Prochlorperazine (Compazine) Safety in Breastfeeding
Prochlorperazine is considered safe to use during breastfeeding and does not require any waiting period or special precautions before nursing. 1
Guideline Recommendation
The Association of Anaesthetists 2020 guideline explicitly lists prochlorperazine among anti-emetics that are compatible with breastfeeding, alongside ondansetron, granisetron, cyclizine, dexamethasone, metoclopramide, and domperidone. 1 This guideline provides clear categorization without caveats or monitoring requirements for prochlorperazine, distinguishing it from medications that require caution (such as tramadol or high-dose oxycodone). 1
Clinical Context
No monitoring required: Unlike some medications where infant observation for sedation or feeding difficulties is recommended, prochlorperazine does not carry such warnings in the guideline framework. 1
Phenothiazine class considerations: While prochlorperazine is a phenothiazine antipsychotic used primarily as an antiemetic, the broader antipsychotic literature suggests that older typical antipsychotics like perphenazine and trifluoperazine (also phenothiazines) demonstrate no known developmental dangers during breastfeeding. 2
Contrast with chlorpromazine: It's worth noting that chlorpromazine, another phenothiazine, may induce developmental concerns according to some sources 2, but prochlorperazine is specifically endorsed in the high-quality 2020 guideline without such warnings. 1
Practical Application
Resume breastfeeding immediately: No need to pump and discard milk or wait after taking prochlorperazine. 1
Standard dosing applies: The medication can be used at therapeutic doses without dose adjustment for breastfeeding mothers. 1
Preferred antiemetic option: Given its explicit inclusion in the safe antiemetic list, prochlorperazine represents a reasonable first-line choice when antiemetic therapy is needed in a breastfeeding mother. 1