Prochlorperazine

Revised June 11, 2018

Section 1.1

Midwives may independently prescribe, order and administer this drug.

(Buccastem®, Compazine®, Nu-Prochlor®, Prorazin®, Stemetil®) is a phenothiazine that acts as a powerful post-synaptic dopamine D2 receptor antagonist and has both anti-psychotic and antiemetic properties.

Indications and Clinical Use:

Prochlorperazine is primarily used in adults for the management of psychotic conditions such as schizophrenia and mania. Prochlorperazine has also been approved by Health Canada to be used as a second line treatment for nausea, vomiting and hyperemesis in pregnancy (see CMBC’s Indications for Discussion, Consult and Transfer of Care). Midwives may prescribe prochlorperazine as a second-line anti-emetic in an outpatient setting during pregnancy.

Contraindications:

Hypersensitivity or known allergy to prochlorperazine or any phenothiazines; severe depression; history of seizures.

Warnings and Precautions:

Prescribers must assess for potential medication interactions prior to prescribing this drug. This drug must  not be prescribed at the same time as other phenothiazine-class medications. Use with caution in patients with cardiovascular disease: may cause hypotension, QTc prolongation and increase risk for venous thromboembolism and stroke. May cause photosensitivity; recommend use of sunscreen.

Pregnancy:

Compatible.

Pregnancy Category C, risk not ruled out: animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

Lactation:

L3– No Data- Probably Compatible.

Adverse Reactions:

Drowsiness, sedation, agitation, seizure, hypotension, arrhythmia, dry mouth, increased appetite, leukopenia, changes in liver function, constipation, extrapyramidal symptoms (drug induced movement disorders). Sudden discontinuation may result in withdrawal symptoms including nausea, vomiting, sweating, confusion and insomnia; discontinue gradually when possible.

Dosage and Administration:

Oral:         5mg- 10 mg Q 6-8h PO; maximum dose 40mg/day

Take with food or milk; avoid taking within two hours of antacids

Rectal:      5mg- 10 mg Q 6-8h PR; maximum dose 40mg/day

OR

25mg PR q 12h PR

Onset of Action:

Oral: 30-40 minutes

Rectal: 60 minutes

Half-life:

17 hours