Prochlorperazine

Prochlorperazine (Compazine, Stemzine, Buccastem, Stemetil, Phenotil) is a dopamine (D2) receptor antagonist that belongs to the phenothiazine class of antipsychotic agents that are used for the antiemetic treatment of nausea and vertigo. It is also a highly potent typical antipsychotic, 10-20x more potent than chlorpromazine. It is also used to treat migraine headaches. Intravenous administration can be used to treat status migrainosus.

Prochlorperazine-Induced Hemidystonia Mimicking Acute Stroke.[Pubmed:26265971]

West J Emerg Med. 2015 Jul;16(4):572-4.

Prochlorperazine is frequently used in the treatment of refractory nausea and migraines. Known side effects include extrapyramidal symptoms such as akathisia and dystonia. We report a pregnant patient taking Prochlorperazine for hyperemesis gravidarum who developed hemidystonia, which triggered an acute code stroke response from prehospital, emergency medicine and neurology providers. We suspect this report to be the first case of Prochlorperazine-induced hemidystonia as a stroke mimic.

Incidence of nausea and vomiting induced by oxycodone administered with prochlorperazine in Japanese cancer patients.[Pubmed:25959201]

J Nippon Med Sch. 2015;82(2):100-5.

BACKGROUND: Nausea and vomiting are the most frequent side effects of opioids and may cause the opioids to be discontinued. New methods for preventing opioid-induced nausea can improve cancer pain management. Oxycodone is one of the most frequently used opioid used in Japan because patients receiving oxycodone report less nausea and vomiting than do patients receiving morphine. The reported incidence of oxycodone-induced nausea varies widely, although the true incidence remains unclear. As a first step toward preventing oxycodone-induced nausea, we aimed to determine the incidence of and risk factors for oxycodone-induced nausea and vomiting. METHODS: In this observational study, we analyzed a series of consecutive inpatients with cancer who received oxycodone with Prochlorperazine as a preventive antiemetic agent. Oxycodone (5 mg) was administered either at 08:00 and 20:00 or at 09:00 and 21:00, and Prochlorperazine (5 mg) was also given at the same times for 5 days. RESULTS: Of the 145 enrolled patients, 138 were suitable for analysis. The incidence of nausea was 18.1%, and that of vomiting was 5.8%. The incidence of nausea was higher, but not to a significant degree, in women than in men (P=0.07). Furthermore, the incidence of vomiting in women was equal to that in men (P=0.28), whereas the incidences of both nausea (P=0.99) and vomiting (P=0.89) in elderly patients were equal to those in younger patients. In addition, the incidence of nausea (P=0.52) and vomiting (P=0.91) in patients with digestive system cancer was equal to that of patients with non-digestive system cancer. CONCLUSIONS: The incidence of nausea induced by oxycodone with Prochlorperazine was 18.1% in opioid-naive Japanese inpatients. Female sex may be a risk factor for oxycodone-induced nausea. These results suggest that a clinical study would require 314 participants (157 in each group) to decrease the incidence from 18% to 8% (10% decrease) with a new preventive treatment (alpha error=0.05, beta error=0.2).

The Safety of Prochlorperazine in Children: A Systematic Review and Meta-Analysis.[Pubmed:26884326]

Drug Saf. 2016 Jun;39(6):509-16.

INTRODUCTION: Prochlorperazine is recommended for adults with breakthrough or refractory chemotherapy-induced nausea and vomiting (CINV). The objective of this review was to describe its safety in children when given for any indication to help define its role for CINV control in children. METHODS: Electronic searches of MEDLINE, EMBASE, PsycINFO, and the Cochrane Central Register of Controlled Trials were performed as of 9 March 2015. All studies in English reporting adverse effects (AEs) associated with Prochlorperazine in children (Prochlorperazine in 758 children were included. The most commonly reported AEs in prospective studies of Prochlorperazine in children were sedation (multiple-dose studies: 10 %, 95 % CI 5-21) and extrapyramidal symptoms (EPS) (single-dose studies: 9 %, 95 % CI 3-29; multiple-dose studies: 4 %, 95 % CI 1-11). Serious AEs (seizure, neuroleptic malignant syndrome, autonomic collapse, tardive dyskinesia) were rarely associated with Prochlorperazine use in children. Five fatalities were reported in children receiving Prochlorperazine. LIMITATIONS: The limitations of this systematic review and meta-analysis were that the AEs reported in the included studies were heterogeneous, the prospective use of systematic clinical tools to identify AEs was rare, and the risk of bias in most prospective studies was moderate. CONCLUSIONS: The most common AEs reported with the pediatric use of Prochlorperazine are EPS and sedation. Fatalities, life-threatening, and persistent AEs have also been reported.