Drug Profiles:
prochlorperazine
AKA Compazine®

General information about Prochlorperazine:
Phenothiazines (FEE-noe-THYE-a-zeens) are used to treat serious mental and emotional disorders, including schizophrenia and other psychotic disorders. Some are used also to control agitation in certain patients, severe nausea and vomiting, severe hiccups, and moderate to severe pain in some hospitalized patients. Prochlorperazine is used also in the treatment of certain types of porphyria, and with other medicines in the treatment of tetanus. Phenothiazines may also be used for other conditions as determined by your doctor.

Phenothiazines may cause unwanted, unattractive, and uncontrolled face or body movements that may not go away when you stop taking the medicine. They may also cause other serious unwanted effects. You and your doctor should talk about the good this medicine will do as well as the risks of using it. Also, your doctor should look for early signs of these effects at regular visits. Your doctor may be able to stop or decrease some unwanted effects, if they do occur, by changing your dose or by making other changes in your treatment.

Oral

• Extended-release capsules (U.S.)
• Oral solution (U.S. and Canada)
• Syrup (U.S. and Canada)
• Tablets (U.S. and Canada)

Parenteral

• Injection (U.S. and Canada)

Rectal

• Suppositories (U.S.)

Before Using This Medicine
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For lithium, the following should be considered:

Allergies-
Tell your doctor if you have ever had any unusual or allergic reaction to phenothiazines. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes. Some of the phenothiazine dosage forms contain parabens, sulfites, or tartrazine.

Pregnancy-
It is not known whether prochlorperazine will harm an unborn baby. Do not take chlorpromazine without first talking to your doctor if you are pregnant.

Breast-feeding-
Prochlorperazine passes into breast milk and may affect a nursing baby. Do not take chlorpromazine without first talking to your doctor if you are breast-feeding a baby.

Children-
Certain side effects, such as muscle spasms of the face, neck, and back, tic-like or twitching movements, inability to move the eyes, twisting of the body, or weakness of the arms and legs, are more likely to occur in children, especially those with severe illness or dehydration. Children are usually more sensitive than adults to the effects of phenothiazines.

Older adults-
Constipation, trouble urinating, dryness of mouth, confusion, problems with memory, dizziness or fainting, drowsiness, trembling of the hands and fingers, and problems with muscle movement, such as decreased or unusual movements, are especially likely to occur in elderly patients, who are usually more sensitive than younger adults to the effects of phenothiazines.

Other medicines-
Always tell your doctor all medications you are taking, both prescription and over-the-counter. Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking phenothiazines, it is especially important that your health care professional know if you are taking any of the following::

• Amantadine (e.g., Symmetrel)
• Antihypertensives (high blood pressure medicine)
• Bromocriptine (e.g., Parlodel)
• Deferoxamine (e.g., Desferal)
• Diuretics (water pills)
• Levobunolol (e.g., Betagan)
• Medicine for heart disease
• Metipranolol (e.g., OptiPranolol)
• Nabilone (e.g., Cesamet) (with high doses)
• Narcotic pain medicine
• Pentamidine (e.g., Pentam)—Severe low blood pressure may occur
• Antidepressants (medicine for depression)—The risk of developing serious side effects, including severe constipation, low blood pressure, severe drowsiness, unusual body or facial movements, and changes in heart rhythm, may be increased
• Antipsychotics, other (medicine for mental illness)
• Promethazine (e.g., Phenergan)
• Trimeprazine (e.g., Temaril)—Severe low blood pressure or unusual body or facial movements may occur
• Antithyroid agents (medicine for overactive thyroid)—The risk of developing serious blood problems may be increased
• Astemizole (e.g., Hismanal)
• Cisapride (e.g., Propulsid)
• Disopyramide (e.g., Norpace)
• Erythromycin (e.g., E.E.S., EryPed)
• Probucol (e.g., Lorelco)
• Procainamide (e.g., Procan SR)
• Quinidine (e.g., Duraquin)—Serious changes in heart rhythm may occur
  Central nervous system (CNS) depressants (medicines that cause drowsiness)—Severe drowsiness and trouble in breathing may occur
  Epinephrine (e.g., Adrenalin)—Severe low blood pressure and fast heartbeat may occur
• Levodopa (e.g., Dopar)—Phenothiazines may prevent levodopa from working properly in the treatment of Parkinson's disease
  Lithium (e.g., Lithane, Lithizine, Lithobid)—Some unwanted effects, such as decreased or unusual body or facial movements, may be increased. The blood levels of the phenothiazine and/or lithium may be changed, so the medicines may not work properly. Your doctor may need to change your dose of either or both medicines
• Metoclopramide (e.g., Reglan)
• Metyrosine (e.g., Demser)
• Pemoline (e.g., Cylert)
• Rauwolfia alkaloids (deserpidine [e.g., Harmonyl], rauwolfia serpentina [e.g., Raudixin], reserpine [e.g., Serpasil])—Taking these medicines with phenothiazines may increase the chance of having decreased or unusual body or facial movements or may make the movement problems worse
• Pimozide (e.g., Orap)—Serious changes in heart rhythm, severe low blood pressure, or unusual body or facial movements may occur
   

Other medical problems-
Make sure you tell your doctor if you have any other medical problems, especially:

• Alcohol abuse—Certain unwanted effects, such as heatstroke and liver disease, may be more likely to occur
• Blood disease
• Breast cancer
• Difficult urination
• Glaucoma
• Heart or blood vessel disease
• Parkinson's disease
• Seizure disorders, or history of
• Stomach ulcers—Phenothiazines may make the condition worse
• Brain damage
• Blood vessel disease in the brain—Serious increase in body temperature may occur
• Enlarged prostate—Difficulty in urinating may occur or may become more severe
• Liver disease—Phenothiazines may make the condition worse. Higher blood levels of phenothiazines may occur, increasing the chance of having unwanted effects
• Lung disease—Difficulty in breathing may become more severe. Decrease in cough reflex caused by phenothiazines may increase the risk of developing complications, such as pneumonia
• Pheochromocytoma
• Kidney disease—Severe low blood pressure may occur
• Reye's syndrome—The risk that the phenothiazine will have unwanted effects on the liver may be increased

Proper Use of This Medicine-

• Take prochlorperazine exactly as directed by your doctor. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you.
• Take each dose with a full glass (8 ounces) of water.
• Prochlorperazine can be taken with or without food or milk.
• Do not crush or chew the sustained-release formulations of prochlorperazine. Swallow them whole. They are specially formulated to release slowly in your body. If you do not know if your medication is a sustained-release formulation, ask your pharmacist.
• Mix the concentrate with 2 to 4 ounces of water, soda, juice, coffee, tea, syrup, milk, or a semisolid food such as applesauce or pudding.
• Do not stop taking prochlorperazine without the approval of your doctor. It may be several weeks before you begin to feel better, and you may require continuous treatment for quite some time. Talk to your doctor before you stop taking this medication.
• Throw away any discolored liquid.

Dosing-

For oral extended-release capsule dosage form:

• For nausea and vomiting:
  • Adults and teenagers—At first, 15 mg taken once a day in the morning, or 10 mg taken every twelve hours. Your doctor may increase your dose if needed. However, the dose usually is not more than 40 mg a day.
  • Children—This dosage form is not recommended for use in children.

For oral dosage form (solution or tablets):

• For nausea and vomiting:
  • Adults and teenagers—5 to 10 mg three or four times a day.
  • Children—Dose is based on body weight and must be determined by your doctor. The usual dose is 2.5 mg taken one to three times a day.

For injection dosage form:

• For nausea and vomiting:
  • Adults and teenagers—5 to 10 mg, injected into a muscle every three to four hours as needed. Or 2.5 to 10 mg injected slowly into a vein. The dose usually is not more than 40 mg a day.
  • Children up to 2 years of age—Dose must be determined by your doctor.
  • Children 2 to 12 years of age—Dose is based on body weight and must be determined by your doctor. The usual dose is 0.132 mg per kg (0.06 mg per pound) of body weight, injected into a muscle. However, the dose for children 2 through 5 years of age usually is not more than 20 mg a day. The dose for children 6 to 12 years of age usually is not more than 25 mg a day.

For rectal dosage form (suppositories):

• For nausea and vomiting:
  • Adults and teenagers—25 mg inserted into the rectum two times a day.
  • Children up to 2 years of age—Dose must be determined by your doctor.
  • Children 2 to 12 years of age—Dose is based on body weight and must be determined by your doctor. The usual dose is 2.5 mg inserted into the rectum one to three times a day.
     

Missed dose-

• If you take one dose of prochlorperazine a day, take the missed dose as soon as you remember, then go back to your regular schedule the next day. If you do not remember until it is time for your next dose, skip the dose you missed and take only your next regularly scheduled dose. Do not take a double dose of this medication.
• If you are taking prochlorperazine on a regular schedule several times a day, take the missed dose within 1 hour of its regular time. If more than 1 hour has passed, skip the missed dose and take only the next regularly scheduled dose. Do not take a double dose of this medication.
• If you are taking prochlorperazine as needed for nausea and vomiting, take the missed dose as soon as possible if needed, then wait at least 4 hours before taking another dose.
   

Storage-

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store the capsule or tablet form of this medicine in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Keep the liquid form of this medicine from freezing.
• Do not keep outdated medicine or medicine no longer needed.
• Be sure that any discarded medicine is out of the reach of children.
   

Precautions While Using This Medicine

• Use caution when driving, operating machinery, or performing other hazardous activities. Chlorpromazine may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities.
• Dizziness may be more likely to occur when you rise from a sitting or lying position. Rise slowly to prevent dizziness and a possible fall.
• Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while you are taking chlorpromazine.
• Avoid prolonged exposure to sunlight. Chlorpromazine may increase the sensitivity of your skin to sunlight. Use a sunscreen and wear protective clothing when sun exposure is unavoidable.

Side Effects of This Medicine

Stop taking this medicine and check with your doctor immediately if any of the following side effects occur:

• Rare--Symptoms of neuroleptic malignant syndrome
  • Confusion (severe) or coma; difficult or fast breathing; drooling;  fast heartbeat; fever; high or low (irregular) blood pressure;  increased sweating; loss of bladder control; muscle stiffness (severe); trembling or shaking; trouble in speaking or swallowing 

Check with your doctor immediately if any of the following side effects occur:

• More common
  • Inability to move eyes; increased blinking or spasms of eyelid; lip smacking or puckering; muscle spasms of face, neck, body, arms, or legs causing unusual postures or unusual expressions on face; puffing of cheeks; rapid or worm-like movements of tongue; sticking out of tongue; tic-like or twitching movements; trouble in breathing, speaking, or swallowing; uncontrolled chewing movements ;  uncontrolled movements of arms or legs; uncontrolled twisting movements of neck, trunk, arms, or legs
  • Rare: irregular or slow heart rate;  recurrent fainting 

Also, check with your doctor as soon as possible if any of the following side effects occur:

• More common
  • Blurred vision, change in color vision, or difficulty in seeing at night; fainting; loss of balance control; mask-like face; restlessness or need to keep moving; shuffling walk; stiffness of arms or legs; trembling and shaking of hands and fingers 
  • Less common: Difficulty in urinating; skin rash; sunburn (severe) 
  • Rare: Abdominal or stomach pains; aching muscles and joints; agitation, bizarre dreams, excitement, or trouble in sleeping; bleeding or bruising (unusual); chest pain; clumsiness; confusion (mild); constipation (severe); convulsions (seizures); dark urine;  fever and chills; hair loss; headaches; hot, dry skin or lack of sweating; itchy skin (severe); muscle weakness; nausea, vomiting, or diarrhea; pain in joints; prolonged, painful, inappropriate erection of the penis; redness of hands; shivering; skin discoloration (tan or blue-gray); sore throat and fever; sores in mouth; unusual bleeding or bruising; unusual tiredness or weakness; yellow eyes or skin 

Phenothiazines may cause your urine to be dark. In most cases, this is not a sign of a serious problem. However, if your urine does become dark, discuss it with your doctor.

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:

• More common
  • Constipation (mild); decreased sweating; dizziness; drowsiness ;  dryness of mouth; nasal congestion 
• Less common: Changes in menstrual period  decreased sexual ability; increased sensitivity of eyes to light; rough or “fuzzy” tongue; secretion of milk (unusual); swelling or pain in breasts; watering of mouth; weight gain (unusual) 

After you stop using this medicine, your body may need time to adjust. The length of time this takes depends on the amount of medicine you were using and how long you used it. During this time, check with your doctor if you notice dizziness, nausea and vomiting, stomach pain, trembling of the fingers and hands, or any of the following signs of tardive dyskinesia or tardive dystonia:

• Inability to move eyes; lip smacking or puckering; muscle spasms of face, neck, body, arms, or legs, causing unusual body positions or unusual expressions on face; puffing of cheeks; rapid or worm-like movements of tongue; sticking out of tongue; tic-like or twitching movements; trouble in breathing, speaking, or swallowing; uncontrolled chewing movements; uncontrolled twisting or other movements of neck, trunk, arms, or legs 

Some commonly used brand names are:

In the U.S.-

In Canada-