Formulary
Prochlorperazine: Indications, Dosing, Side Effects and Interactions
Prochlorperazine clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 6 min read
Prochlorperazine: Indications, Dosing, Side Effects and Interactions
Prochlorperazine clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Schizophrenia and other psychoses,Mania**
- **Adult** (By Mouth): 12.5 mg twice daily for 7 days, dose to be adjusted at intervals of 4-7 days according to response; usual dose 75-100 mg per day.
- **Adult** (By Deep Intramuscular Injection): 12.5-25 mg 2-3 times a day.
**Short-term adjunctive management of severe anxiety**
- **Adult** (By Mouth): 15-20 mg daily in divided doses; maximum 40 mg per day.
**Nausea and vomiting, acute attack**
- **Adult** (By Mouth): Initially 20 mg for 1 dose, then 10 mg for 1 dose, to be given 2 hours after first dose.
- **Adult** (By Deep Intramuscular Injection): 12.5 mg as required, to be followed if necessary after 6 hours by an oral dose.
**Nausea and vomiting, prevention**
- **Adult** (By Mouth): 5-10 mg 2-3 times a day.
- **Adult** (By Deep Intramuscular Injection): 12.5 mg as required, to be followed if necessary after 6 hours by an oral dose.
**Prevention and treatment of nausea and vomiting**
- **Child** (By Mouth): 12-17 years 5-10 mg up to 3 times a day as required.
- **Child** (By Intramuscular Injection): 12-17 years 12.5 mg up to 3 times a day as required.
**Labyrinthine disorders**
- **Adult** (By Mouth): 5 mg 3 times a day, dose can be increased gradually to 30 mg daily in divided doses if necessary, then reduced to 5-10 mg per day after several weeks.
**Acute migraine**
- **Adult** (By Mouth): 10 mg for 1 dose, to be taken as soon as migraine symptoms develop.
**Prevention and treatment of nausea and vomiting for prochlorperazine**
- **Child 1-11 years (body-weight 10 kg and above)** (By mouth): 250 micrograms/kg 2-3 times a day.
- **Child 12-17 years** (By mouth): 5-10 mg up to 3 times a day as required.
- **Child 2-4 years** (By intramuscular injection): 1.25-2.5 mg up to 3 times a day as required.
- **Child 5-11 years** (By intramuscular injection): 5-6.25 mg up to 3 times a day as required.
- **Child 12-17 years** (By intramuscular injection): 12.5 mg up to 3 times a day as required.
**Nausea and vomiting in previously diagnosed migraine for prochlorperazine**
- **Child 12-17 years** (By buccal administration): 3-6 mg twice daily.
Cautions
For all antipsychotic drugs Blood dyscrasias; cardiovascular disease; conditions predisposing to seizures; depression; diabetes (may raise blood glucose); epilepsy; history of jaundice; myasthenia gravis; Parkinson's disease (may be exacerbated) (in adults); photosensitisation (may occur with higher dosages); prostatic hypertrophy (in adults); severe respiratory disease; susceptibility to angle-closure glaucoma Cautions, further information Cardiovascular disease An ECG may be required, particularly if physical examination identifies cardiovascular risk factors, personal history of cardiovascular disease, or if the patient is being admitted as an inpatient. Elderly In adults: Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: for all antipsychotics (other than quetiapine and clozapine) in patients with parkinsonism or Lewy Body Disease (risk of severe extrapyramidal symptoms) in behavioural and psychological symptoms of dementia (BPSD), unless symptoms are severe and other non-pharmacological treatments have failed (increased risk of stroke) for use as a hypnotic, unless sleep disorder is due to psychosis or dementia (risk of confusion, hypotension, extrapyramidal side-effects, and falls) in patients prone to falls (may cause gait dyspraxia, parkinsonism) if prescribed a phenothiazine (other than prochlorperazine for nausea, vomiting, or vertigo; chlorpromazine for relief of persistent hiccups; levomepromazine as an antiemetic in palliative care) as first-line treatment (sedative, significant antimuscarinic (anticholinergic) toxicity in older people, and safer and more efficacious alternatives exist) if prescribed an antipsychotic drug with moderate or marked antimuscarinic effects (e.g. chlorpromazine, clozapine, flupenthixol, fluphenazine, pipothiazine, promazine, and zuclopenthixol) in patients with a history of prostatism or urinary retention (high risk of urinary retention) Cautions For prochlorperazine General cautions: Elderly (in adults); hypotension (more likely after intramuscular injection); susceptibility to QT interval prolongation Specific cautions: With systemic use Hypothyroidism (in adults) Cautions, further information Elderly In adults: Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information): potentially inappropriate in patients with parkinsonism (risk of exacerbating parkinsonian symptoms).
Contraindications
Avoid oral route in child under 10 kg; CNS depression; comatose states; phaeochromocytoma
Side effects
For all antipsychotic drugs Common or very common Agitation; amenorrhoea; arrhythmias; constipation; dizziness; drowsiness; dry mouth; erectile dysfunction; fatigue; galactorrhoea; gynaecomastia; hyperglycaemia; hyperprolactinaemia; hypersalivation; hypotension (dose-related); insomnia; leucopenia; movement disorders; muscle rigidity; neutropenia; parkinsonism; postural hypotension (dose-related); QT interval prolongation; rash; seizure; tremor; urinary retention; vomiting; weight increased Uncommon Agranulocytosis; confusion; neuroleptic malignant syndrome (discontinue-potentially fatal) Rare or very rare Sudden death; withdrawal syndrome neonatal Side-effects, further information For depot antipsychotics-side-effects may persist until the drug has been cleared from its depot site. Overdose Phenothiazines cause less depression of consciousness and respiration than other sedatives. Hypotension, hypothermia, sinus tachycardia, and arrhythmias may complicate poisoning. For details on the management of poisoning see Antipsychotics under Emergency treatment of poisoning . Side-effects For prochlorperazine General side-effects: Frequency not known Glucose tolerance impaired; hyponatraemia; photosensitivity reaction; SIADH Specific side-effects: Rare or very rare With buccal use Blood disorder; hepatic disorders Frequency not known With buccal use Oral disorders; skin eruption; taste altered With intramuscular use Atrioventricular block; cardiac arrest; jaundice; nasal congestion; oculogyric crisis; respiratory depression With oral use Atrioventricular block; cardiac arrest; jaundice; nasal congestion; oculogyric crisis; respiratory depression Side-effects, further information Acute dystonias are more common with potent first-generation antipsychotics. The risk is increased in men, young adults, children, antipsychotic-nave patients, rapid dose escalation, and abrupt treatment discontinuation.
Interactions
**Other interactions (5):**
- Desferal should not be used in combination with prochlorperazine (a phenothiazine derivative) since prolonged unconsciousness may result.
- Simultaneous administration of deferoxamine and prochlorperazine has been observed to induce a transient metabolic encephalopathy characterised by loss of consciousness for 48-72 hours.
- It is possible this may occur with Chlorpromazine since it shares many of the pharmacological properties of prochlorperazine.
- Simultaneous administration of desferrioxamine and prochlorperazine has been observed to induce a transient metabolic encephalopathy characterised by loss of consciousness for 48-72 hours.
- It is possible this may occur with Pericyazine since it shares many of the pharmacological properties of prochlorperazine.
Pregnancy
For all antipsychotic drugs Extrapyramidal effects and withdrawal syndrome have been reported occasionally in the neonate when antipsychotic drugs are taken during the third trimester of pregnancy. Following maternal use of antipsychotic drugs in the third trimester, neonates should be monitored for symptoms including agitation, hypertonia, hypotonia, tremor, drowsiness, feeding problems, and respiratory distress.
Breast feeding
For all antipsychotic drugs There is limited information available on the short- and long-term effects of antipsychotic drugs on the breast-fed infant. Animal studies indicate possible adverse effects of antipsychotic medicines on the developing nervous system. Chronic treatment with antipsychotic drugs whilst breast-feeding should be avoided unless absolutely necessary. Phenothiazine derivatives are sometimes used in breast-feeding women for short-term treatment of nausea and vomiting.
Hepatic impairment
Manufacturer advises avoid.
Renal impairment
Dose adjustments Start with small doses in severe renal impairment because of increased cerebral sensitivity.
Medicinal forms
Tablet,Tablet,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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