Generic Compazine ( Prochlorperazine )

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Compazine is a phenothiazine medication used to treat nausea and vomiting from many causes, including chemotherapy, radiation, and motion sickness. It is also used for vertigo due to Meniere's syndrome and labyrinthitis, and for migraine. In higher doses, it was once used to treat schizophrenia and other psychotic disorders. The medication works by blocking dopamine receptors in the brain, which calms the vomiting centre and reduces psychotic symptoms.
The usual adult dose for nausea and vomiting is 5 mg to 10 mg taken three or four times daily. For vertigo, the typical dose is 5 mg three times a day. In psychiatric conditions, the starting dose is 10 mg three or four times daily, with gradual increases as needed.
The administration form is film-coated tablets containing 5 mg of prochlorperazine maleate. A 10 mg tablet is also available, along with a 5 mg/mL injection and 10 mg suppositories.
The medication starts working within 30 to 60 minutes after oral intake. Its antiemetic effect typically lasts 4 to 6 hours, though the sedative effect can last longer.
Alcohol should be avoided during treatment. It adds to the drowsiness and dizziness that prochlorperazine can cause, and it can increase the risk of serious side effects like low blood pressure and respiratory depression.
The most common side effects are drowsiness, dizziness, dry mouth, and blurred vision.
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Common Use Compazine

Prochlorperazine is a typical antipsychotic from the phenothiazine family. It works by blocking dopamine D2 receptors in the chemoreceptor trigger zone of the brain, which is the area that triggers nausea and vomiting. At higher doses, it also blocks dopamine receptors in the mesolimbic pathway, which reduces hallucinations, delusions, and disorganized thinking in schizophrenia. Health Canada has approved prochlorperazine for the treatment of nausea and vomiting of various causes, including gastroenteritis, drug intolerance, motion sickness, radiation sickness, and post-operative conditions. It is also indicated for vertigo due to Meniere's syndrome, labyrinthitis, and other causes, and for the symptomatic treatment of migraine. In psychiatric practice, it is used for schizophrenia, particularly in the chronic stage, for acute mania, and as a short-term adjunct for anxiety. The 5 mg tablet strength is most commonly used for nausea, vomiting, and vertigo, where lower doses are sufficient. Higher doses are reserved for psychiatric conditions.

Basic Compazine Information

• INN (International Nonproprietary Name): Prochlorperazine maleate
• Brand names available in Canada: Compazine® is the U.S. brand and is not marketed in Canada. In Canada, prochlorperazine is sold under Stemetil® (Sanofi-Aventis Canada Inc.), Apo-Prochlorperazine (Apotex Inc.), Nu-Prochlor (Nu-Pharm Inc.), PMS-Prochlorperazine (Pharmascience Inc.), and Sandoz-Prochlorperazine (Sandoz Canada Inc.).
• ATC Code: N05AB04
• Forms and dosages: Film-coated tablets – 5 mg and 10 mg. Injection solution – 5 mg/mL (mesylate formulation). Suppositories – 10 mg and 25 mg.
• Manufacturers in Canada: Sanofi-Aventis Canada Inc. (Stemetil), Apotex Inc. (Apo-Prochlorperazine), Nu-Pharm Inc. (Nu-Prochlor), Pharmascience Inc. (PMS-Prochlorperazine), Sandoz Canada Inc. (Sandoz-Prochlorperazine), and AA Pharma Inc. (Prochlorazine, generic). The Stemetil 5 mg tablet is listed under DIN 01927752. Apo-Prochlorperazine 5 mg is listed under DIN 00886440. Nu-Prochlor 5 mg is listed under DIN 01964399, though this DIN is now cancelled after market.
• Registration status in Canada: Approved by Health Canada. Multiple DINs exist, including 01927752 (Stemetil 5 mg, Sanofi-Aventis), 00886440 (Apo-Prochlorperazine 5 mg, Apotex), 01927779 (Stemetil injection 5 mg/mL, Sanofi-Aventis), and 00789720 (Sandoz Prochlorperazine 10 mg suppository, Sandoz Canada). Some older generic DINs, such as Nu-Prochlor 5 mg (01964399), are now cancelled after market.
• OTC / Rx classification: Prescription only (Rx) – not legally sold over-the-counter in Canadian pharmacies

Dosage & Direction

Take prochlorperazine exactly as your doctor prescribes. The dose depends on what is being treated. For nausea and vomiting in adults, the usual dose is 5 mg to 10 mg three or four times daily. In mild cases, a single dose of 5 mg may be enough. For vertigo and Meniere's disease, the typical starting dose is 5 mg three times a day, increasing if necessary to a total of 30 mg daily. After several weeks, the dose may be reduced gradually to 5 mg to 10 mg daily. For migraine, 5 mg to 10 mg is often taken at the first sign of an attack. For short-term management of anxiety, the starting dose is 10 mg to 20 mg daily in divided doses, with a maximum of 40 mg daily. For schizophrenia and other psychotic disorders, the usual effective daily oral dose is in the order of 75 mg to 100 mg, though patients vary widely in response. The recommended schedule starts at 12.5 mg twice daily for 7 days, with increases of 12.5 mg at four- to seven-day intervals until a satisfactory response is obtained. Take the tablet with or without food. If it upsets your stomach, take it with a meal. Swallow the tablet whole with water. Do not crush or chew it. Do not stop the medication suddenly without talking to your doctor, because withdrawal symptoms can occur. If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed one and continue with your regular schedule. Do not take two doses at once to make up for a missed one.

Precautions

Prochlorperazine can cause extrapyramidal symptoms, which are movement side effects caused by dopamine blockade in the brain. These include akathisia (a feeling of inner restlessness), dystonia (involuntary muscle contractions that can cause the neck to twist or the eyes to roll upward), parkinsonism (tremor, rigidity, and slow movement), and tardive dyskinesia (involuntary movements of the tongue, lips, face, and sometimes the limbs). Tardive dyskinesia can be permanent, and the risk increases with longer treatment and higher total doses. If you develop any abnormal movements, tell your doctor right away. Neuroleptic malignant syndrome (NMS) is a rare but life-threatening reaction that has been reported with prochlorperazine. It causes high fever, severe muscle rigidity, confusion, and autonomic instability. Stop the medication and seek emergency care if these symptoms occur. Prochlorperazine can cause drowsiness, so do not drive or operate machinery until you know how it affects you. It can also cause low blood pressure when standing up, especially in older adults and people who are dehydrated. Move slowly when getting up from a sitting or lying position. The medication can cause photosensitivity, so use sunscreen and avoid prolonged sun exposure. Prochlorperazine can mask the symptoms of nausea and vomiting caused by a serious underlying condition, such as a brain tumour or bowel obstruction, so a proper diagnosis matters. Tell your doctor if you have liver disease, kidney disease, heart disease, Parkinson's disease, epilepsy, glaucoma, an enlarged prostate, or myasthenia gravis. Elderly patients with dementia-related psychosis are at an increased risk of death when treated with antipsychotics, including prochlorperazine, and the medication is not approved for that use. Prochlorperazine is not recommended during pregnancy unless the benefit clearly outweighs the risk. It passes into breast milk, so breastfeeding is not recommended during treatment. Women who could become pregnant should use effective contraception. Children are more sensitive to the extrapyramidal effects of prochlorperazine, especially after cumulative doses of 0.5 mg/kg. The medication is not recommended for children under 2 years of age or weighing less than 10 kg.

Contraindications

Do not take prochlorperazine if you have had an allergic reaction to prochlorperazine, other phenothiazines, or any of the inactive ingredients in the tablet. The medication is contraindicated in patients with circulatory collapse or severe central nervous system depression, including comatose states from any cause. Do not use it in the presence of large amounts of central nervous system depressants, such as alcohol, opioids, or barbiturates. Prochlorperazine is contraindicated in patients with a history of blood dyscrasias, such as agranulocytosis, or with bone marrow depression. It should not be used in patients with severe liver impairment, because the drug is extensively metabolized by the liver. Prochlorperazine is also contraindicated in patients with epilepsy, Parkinson's disease, prostatic hypertrophy, or narrow-angle glaucoma, because its anticholinergic and dopamine-blocking effects can worsen these conditions. Do not use prochlorperazine in pediatric surgery. It is contraindicated in children under 2 years of age or weighing less than 10 kg. The medication should not be used during pregnancy or breastfeeding unless specifically directed by a doctor.

Possible Side Effects

More than 1 in 10 people experience drowsiness, dizziness, dry mouth, and blurred vision. These effects are often most noticeable when starting treatment or increasing the dose, and they may fade with time. Other common side effects include nasal congestion, constipation, urinary retention, and changes in appetite. Some people notice insomnia, excitement, or bizarre dreams. These effects often settle as your body adjusts, but if they persist or bother you, tell your doctor. Serious side effects require immediate medical attention. Extrapyramidal symptoms include akathisia, dystonia, parkinsonism, and tardive dyskinesia. Neuroleptic malignant syndrome presents with high fever, severe muscle rigidity, confusion, and autonomic instability. Agranulocytosis, a severe drop in white blood cells, can cause fever, sore throat, and mouth ulcers. Torsades de pointes, a dangerous heart rhythm, can cause palpitations, fainting, or sudden collapse. Sudden cardiac death has been reported with prochlorperazine. Low blood pressure can cause fainting. Cholestatic jaundice, a liver reaction, causes yellowing of the skin and eyes. Blood disorders, including leukopenia and thrombocytopenia, have been reported. Endocrine effects include breast enlargement, milk production in men and women, menstrual irregularities, and decreased sexual interest. If you develop any of these serious effects, stop the medication and seek medical help right away.

Drug Interaction

Prochlorperazine is metabolized by the liver enzymes CYP2D6 and CYP2C19, so drugs that affect these enzymes can change its levels. Co-administration of prochlorperazine with amitriptyline, a CYP2D6 substrate, may increase the plasma levels of amitriptyline. Duloxetine, a CYP2D6 inhibitor, can decrease the metabolism of prochlorperazine and raise its levels. Propafenone and ranolazine also inhibit CYP2D6 and can increase prochlorperazine levels. Drugs that cause drowsiness add to the sedative effects of prochlorperazine and can lead to excessive sedation and respiratory depression. This list includes alcohol, benzodiazepines (such as lorazepam), opioids (such as codeine and fentanyl), antihistamines (such as diphenhydramine), muscle relaxants, and some antidepressants. Prochlorperazine can exaggerate the blood pressure-lowering effect of antihypertensive drugs, especially alpha-blockers like guanethidine and guanadrel. It can also interact with lithium, increasing the risk of neurotoxicity. Antacids and anti-Parkinson agents can reduce the absorption of prochlorperazine, so take them at least 2 hours apart. Metrizamide, a contrast agent used in some imaging procedures, can increase the risk of seizures when combined with prochlorperazine. Cabergoline, a dopamine agonist used for Parkinson's disease and high prolactin levels, has its effects reduced by prochlorperazine. Grepafloxacin and sparfloxacin, two antibiotics, can increase the risk of heart rhythm problems when taken with prochlorperazine. Tell your doctor and pharmacist about every medication you take, including over-the-counter products, vitamins, and herbal supplements.

Missed Dose

If you miss a dose of prochlorperazine, take it as soon as you remember. If it is almost time for your next dose, skip the missed one and continue with your regular schedule. Do not take two doses at once to make up for a missed one. Taking a double dose can increase the risk of sedation, low blood pressure, and extrapyramidal symptoms. If you miss several doses in a row, contact your doctor before restarting. Abrupt discontinuation after long-term use can cause withdrawal symptoms, including nausea, vomiting, insomnia, and agitation.

Overdose

Prochlorperazine overdose is a medical emergency. Symptoms include severe drowsiness, confusion, agitation, hallucinations, muscle rigidity, and seizures. The heart can develop dangerous arrhythmias, including QT prolongation and torsades de pointes, which can lead to cardiac arrest. Blood pressure can drop dangerously low, and breathing can slow. There is no specific antidote. Treatment is supportive and may include activated charcoal if the overdose was recent, intravenous fluids, and medications to control seizures and support blood pressure. Close monitoring of heart rhythm and vital signs is necessary. Contact a poison control centre or go to an emergency department immediately if you or someone else has taken too much. Do not try to manage an overdose at home.

Storage

Store prochlorperazine tablets at room temperature between 20 and 25 degrees Celsius (68 and 77 degrees Fahrenheit). Protect from light and moisture. Keep the container tightly closed and store it in a dry place. Do not store in the bathroom or near a sink. Keep out of reach of children and pets. Do not use after the expiry date on the label. Dispose of unused medication according to local guidelines. Do not flush prochlorperazine down the toilet or pour it down the sink.

Disclaimer

We provide only general information about medications which does not cover all directions, possible drug integrations, or precautions. Information at the site cannot be used for self-treatment and self-diagnosis. Any specific instructions for a particular patient should be agreed with your health care adviser or doctor in charge of the case. We disclaim reliability of this information and mistakes it could contain. We are not responsible for any direct, indirect, special or other indirect damage as a result of any use of the information on this site and also for consequences of self-treatment.

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