prochlorperazine
Brand: Compazine
Beers Criteria Prototype: haloperidol
Drug Class: antiemetic / antipsychotic
Drug Family: antipsychotic
Subclass: phenothiazine D2 receptor antagonist
Organ Systems: gastrointestinalcns
Mechanism of Action
Phenothiazine with central D2 antagonism in CTZ (anti-emetic); also alpha-1, histamine H1, and muscarinic blockade.
dopamine D2 receptor
Indications
- nausea/vomiting
- migraine headache (acute — adjunct)
- vertigo
Contraindications
- CNS depression
- Parkinson's disease
- bone marrow suppression
- children under 2 years
Adverse Effects
Common
- drowsiness
- EPS
- hypotension
- anticholinergic effects
Serious
- tardive dyskinesia
- NMS
- QT prolongation
Pharmacokinetics (ADME)
| Absorption | ~13% oral bioavailability; IM preferred |
| Distribution | moderate |
| Metabolism | extensive hepatic |
| Excretion | renal/fecal |
| Half-life | 6-8 hours |
| Onset | 30-40 min |
| Peak | 1-2 hours (IM) |
| Duration | 4-6 hours |
| Protein Binding | >99% |
| Vd | large |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| CNS depressants | additive CNS depression | major |
| phenothiazines | additive toxicity | major |
Nursing Considerations
- Monitor for EPS; akathisia is common side effect
- IM or rectal suppository when oral not tolerated
- NMS: stop drug immediately if hyperthermia, rigidity, altered consciousness, autonomic instability develop
- Avoid in Parkinson's disease
Clinical Pearls
- Acute dystonia: tongue protrusion, oculogyric crisis — treat with diphenhydramine or benztropine
- IV administration increases EPS risk — IM preferred for parenteral use
Safety Profile
Pregnancy avoid
Lactation use-with-caution
Renal Adjustment Not required
Hepatic Adjustment Required
TDM Not required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.