What is the use of Prochlorperazine (antiemetic medication)?

From the Guidelines

Prochlorperazine is recommended as a first-line treatment for nausea and vomiting, with a typical adult dose of 5-10 mg orally three to four times daily, as supported by the most recent and highest quality study 1.

Key Points

• Prochlorperazine belongs to the phenothiazine class of drugs and works by blocking dopamine receptors in the brain's chemoreceptor trigger zone.
• The medication typically begins working within 30-60 minutes of administration and can provide relief for several hours.
• Common side effects include drowsiness, dizziness, and dry mouth, while more serious side effects can include extrapyramidal symptoms like akathisia and dystonia.
• Prochlorperazine should be used cautiously in elderly patients and those with Parkinson's disease, seizure disorders, or liver problems.
• Patients should be advised to avoid alcohol while taking this medication as it can enhance sedative effects.

Administration and Dosage

• The typical adult dose is 5-10 mg orally three to four times daily, or 25 mg as a suppository twice daily.
• For acute treatment, it can be administered as a 5-10 mg intramuscular injection.
• The dosage and administration route may vary depending on the individual patient's needs and medical history.

Considerations and Precautions

• Prochlorperazine should not be used in patients with severe central nervous system depression or those taking large amounts of CNS depressants.
• Patients with a history of opioid-induced nausea may require prophylactic treatment with antiemetic agents, including prochlorperazine 1.
• The medication may interact with other drugs, such as serotonin receptor antagonists, and patients should be monitored for potential interactions.

From the FDA Drug Label

PRECAUTIONS Leukopenia, Neutropenia and Agranulocytosis In clinical trial and postmarketing experience, events of leukopenia/neutropenia and agranulocytosis have been reported temporally related to antipsychotic agents. The FDA drug label does not answer the question.

From the Research

Prochlorperazine Overview

• Prochlorperazine is a medication used to prevent nausea and vomiting, particularly in cases where opioids are introduced 2.
• It is also used to treat nausea and vomiting caused by other factors, such as gastritis or gastroenteritis 3.

Efficacy and Side Effects

• Prochlorperazine has been shown to be effective in preventing nausea and vomiting, but it can cause extrapyramidal symptoms, such as akathisia 2, 4.
• The incidence of extrapyramidal symptoms is higher with prochlorperazine compared to other antiemetic medications, such as perospirone 2.
• Prochlorperazine has been compared to other antiemetic medications, such as promethazine and ondansetron, and has been found to be more effective in some cases 3, 5.
• However, prochlorperazine can cause more side effects, such as sedation and akathisia, compared to other medications 3, 5.

Administration and Dosage

• Prochlorperazine can be administered orally or intravenously, and the dosage varies depending on the specific use and patient population 2, 4.
• The rate of infusion can affect the incidence of akathisia, but slowing the rate of infusion does not necessarily decrease the incidence of akathisia 4.

Comparison to Other Antiemetic Medications

• Prochlorperazine has been compared to other antiemetic medications, such as ondansetron and promethazine, and has been found to be more effective in some cases 3, 5.
• However, the choice of antiemetic medication depends on the specific cause of nausea and vomiting, as well as the patient's individual needs and medical history 6.