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.
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 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.
L3– No Data- Probably Compatible.
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
25mg PR q 12h PR
Onset of Action:
Oral: 30-40 minutes
Rectal: 60 minutes