Contraindications for Stemtil (Prochlorperazine) Injection
Prochlorperazine injection is contraindicated in patients with CNS depression, coma, bone marrow depression, hypersensitivity to phenothiazines, and in those taking monoamine oxidase inhibitors. 1
Absolute Contraindications
Hematologic Conditions
- Bone marrow depression or previous blood dyscrasias with phenothiazines (including leukopenia, agranulocytosis, thrombocytopenic purpura) are absolute contraindications unless potential benefits clearly outweigh risks 1
Neurologic and Psychiatric States
- CNS depression or comatose states preclude use of prochlorperazine 1
- Concurrent MAOI therapy is contraindicated due to severe drug interactions 2
Hypersensitivity
- Previous hypersensitivity reactions to phenothiazines, including jaundice or blood dyscrasias, contraindicate use 1
Critical Drug Interactions (Contraindicated Combinations)
Cardiac Medications
- Dofetilide therapy: Prochlorperazine is explicitly contraindicated with dofetilide due to QT prolongation risk 2
- This interaction is particularly dangerous as both drugs prolong the QT interval, creating additive risk for torsades de pointes 2
Serotonergic Agents
- Extreme caution required (approaching contraindication) when combining with tramadol, meperidine, methadone, fentanyl, dextromethorphan, or amphetamines due to serotonin syndrome risk 3
High-Risk Populations Requiring Extreme Caution
Cardiovascular Disease
- Patients with mitral insufficiency or pheochromocytoma have experienced severe hypotension with phenothiazines at recommended doses 1
- Uncontrolled hypertension or ischemic heart disease warrant extreme caution 2
Neurologic Conditions
- Dementia, glaucoma, or seizure disorder require careful risk-benefit assessment 2
- History of leukopenia or neutropenia necessitates caution due to drug-induced blood dyscrasias risk 2, 1
Pregnancy and Lactation
- All antipsychotic medications, including prochlorperazine, are contraindicated in women who are or may become pregnant 2
Common Pitfalls to Avoid
Pediatric Use
- Children have significantly higher risk of extrapyramidal symptoms (9% after single dose, 4% with multiple doses) and sedation (10%) 4
- Serious adverse events including seizures, neuroleptic malignant syndrome, and five reported fatalities have occurred in pediatric patients 4, 5
- Dyskinesia is the most frequent neurological manifestation in children, appearing independent of dosage 5
Elderly Patients
- Increased risk of falls due to somnolence, postural hypotension, and motor instability 1
- Complete fall risk assessments are mandatory when initiating treatment 1
Concurrent Lithium Therapy
- Lithium plus prochlorperazine can cause encephalopathic syndrome (weakness, lethargy, fever, tremulousness, confusion, extrapyramidal symptoms) potentially followed by irreversible brain damage 1
- Monitor closely for early neurologic toxicity and discontinue promptly if signs appear 1
Contact Dermatitis Risk
- Avoid skin contact with injection solution due to contact dermatitis risk 1