Names and pronunciation
(proe-klor-pair′a-zeen) Compazine, Compro
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Drug reference
(proe-klor-pair′a-zeen) Compazine, Compro
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Func. class.: Antiemetic, antipsy- chotic
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Chem. class.: Phenothiazine, pipera- zine derivative
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Do not confuse: prochlorperazine/chlorproMAZINE
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ACTION: Decreases DOPamine neurotransmission by increasing DOPamine turnover through the blockade of the D2 somatodendritic autoreceptor in the mesolimbic system
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USES: Nausea, vomiting, psychotic disorders
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Unlabeled uses: Migraine
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CONTRAINDICATIONS: Hyper sensitivity to phenothiazines, coma; infants, neonates, children <2 yr or <20 lb; surgery Precautions: Pregnancy, breastfeeding, geriatric patients, seizure, encephalopa- thy, glaucoma, hepatic disease, Parkin- son’s disease, BPH
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Black Box Warning: Increased mortality in elderly patients with dementia-related psychosis
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SIDE EFFECTS CNS: Neuroleptic malignant syndrome, extrapyramidal reactions, tardive dyski nesia, euphoria, depression, drowsiness, restlessness, tremor, dizziness, headache CV: tachycardia, hypotension, ECG changes EENT: Blurred vision GI: Nausea, vomiting, anorexia, dry mouth, diarrhea, constipation, weight loss, metallic taste, cramps HEMA: Agranulocytosis MISC: Impotence; urine color change RESP: Respiratory depression
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INTERACTIONS Increase: anticholinergic action—anti- cholinergics, antiparkinson products, antidepressants Increase: CNS depression—CNS depressants Increase: serotonin syndrome, neurolep- tic malignant syndrome—SSRIs, SNRIs Decrease: prochlorperazine effect—bar- biturates, antacids, lithium P Drug/Herb Increase: CNS depression—chamomile, hops, kava, St. John’s wort, valerian Increase: EPS—kava Drug/Lab Test Increase: LFTs, cardiac enzymes, choles- terol, blood glucose, prolactin, bilirubin, PBI, 131I, alk phos, leukocytes, granulo- cytes, platelets Decrease: hormones (blood and urine) False positive: pregnancy tests, urine bilirubin negative: urinary steroids, False 17-OHCS, pregnancy tests
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DOSAGE AND ROUTES Postoperative nausea/vomiting • Adult: IM 5-10 mg 1-2 hr before an- esthesia; may repeat after 30 min; IV 5-10 mg 15-30 min before anesthesia; IV INFUSION 20 mg/L D5W or NS 15- 30 min before anesthesia, max 40 mg/ day Severe nausea/vomiting • Adult: PO 5-10 mg tid-qid; SUS REL 15 mg/day in am or 10 mg q12hr; RECT 25 mg/bid; IM 5-10 mg q3-4hr prn, max 40 mg/day • Child 18-39 kg: PO 2.5 mg tid or 5 mg bid; IM 0.132 mg/kg q3-4hr prn, max 15 mg/day • Child 14-17 kg: PO/RECT 2.5 mg bid- tid; IM 0.132 mg/kg q3-4hr prn, max 10 mg/day • Child 9-13 kg: PO/RECT 2.5 mg/day- bid; IM 0.132 mg/kg q3-4hr prn, max 7.5 mg/day Antipsychotic • Adult/child ≥12 yr: PO 5-10 mg tid- qid; may increase q2-3days, max 150 mg/day; IM 10-20 mg q2-4hr up to 4 doses, then 10-20 mg q4-6hr • Child 2-12 yr: PO 2.5 mg bid-tid; IM 0.132 mg/kg change to oral ASAP Antianxiety • Adult/child ≥12 yr: PO 5 mg tid-qid, max 20 mg/day • Child 2-12 yr: IM 0.132 mg/kg change to oral ASAP
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Available forms: Tabs 5, 10 mg; supp 10 , 25 mg; sol for inj 5 mg/mL
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Administer: • Avoid other CNS depressants IM route • IM inj in large muscle mass; aspirate to avoid IV administration • Keep patient recumbent for 1/2 hr Direct IV route • May give diluted or undiluted; inject directly in a vein ≤5 mg/min; do not give as bolus Intermittent IV INFUSION route • May dilute 20 mg/L NaCl and give as infusion 15-30 min before anesthesia induction
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Assess: • EPS: abnormal movement, tardive dyskinesia, akathisia • VS, B/P; check patients with cardiac disease more often • Neuroleptic malignant syndrome: seizures, hypo/hypertension, fever, tachy- cardia, dyspnea, fatigue, muscle stiffness, loss of bladder control; notify prescriber immediately • CBC, LFTs during course of treatment; blood dyscrasias, hepatotoxicity may occur • Respiratory status before, during, after administration of emetic; check rate, rhythm, character; respiratory de- pression can occur rapidly among geriat- ric or debilitated patients • Beers: avoid in older adults with a high risk of delirium • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk; EPS may re- sult; cautious use in breastfeeding, ex- creted in breast milk
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Evaluate: • Therapeutic response: absence of nau- sea, vomiting; reduced anxiety, agitation, excitability
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To avoid hazardous activities, activities requiring alertness because dizziness may occur • To avoid alcohol • Not to double or skip doses • That urine may be pink to reddish brown • That suppositories may contain coco- nut/palm oil • To report dark urine, clay-colored stools, bleeding, bruising, rash, blurred vision • To avoid sun; wear sunscreen, protec- tive clothing
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PHARMACOKINETICS Metabolized by liver; excreted in urine, breast milk; crosses placenta; 91%-99% protein binding IM: Onset 10-20 min, duration 4-6 hr; children: 12 hr PO: Onset 30-40 min, duration 3-4 hr RECT: Onset 60 min, duration 3-4 hr
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• Adult: IM 5-10 mg 1-2 hr before an- esthesia; may repeat after 30 min; IV 5-10 mg 15-30 min before anesthesia; IV INFUSION 20 mg/L D5W or NS 15- 30 min before anesthesia, max 40 mg/ day Severe nausea/vomiting
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• Adult: PO 5-10 mg tid-qid; SUS REL 15 mg/day in am or 10 mg q12hr; RECT 25 mg/bid; IM 5-10 mg q3-4hr prn, max 40 mg/day
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• Child 18-39 kg: PO 2.5 mg tid or 5 mg bid; IM 0.132 mg/kg q3-4hr prn, max 15 mg/day
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• Child 14-17 kg: PO/RECT 2.5 mg bid- tid; IM 0.132 mg/kg q3-4hr prn, max 10 mg/day
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• Child 9-13 kg: PO/RECT 2.5 mg/day- bid; IM 0.132 mg/kg q3-4hr prn, max 7.5 mg/day Antipsychotic
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• Adult/child ≥12 yr: PO 5-10 mg tid- qid; may increase q2-3days, max 150 mg/day; IM 10-20 mg q2-4hr up to 4 doses, then 10-20 mg q4-6hr
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• Child 2-12 yr: PO 2.5 mg bid-tid; IM 0.132 mg/kg change to oral ASAP Antianxiety
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• Adult/child ≥12 yr: PO 5 mg tid-qid, max 20 mg/day
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• Child 2-12 yr: IM 0.132 mg/kg change to oral ASAP
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