome 2
• Avoid concurrent use with other QT-prolonging medications when possible 2

Hepatic and Renal Impairment

• Severe hepatic impairment - Use with caution and consider dose reduction 2
• Severe renal impairment - Use with caution and consider dose reduction 2

Pregnancy and Lactation

Pregnancy

• Not recommended during pregnancy except in cases of severe, intractable nausea and vomiting where drug intervention is required and potential benefits outweigh possible hazards 1
• Third trimester exposure poses risk to neonates including extrapyramidal symptoms, withdrawal symptoms, agitation, hypertonia, hypotonia, tremor, somnolence, respiratory distress, and feeding disorders 1
• Reported cases of prolonged jaundice, extrapyramidal signs, and abnormal reflexes in newborns whose mothers received phenothiazines 1

Lactation

• Excreted in breast milk - Caution should be exercised when administering to nursing mothers 1

Special Population Warnings

Pediatric Use

• Extrapyramidal symptoms occur in 4-9% of children receiving prochlorperazine 3
• Sedation occurs in approximately 10% of pediatric patients 3
• Serious adverse events including seizures, neuroleptic malignant syndrome, and fatalities have been reported in children 3

Elderly Patients

• Increased fall risk - Prochlorperazine causes somnolence, postural hypotension, and motor/sensory instability leading to falls, fractures, and injuries 1
• Complete fall risk assessments required when initiating therapy and recurrently during long-term use 1
• Lower doses recommended in older or frail patients 2

Common Pitfalls to Avoid

• Do not overlook movement disorder history - Even remote history of Parkinson's disease or Lewy body dementia is an absolute contraindication 2
• Do not ignore prior phenothiazine reactions - Any previous adverse reaction to phenothiazines should prompt extreme caution or avoidance 1
• Do not combine with multiple CNS depressants - Prochlorperazine intensifies and prolongs the action of alcohol, anesthetics, and narcotics 1
• Do not use casually in pregnancy - Reserve only for severe, intractable cases where benefits clearly outweigh substantial fetal risks 1