Classifications: psychotherapeutic; antipsychotic phenothiazine; antiemetic; Therapeutic: antipsychotic; antiemetic
Pregnancy Category: C
5 mg, 10 mg, 25 mg tablets; 10 mg, 15 mg, 30 mg sustained release capsule; 2.5 mg, 5 mg, 25 mg suppositories; 5 mg/mL injection;
Edisylate: 5 mg/mL injection
Phenothiazine derivative. Produces strong antipsychotic effects thought to be related to blockade of postsynaptic dopamine receptors in the brain. Action on the hypothalamus and reticular formation results in sedative effects. Antiemetic effect is produced by suppression of the chemoreceptor trigger zone (CTZ). Inhibits dopamine reuptake; may be basis for moderate extrapyramidal symptoms.
Greater extrapyramidal effects and antiemetic potency but fewer sedative, hypotensive, and anticholinergic effects than chlorpromazine.
Management of manifestations of psychotic disorders, of excessive anxiety, tension, and agitation, and to control severe nausea and vomiting.
Behavioral syndromes in dementia.
Hypersensitivity to phenothiazines; bone marrow depression; blood dyscrasias, jaundice; comatose or severely depressed states; children <9 kg (20 lb) or 2 y of age; pediatric surgery; short-term vomiting in children or vomiting of unknown etiology; Reye's syndrome or other encephalopathies; history of dyskinetic reactions or epilepsy; pregnancy (category C), lactation.
Patient with previously diagnosed breast cancer, children with acute illness or dehydration; Parkinson's disease; GI obstruction; hepatic disease; seizure disorders; urinary retention, BPH.
Route & Dosage
|Severe Nausea, Vomiting
Adult: PO 510 mg 34 times/d; sustained release: 1015 mg q12h IM 510 mg q34h up to 40 mg/d IV 2.510 mg q34h (max: 40 mg/d) PR 25 mg b.i.d.
Child (>9 kg): PO/PR 2.5 mg 13 times/d or 5 mg b.i.d. (max: 15 mg/d) IM 0.13 mg/kg q34h
Adult: PO 510 mg 34 times/d; titrate up q23 d IM 1020 mg; may repeat q14h to gain control, then q46h
Child (212 y): PO/PR 2.5 mg 23 times/d (max: 20 mg daily ages 25 and 25 mg daily ages 612)
- Dosages for older adults, emaciated patients and children should be increased slowly.
- Ensure that sustained release form is not chewed or crushed. Must be swallowed whole.
- Do not give oral concentrate to children.
- Avoid skin contact with oral concentrate or injection solution because of possibility of contact dermatitis.
- Do not inject drug SC.
- Make injection deep into the upper outer quadrant of the buttock in adults. Follow agency policy regarding IM injection site for children.
PREPARE: Direct: May be given undiluted or diluted in small amounts of NS. IV Infusion: Dilute in 50100 mL of D5W, NS, D5/0.45% NaCl, RL or other compatible solution.
ADMINISTER: Direct: ??Do not exceed 10 mg for a single dose. ??DO NOT give a bolus dose. Give at a maximum rate of 5 mg/min. IV Infusion: Give over 1530 min. Do not exceed direct IV rate.
INCOMPATIBILITIES Solution/additive: Aminophylline, amphotericin B, ampicillin, calcium gluconate, cephalothin, chloramphenicol, chlorothiazide, dimenhydrinate, epinephrine, erythromycin, furosemide, hydrocortisone, hydromorphone, kanamycin, ketorolac, methohexital, midazolam, morphine, penicillin G sodium, pentobarbital, phenobarbital, tetracycline, thiopental, vancomycin, warfarin. Y-site: Aldesleukin, allopurinol, amifostine, amphotericin B cholesteryl complex, aztreonam, bivalirudin, cefepime, etoposide, fenoldopam, filgrastim, fludarabine, foscarnet, gemcitabine, piperacillin-tazobactam.
Adverse Effects (≥1%)CNS: Drowsiness, dizziness, extrapyramidal reactions (akathisia, dystonia, or parkinsonism), persistent tardive dyskinesia, acute catatonia. CV: Hypotension. GI: Cholestatic jaundice. Skin: Contact dermatitis, photosensitivity. Endocrine: Galactorrhea, amenorrhea. Special Senses: Blurred vision. Hematologic: Leukopenia, agranulocytosis.
InteractionsDrug: Alcohol, cns depressants increase CNS depression; antacids, antidiarrheals decrease absorption, therefore, administer 2 h apart; phenobarbital increases metabolism of prochlorperazine; general anesthetics increase excitation and hypotension; antagonizes antihypertensive action of guanethidine; phenylpropanolamine poses possibility of sudden death; tricyclic antidepressants intensify hypotensive and anticholinergic effects; decreases seizure thresholdanticonvulsant dosage may need to be increased. Herbal: Kava may increase risk and severity of dystonic reactions.
PharmacokineticsAbsorption: Readily from GI tract. Onset: 3040 min PO; 60 min PR; 1020 min IM. Duration: 34 h PO; 1012 h sustained release PO; 34 h PR; up to 12 h IM. Distribution: Crosses placenta; distributed into breast milk. Metabolism: In liver. Elimination: In urine.
Assessment & Drug Effects
- Positioned nauseated patients who have received prochlorperazine carefully to prevent aspiration of vomitus; may have depressed cough reflex.
- Most older adult and emaciated patients and children, especially those with dehydration or acute illness, appear to be particularly susceptible to extrapyramidal effects. Be alert to onset of symptoms: Early in therapy watch for pseudoparkinson's and acute dyskinesia. After 12 mo, be alert to akathisia.
- Keep in mind that the antiemetic effect may mask toxicity of other drugs or make it difficult to diagnose conditions with a primary symptom of nausea, such as intestinal obstruction and increased intracranial pressure.
- Lab tests: Periodic CBC with differential in long-term therapy.
- Be alert to signs of high core temperature: Red, dry, hot skin; full bounding pulse; dilated pupils; dyspnea; confusion; temperature over 40.6° C (105° F); elevated BP. Exposure to high environmental temperature, to sun's rays, or to a high fever associated with serious illness places this patient at risk for heat stroke. Inform physician and institute measures to reduce body temperature rapidly.
Patient & Family Education
- Take drug only as prescribed and do not alter dose or schedule. Consult physician before stopping the medication.
- Avoid hazardous activities such as driving a car until response to drug is known because drug may impair mental and physical abilities, especially during first few days of therapy.
- Be aware that drug may color urine reddish brown. It also may cause the sun-exposed skin to turn gray-blue.
- Protect skin from direct sun's rays and use a sunscreen lotion (SPF >12) to prevent photosensitivity reaction.
- Withhold dose and report to the physician if the following symptoms persist more than a few hours: Tremor, involuntary twitching, exaggerated restlessness. Other reportable symptoms include light-colored stools, changes in vision, sore throat, fever, rash.