Compazine (Prochlorperazine)







Introduction to Compazine

Compazine (prochlorperazine) is a phenothiazine medication used to manage severe nausea and vomiting, treat psychotic disorders like schizophrenia, and address short-term anxiety, offering rapid symptom relief across multiple conditions.

Development and Approval

Introduced in the 1950s, prochlorperazine was FDA-approved for nausea, psychosis, and anxiety. Its versatility and efficacy have made it a staple in clinical settings.

Key Benefits and Features

  • Nausea Control: Effectively manages severe nausea and vomiting.
  • Psychosis Management: Reduces symptoms of schizophrenia.
  • Anxiety Relief: Calms short-term anxiety episodes.
  • Multiple Forms: Tablets, suppositories, and injections for flexible use.
  • Rapid Action: Quick onset, especially with injections.

Efficacy

Clinical studies confirm Compazine’s effectiveness in controlling nausea (e.g., post-chemotherapy), reducing psychotic symptoms, and alleviating anxiety, improving patient comfort and mental health outcomes.

Safety and Tolerability

Compazine is generally well-tolerated, with common side effects like drowsiness or dry mouth. Serious risks, such as extrapyramidal symptoms (EPS) or neuroleptic malignant syndrome (NMS), are rare but require monitoring.

Approved Uses

Conditions Treated

  • Severe Nausea/Vomiting: Including chemotherapy or surgery-related cases.
  • Schizophrenia: Manages hallucinations and delusions.
  • Short-Term Anxiety: Calms acute anxiety symptoms.

Symptoms Addressed

Relieves nausea, vomiting, psychotic symptoms (e.g., hallucinations), and acute anxiety, restoring comfort and stability.

Dosage and Administration

Adult Dosing

Nausea/Vomiting: 5–10 mg orally 3–4 times daily or 25 mg suppository twice daily; 5–10 mg IM/IV as needed.
Schizophrenia: 10–20 mg orally 3–4 times daily, up to 150 mg daily.
Anxiety: 5 mg orally 3–4 times daily, max 20 mg/day.

Pediatric Dosing

For children (2–12 years): 0.1–0.15 mg/kg/day orally or IM for nausea/psychosis, under strict medical supervision; not for anxiety in children.

Administration Tips

Take oral doses with water; suppositories for rectal use; injections in clinical settings. If a dose is missed, take as soon as remembered unless close to the next dose; do not double doses.

Mechanism of Action

How It Works

Prochlorperazine blocks dopamine D2 receptors in the brain, reducing psychotic symptoms and nausea, and exerts antihistamine and anticholinergic effects for additional calming.

Biochemical Effects

Inhibits dopamine signaling in the chemoreceptor trigger zone (nausea) and limbic system (psychosis).

Physiological Benefits

Controls nausea, stabilizes mood, and reduces anxiety by modulating brain signaling.

Composition

Active Ingredient

Prochlorperazine (5 mg, 10 mg tablets; 25 mg suppositories; injectable solutions).

Inactive Ingredients

May include lactose, magnesium stearate, and starch for tablets; cocoa butter for suppositories.

Side Effects

Common: Drowsiness, dry mouth, constipation, blurred vision.
Less Common: Dizziness, weight gain, or low blood pressure.
Serious: Extrapyramidal symptoms (EPS) like tremors, tardive dyskinesia, or neuroleptic malignant syndrome (NMS); seek immediate care.

Managing Side Effects

Prevention Strategies

Take at bedtime to manage drowsiness, stay hydrated for dry mouth, and avoid alcohol to reduce CNS depression.

Tolerability Tips

Monitor for movement disorders or fever (NMS signs), report to provider, and adjust dose if needed.

Contraindications

Medical Restrictions

  • Hypersensitivity to prochlorperazine or phenothiazines.
  • Coma or severe CNS depression.
  • Children under 2 years or <10 kg for most uses.
  • Blood disorders or liver damage.

Reasons for Restrictions

Prevents severe allergic reactions, CNS toxicity, or harm in vulnerable populations.

Warnings and Precautions

Safety Alerts

  • EPS Risk: May cause tremors or rigidity, especially at higher doses.
  • NMS: Rare but life-threatening; watch for fever, muscle stiffness.
  • Sedation: Avoid driving or operating machinery until effects are known.

Monitoring Needs

Regular check-ups to assess symptom relief, side effects, and neurological status, especially in long-term use for schizophrenia.

Missed Doses

Handling Missed Doses

Take a missed dose as soon as remembered, unless close to the next dose; then skip and resume schedule. Avoid doubling doses.

Preventing Missed Doses

Use pill organizers or reminders to maintain consistent dosing.

Drug Interactions

PotentialLazy load this section? interactions

  • CNS Depressants (e.g., alcohol, opioids): Increased sedation risk.
  • Anticholinergics: Enhanced side effects like dry mouth or constipation.
  • Antihypertensives: May cause severe low blood pressure.

Managing Interactions

Inform your provider of all medications and supplements to adjust dosing or avoid interactions.

Overdose

Overdose Symptoms

Severe drowsiness, agitation, seizures, or irregular heartbeat; seek emergency care immediately.

Emergency Response

Contact emergency services; provide dosage and timing details for appropriate treatment, such as supportive care.

Pharmacokinetics

Absorption

Rapidly absorbed; oral peaks in 2–4 hours, injections faster.

Distribution

Crosses blood-brain barrier, concentrating in CNS.

Metabolism

Metabolized in the liver to active and inactive metabolites.

Excretion

Excreted in urine and feces; half-life of 6–8 hours.

Dosage Forms

Available Forms

  • Tablets: 5 mg, 10 mg for oral use.
  • Suppositories: 25 mg for rectal administration.
  • Injections: Various concentrations for clinical use.

Benefits of Forms

Tablets for routine use, suppositories for oral intolerance, injections for rapid relief in severe cases.

Pregnancy and Breastfeeding

Pregnancy Considerations

FDA Category C: Use only if benefits outweigh risks, as fetal safety is not fully established.

Breastfeeding Guidance

Excreted in breast milk; avoid or use cautiously, monitoring infants for sedation or irritability, consulting a provider for alternatives.

Storage Instructions

General Guidelines

Store at 20–25°C (68–77°F) in a dry, light-protected container, out of reach of children and pets.

Specific Tips

Refrigerate suppositories if required; store injections per manufacturer guidelines; dispose of expired medication safely.

Clinical Evidence

Research Summary

Clinical trials demonstrate Compazine’s efficacy in rapidly controlling nausea, reducing schizophrenia symptoms, and managing acute anxiety, with significant improvements in patient outcomes.

Key Findings

  • Effective for chemotherapy-induced nausea within hours.
  • Reduces psychotic symptoms in schizophrenia with consistent use.
  • Well-tolerated for short-term anxiety relief.

Conclusion

Summary of Compazine

Compazine (prochlorperazine) is a versatile phenothiazine for severe nausea, schizophrenia, and short-term anxiety, offering rapid and effective symptom relief.

Core Benefits

Controls nausea, stabilizes psychosis, calms anxiety, and provides multiple administration options.

Usage Recommendations

Follow prescribed dosing, monitor for side effects, avoid driving if sedated, and consult providers regularly for safe and effective use.