PROCHLORPERAZINE

Medical Diagnosis and Drugs, Medications
PROCHLORPERAZINE
(proe-klor-per'a-zeen)
Compazine, Compro
PROCHLORPERAZINE EDISYLATE
Compazine
PROCHLORPERAZINE MALEATE
Compazine, Stemetil 
Classifications: psychotherapeutic; antipsychotic phenothiazine; antiemetic;
Therapeutic: antipsychotic
; antiemetic
Pregnancy Category: C

Availability

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

Action

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.

Therapeutic Effect

Greater extrapyramidal effects and antiemetic potency but fewer sedative, hypotensive, and anticholinergic effects than chlorpromazine.

Uses

Management of manifestations of psychotic disorders, of excessive anxiety, tension, and agitation, and to control severe nausea and vomiting.

Unlabeled Uses

Behavioral syndromes in dementia.

Contraindications

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.

Cautious Use

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 5–10 mg 3–4 times/d; sustained release: 10–15 mg q12h IM 5–10 mg q3–4h up to 40 mg/d IV 2.5–10 mg q3–4h (max: 40 mg/d) PR 25 mg b.i.d.
Child (>9 kg): PO/PR 2.5 mg 1–3 times/d or 5 mg b.i.d. (max: 15 mg/d) IM 0.13 mg/kg q3–4h

Psychotic Disorders
Adult: PO 5–10 mg 3–4 times/d; titrate up q2–3 d IM 10–20 mg; may repeat q1–4h to gain control, then q4–6h
Child (2–12 y): PO/PR 2.5 mg 2–3 times/d (max: 20 mg daily ages 2–5 and 25 mg daily ages 6–12)

Administration

Oral
  • 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.
Intramuscular
  • 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.
Intravenous

PREPARE: Direct: May be given undiluted or diluted in small amounts of NS.  IV Infusion: Dilute in 50–100 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 15–30 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.

  • Discard markedly discolored solutions; slight yellowing does not appear to alter potency.

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.

Interactions

Drug: 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 threshold—anticonvulsant dosage may need to be increased. Herbal: Kava may increase risk and severity of dystonic reactions.

Pharmacokinetics

Absorption: Readily from GI tract. Onset: 30–40 min PO; 60 min PR; 10–20 min IM. Duration: 3–4 h PO; 10–12 h sustained release PO; 3–4 h PR; up to 12 h IM. Distribution: Crosses placenta; distributed into breast milk. Metabolism: In liver. Elimination: In urine.

Nursing Implications

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 1–2 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.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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