BP

Prochlorperazine

Proprietary

Prochlorperazine 5 mg tablets (Actavis UK Ltd); 12.5 mg/mL injection (Goldshield Group Ltd); Stemetil^® tablets, injection and syrup (Sanofi-Aventis)
(non-proprietary, see BNF for details)

Group

Antiemetic – antipsychotic

Uses/indications

Prophylaxis with the use of opioid analgesic, with excessive emesis

Type of drug

POM

Presentation

Ampoules, tablets

Dosage

IM: 12.5 mg 6–8-hrly
Oral: initially 20 mg then 10 mg after 2 h
Prevention of emesis: 5–10 mg b.d. or t.d.s.
Migraine or labyrinthitis: 5 mg t.d.s.

Route of admin

IM, oral, P.R.

Contraindications

Pregnancy, myasthenia gravis, cardiovascular and respiratory disease, epilepsy, phaeochromocytoma, liver or renal dysfunction, hypothyroidism

Side effects

Can cause prolonged labour and should be withheld until 3–4 cm dilation, drowsiness, pallor, hypothermia, extrapyramidal effects, postural hypotension with tachycardia, liver dysfunction

Interactions

Alcohol – increases the sedative effect, particularly respiratory depression
Antacids – interfere with the absorption of oral Stemetil
Anaesthetics – increases their hypertensive effect
Antiepileptics – phenobarbital – decreases plasma concentrations but is not thought to be clinically significant
Antihistamines – increased risk of ventricular arrhythmias with terfenadine
Antihypertensives – with methyldopa there is an increased risk of extrapyramidal effects

Pharmacodynamic properties

A potent phenothiazine neuroleptic used in nausea and vomiting, and in schizophrenia, acute mania and the management of anxiety

Fetal risk

In the first trimester there are reports of congenital defects associated with repeated use even at low doses, but single or occasional low doses appear safe; extrapyramidal symptoms in the neonate, lethargy and tremor, low APGARs, paradoxical hyperexcitability