Prochlorperazine (prochlorperazine edisylate, prochlorperazine maleate)
Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death; most deaths appeared to be cardiovascular (CV) (eg, heart failure, sudden death) or infectious (eg, pneumonia) in nature. Treatment with conventional antipsychotic drugs may similarly increase mortality. Not approved for the treatment of patients with dementia-related psychosis.
OTHER BRAND NAMES
Control of severe N/V. Treatment of schizophrenia. (Tab) Short-term treatment of generalized nonpsychotic anxiety.
Usual: 5mg or 10mg tid-qid
Daily dose >40mg should only be used in resistant cases
Initial: 5-10mg q3-4h prn
2.5-10mg slow inj or infusion at rate ≤5mg/min
Max: 10mg single dose and 40mg/day
N/V w/ Surgery:
5-10mg 1-2 hrs before induction of anesthesia (repeat once in 30 min if necessary)
5-10mg as slow inj or infusion 15-30 min before induction of anesthesia. To control acute symptoms during or after surgery, repeat once if necessary
Usual: 5mg tid-qid
Max: 20mg/day, not longer than 12 weeks
Mild Conditions Including Schizophrenia:
Usual: 5 or 10mg tid-qid
Moderate-Severe Conditions (Hospitalized/Supervised):
Initial: 10mg tid-qid.
Titrate: Increase gradually until controlled or bothersome side effects
More Severe Disturbances:
Start w/ lowest recommended dose and adjust based on severity
Schizophrenia w/ Severe Symptomatology:
Initial: 10-20mg, may repeat q2-4h if necessary (or, in resistant cases, every hr)
Switch to PO after obtaining control at the same dosage level or higher
Prolonged Parenteral Therapy:
10-20mg IM q4-6h
Usual: 2.5mg qd-bid
Usual: 2.5mg bid-tid
Usual: 2.5mg tid or 5mg bid
Usual: 0.06mg/lb; control is usually obtained w/ 1 dose
Initial: 2.5mg bid-tid; do not give >10mg on the 1st day
Titrate: Increase according to response
2-5 Years: 20mg/day
6-12 Years: 25mg/day
Usual: 0.06mg/lb. Control is usually obtained with 1 dose. Switch to PO after obtaining control at the same dosage level or higher
Start at lower end of dosing range and increase more gradually
Other Important Considerations
Debilitated or Emaciated Adults:
Increase more gradually
IV, IM, Oral route
Inject deeply into upper, outer quadrant of the buttock
SQ is not advisable because of local irritation
May be administered either undiluted or diluted in isotonic sol
When given IV, do not use bolus inj
Do not mix w/ other agents in the syringe
Avoid getting injection sol on hands or clothing because of potential contact dermatitis
Inj: (Edisylate) 5mg/mL [2mL, 10mL]; Tab: (Maleate) 5mg, 10mg
Comatose states, concomitant large doses of CNS depressants (eg, alcohol, barbiturates, narcotics), pediatric surgery, pediatrics <2 yrs of age or <20 lbs.
Secondary extrapyramidal symptoms can occur. Tardive dyskinesia (TD) may develop, especially in elderly and during long-term use. Neuroleptic malignant syndrome (NMS) reported; d/c if it occurs and institute appropriate treatment. Caution during reintroduction of therapy as NMS recurrence reported. Avoid in patients with bone marrow depression, previous hypersensitivity reaction, and in pregnant women. May impair mental and/or physical abilities, especially during the 1st few days of therapy. May mask symptoms of overdose of other drugs, and obscure diagnosis of intestinal obstruction, brain tumor, and Reye's syndrome; avoid in children/adolescents whose signs and symptoms suggest Reye's syndrome. May cause hypotension; caution with large doses and parenteral administration in patients with impaired CV system. May interfere with thermoregulation; caution in patients exposed to extreme heat. Evaluate therapy periodically with prolonged use. Leukopenia/neutropenia/agranulocytosis reported; monitor during 1st few months of therapy, and d/c at 1st sign of leukopenia or if severe neutropenia (absolute neutrophil count <1000/mm3) occurs. Caution with glaucoma, in children with dehydration or acute illness, and in elderly. May produce α-adrenergic blockade, lower seizure threshold, or elevate prolactin levels. D/C 48 hrs before myelography; may resume after 24 hrs postprocedure.
NMS, cholestatic jaundice, leukopenia, agranulocytosis, drowsiness, dizziness, amenorrhea, blurred vision, skin reactions, hypotension, motor restlessness, extrapyramidal symptoms, TD, dystonia, pseudoparkinsonism.
See Contraindications. May intensify and prolong action of CNS depressants (eg, alcohol, anesthetics, narcotics), atropine, and organophosphorus insecticides. May decrease oral anticoagulant effects. Thiazide diuretics accentuate orthostatic hypotension. Increased levels of both drugs with propranolol. Anticonvulsants may need dosage adjustment; may lower convulsive threshold. May interfere with metabolism of phenytoin and precipitate toxicity. Risk of encephalopathic syndrome occurs with lithium. May antagonize antihypertensive effects of guanethidine and related compounds. Avoid use prior to myelography with metrizamide; vomiting as a sign of toxicity of cancer chemotherapeutic drugs may be obscured by the antiemetic effect. May reverse effect of epinephrine. May cause paradoxical further lowering of BP with epinephrine and other pressor agents (excluding norepinephrine bitartrate and phenylephrine HCl).
PREGNANCY AND LACTATION
Safety is not known in pregnancy; caution in nursing.
MECHANISM OF ACTION
Phenothiazine derivative; antiemetic and antipsychotic.
Distribution: Excreted in breast milk.
Assess for Reye's syndrome, TD, pregnancy/nursing status, possible drug interactions, impaired CV system, breast cancer, glaucoma, bone marrow depression, preexisting low WBC count, history of drug-induced leukopenia/neutropenia, history of psychosis, and seizure disorder. Assess use in children with acute illness or dehydration, elderly, debilitated, or emaciated patients.
Monitor for extrapyramidal symptoms, signs/symptoms of TD, NMS, hypotension, fever, sore throat, infection, jaundice, motor restlessness, dystonia, pseudoparkinsonism, and hypersensitivity reactions. Monitor CBC, WBC, and prolactin levels. Conduct liver studies if fever with grippe-like symptoms occur.
Inform about the risks and benefits of therapy. Instruct to avoid engaging in hazardous activities and exposure to extreme heat. Counsel to seek medical attention if symptoms of TD, NMS, hypotension, mydriasis, encephalopathic syndrome, sore throat, infection, deep sleep, or hypersensitivity reactions occur.
Tab, Inj: 20-25°C (68-77°F). Protect from light. (Inj) Do not freeze.
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