Adult: Dose is expressed in terms of prochlorperazine maleate: 3-6 mg bid. Treatment recommendations may vary among countries or between individual products (refer to specific product guidelines). Child: ≥12 years Same as adult dose.
Buccal Vertigo
Adult: In cases due to Meniere's disease, labyrinthitis and other causes: Dose is expressed in terms of prochlorperazine maleate: 3-6 mg bid. Treatment recommendations may vary among countries or between individual products (refer to specific product guidelines).
Intramuscular Nausea and vomiting
Adult: As prochlorperazine mesilate: 12.5 mg via deep IM inj, followed by an oral dose after 6 hours if necessary. As prochlorperazine edisilate: For severe cases: Initially, 5-10 mg via deep IM inj, may repeat dose 3-4 hourly if necessary. Max: 40 mg daily. For control of severe nausea and vomiting during surgery: 5-10 mg given 1-2 hours before induction of anaesthesia, or to control acute symptoms during or after surgery; may repeat dose once after 30 minutes if necessary. Dosage and treatment recommendations may vary among countries or between individual products (refer to specific product guidelines). Elderly: Dose reduction may be necessary.
Intramuscular Schizophrenia
Adult: As prochlorperazine mesilate: 12.5-25 mg bid or tid via deep IM inj until oral treatment is possible. As prochlorperazine edisilate: Initially, 10-20 mg via deep IM inj, may repeat dose 2-4 hourly if necessary (or hourly in resistant cases). Switch to oral form once control is achieved. Dosage and treatment recommendations may vary among countries or between individual products (refer to specific product guidelines). Elderly: Dose reduction may be necessary.
Intramuscular Mania
Adult: As prochlorperazine mesilate: 12.5-25 mg bid or tid via deep IM inj until oral treatment is possible. Treatment recommendations may vary among countries or between individual products (refer to specific product guidelines). Elderly: Dose reduction may be necessary.
Intravenous Severe nausea and vomiting
Adult: As prochlorperazine edisilate: 2.5-10 mg via slow IV inj or infusion at a rate not exceeding 5 mg/min. Max: 10 mg/dose; 40 mg daily. For control of severe nausea and vomiting during surgery: 5-10 mg via slow IV inj or infusion at a rate not exceeding 5 mg/min, given 15-30 minutes before induction of anaesthesia, or to control acute symptoms during or after surgery; may repeat dose once if necessary. Dosage and treatment recommendations may vary among countries or between individual products (refer to specific product guidelines). Elderly: Dose reduction may be necessary.
Oral Short-term management of anxiety
Adult: Dose is expressed in terms of prochlorperazine maleate: As an adjunct: Initially, 15-20 mg daily in divided doses, may be increased to a Max of 40 mg daily if necessary. Dose is expressed in terms of prochlorperazine base: For generalised non-psychotic cases: 5 mg 3 or 4 times daily. Max: 20 mg daily. Do not use longer than 12 weeks. Dosage and treatment recommendations may vary among countries or between individual products (refer to specific product guidelines). Elderly: Dose reduction may be necessary.
Oral Mania
Adult: Dose is expressed in terms of prochlorperazine maleate: Initially, 12.5 mg bid for 7 days, may be increased in increments of 12.5 mg at 4- to 7-day intervals until satisfactory response is achieved. Usual dose: 75-100 mg daily. May reduce dose after some weeks at the effective dosage. Dosage and treatment recommendations may vary among countries or between individual products (refer to specific product guidelines). Elderly: Dose reduction may be necessary.
Oral Schizophrenia
Adult: Dose is expressed in terms of prochlorperazine maleate: Initially, 12.5 mg bid for 7 days, may be increased in increments of 12.5 mg at 4- to 7-day intervals until satisfactory response is achieved. Usual dose: 75-100 mg daily. May reduce dose after some weeks at the effective dosage. Dose is expressed in terms of prochlorperazine base: 5-10 mg 3 or 4 times daily, may gradually increase dose every 2-3 days according to response and tolerability; doses up to 150 mg daily may be required in some patients with severe disturbances. Dosage and treatment recommendations may vary among countries or between individual products (refer to specific product guidelines). Elderly: Dose reduction may be necessary. Child: Dose is expressed in terms of prochlorperazine base: 2-12 years Initially, 2.5 mg bid or tid. Max of 10 mg on the 1st day. May increase dose according to response and tolerance. Max: 2-5 years 20 mg daily; 6-12 years 25 mg daily. Treatment recommendations may vary among countries or between individual products (refer to specific product guidelines).
Oral Nausea and vomiting
Adult: Dose is expressed in terms of prochlorperazine maleate: For prevention: 5-10 mg bid or tid. For treatment: Initially, 20 mg, followed by 10 mg after 2 hours if necessary. Dose is expressed in terms of prochlorperazine base: For control of severe cases: 5-10 mg 3 or 4 times daily. Max: 40 mg daily. Dosage and treatment recommendations may vary among countries or between individual products (refer to specific product guidelines). Elderly: Dose reduction may be necessary. Child: Dose is expressed in terms of prochlorperazine maleate: For prevention and treatment in patients weighing ≥10 kg: 0.25 mg/kg bid or tid. Dose is expressed in terms of prochlorperazine base: For control of severe cases: ≥2 years In patients weighing 9-13 kg: 2.5 mg 12-24 hourly as needed (Max: 7.5 mg daily); >13-18 kg: 2.5 mg 8-12 hourly as needed (Max: 10 mg daily); >18-39 kg: 2.5 mg 8 hourly or 5 mg 12 hourly as needed (Max: 15 mg daily). Dosage and treatment recommendations may vary among countries or between individual products (refer to specific product guidelines).
Oral Vertigo
Adult: In cases due to Meniere's disease, labyrinthitis and other causes: Dose is expressed in terms of prochlorperazine maleate: 5 mg tid, may be increased to a total of 30 mg daily if necessary. Dose may be gradually reduced to 5-10 mg daily after several weeks. Treatment recommendations may vary among countries or between individual products (refer to specific product guidelines). Elderly: Dose reduction may be necessary.
Rectal Severe nausea and vomiting
Adult: As prochlorperazine base supp: 25 mg bid. Treatment recommendations may vary among countries or between individual products (refer to specific product guidelines). Elderly: Dose reduction may be necessary.
What are the brands available for Prochlorperazine in Hong Kong?
Prochlorperazine May be taken with or without food.
Reconstitution
IV infusion: May dilute in isotonic solution.
Incompatibility
Prochlorperazine edisilate/mesilate: Incompatible with aminophylline, amphotericin B, ampicillin Na, benzylpenicillin, Ca gluconate, chloramphenicol Na succinate, chlorothiazide Na, hydrocortisone Na succinate, heparin Na, aztreonam, cefmetazole Na, cefalotin Na, dimenhydrinate, midazolam hydrochloride, some sulfonamides and some barbiturates.
Contraindications
Circulatory collapse, comatose states or presence of large amounts of CNS depressants (e.g. alcohol, barbiturates, narcotics), bone marrow depression. Use in paediatric surgery. Children <2 years or weighing <9 kg. Contraindications may vary among countries and between individual products (refer to specific product guidelines).
Special Precautions
Patient with risk factors for blood dyscrasias (e.g. pre-existing low WBC, history of drug-induced leucopenia or neutropenia); severe CV disease, congenital or acquired QT prolongation, bradycardia, hypokalaemia; risk factors for stroke; decreased gastrointestinal motility (e.g. paralytic ileus); ophthalmic condition (e.g. visual problems, history of narrow-angle glaucoma), phaeochromocytoma, hypothyroidism, Parkinson's disease, myasthenia gravis, diabetes mellitus; epilepsy or risk factors for seizures (e.g. history of seizures, head trauma, alcoholism, brain damage, concomitant use of medications that may lower seizure threshold); urinary retention or benign prostatic hyperplasia. Patient subjected to strenuous exercise or exposed to extreme heat. Dehydrated patients. Avoid use in children and adolescents with signs and symptoms suggestive of Reye's syndrome. Avoid abrupt withdrawal. Avoid skin contact with parenteral solution. Renal and hepatic impairment. Children (particularly those with acute illnesses). Elderly; elderly patients with dementia-related psychosis may have an increased risk of mortality when treated with antipsychotic agents. Prochlorperazine is not approved for the treatment of dementia-related psychosis. Pregnancy and lactation.
Adverse Reactions
Significant: Hypersensitivity reactions (e.g. anaphylaxis, urticaria, angioedema); hyperprolactinaemia; pigmentary retinopathy, lenticular and corneal deposits; CNS depression (e.g. drowsiness, motor dysfunction, sedation); extrapyramidal symptoms (e.g. acute dystonia, tardive dyskinesia, akathisia, parkinsonism); anticholinergic effects (e.g. blurred vision, constipation, confusion, dry eye, dry mouth, urinary retention); impaired core body temperature regulation, photosensitivity, hyperglycaemia; hypotension, usually postural (particularly in elderly or volume-depleted patients); VTE; aspiration of vomit (in post-surgical patients); contact dermatitis (skin contact with parenteral solution). Very rarely, acute withdrawal symptoms (after abrupt cessation of high doses). Blood and lymphatic system disorders: Eosinophilia. Gastrointestinal disorders: Gum or mouth irritation, taste disorders, oral hypoaesthesia or paraesthesia (buccal tab). General disorders and administration site conditions: Peripheral oedema. Hepatobiliary disorders: Cholestatic jaundice, liver damage. Investigations: Increased serum levels of bilirubin and hepatic enzymes; ECG changes. Metabolism and nutrition disorders: Hyponatraemia, SIADH. Nervous system disorders: Seizures, dizziness. Psychiatric disorders: Insomnia, agitation. Reproductive system and breast disorders: Priapism, ejaculation disorder, amenorrhoea. Respiratory, thoracic and mediastinal disorders: Respiratory depression, nasal congestion. Potentially Fatal: May potentiate QT interval prolongation which increases the risk of ventricular arrhythmias of torsades de pointes type; leucopenia, neutropenia, agranulocytosis, neuroleptic malignant syndrome.
Patient Counseling Information
This drug may cause drowsiness, if affected, do not drive or operate machinery. Avoid exposure to direct sunlight; use sunscreen or wear protective clothing when going outdoors.
Monitoring Parameters
Monitor CBC, mental status and alertness, and vital signs (as clinically indicated); liver function, electrolytes (annually and as clinically indicated); fasting plasma glucose level or HbA1c (at baseline, then annually); lipid profile (at baseline, then every 2 years if LDL is normal or every 6 months if LDL is >130 mg/dL). Assess for changes in menstruation, libido, erectile and ejaculatory function, galactorrhoea (at each visit for the 1st 12 weeks of antipsychotic treatment or until dose is stable, then annually); signs and symptoms of abnormal involuntary movements or parkinsonism (at baseline, then repeat weekly until dose is stabilised for at least 2 weeks after initiation and for 2 weeks after significant dose increase); tardive dyskinesia (every 6 months); and visual changes (annually). Perform ocular examination annually in patients >40 years of age or every 2 years in younger patients.
Overdosage
Symptoms: Drowsiness, dry mouth, ileus, hypotension, tachycardia, ECG changes, ventricular arrhythmias, hypothermia, severe extrapyramidal dyskinesias, agitation, restlessness, coma, and loss of consciousness. Management: Supportive and symptomatic treatment. Perform gastric lavage if patient is seen soon (up to 6 hours) after ingestion of toxic dose. Administer activated charcoal. In case of hypotension, give strict attention to ventilation and posturing of the patient; if needed, consider administering volume expansion by IV fluids. If effect is insufficient, positive inotropic agents (e.g. dopamine) may be considered. Avoid use of epinephrine. Ventricular or supraventricular tachyarrhythmias may usually respond to normal body temperature restoration and correction of metabolic or circulatory disturbances. In persistent or life-threatening cases, may consider using appropriate antiarrhythmic agents. Pronounced CNS depression necessitates maintenance of airway or assisted respiration (in severe cases). Administer anti-parkinsonism drugs, barbiturates or diphenhydramine to treat extrapyramidal symptoms. In case of severe dystonic reactions, may give procyclidine or orphenadrine via IM or IV. Administer IV diazepam to treat convulsions. Treat neuroleptic malignant syndrome with cooling procedures; dantrolene may be given.
Drug Interactions
May increase CNS depressant effect with barbiturates and other sedatives. May reduce antipsychotic effect with anticholinergic agents. May increase the hypotensive effect of α-adrenoceptor blocking agents. May counteract the action of amphetamine, levodopa, clonidine, guanethidine, and epinephrine. Concomitant use with deferoxamine may cause transient metabolic encephalopathy. Increased risk of arrhythmias with QT-prolonging drugs (e.g. antiarrhythmic agents, antidepressants, other antipsychotic agents) and drugs causing electrolyte imbalance. Increased risk of agranulocytosis with agents with myelosuppressive potential (e.g. carbamazepine, certain antibiotics, cytotoxic agents). Increased risk of neurotoxicity with lithium. May increase the plasma concentration of amitriptyline. Antacids, anti-parkinsonian agents, and lithium may interfere with the absorption of prochlorperazine.
Food Interaction
May increase CNS depressant effect with alcohol.
Lab Interference
May produce false-positive results for pregnancy and phenylketonuria tests.
Action
Description: Mechanism of Action: Prochlorperazine, a phenothiazine derivative, is an antipsychotic and antiemetic agent. It blocks postsynaptic mesolimbic dopaminergic D1 and D2 receptors in the brain (including the chemoreceptor trigger zone), demonstrates a strong α-adrenergic and anticholinergic blocking effect, and reduces the release of hypothalamic and hypophyseal hormones. Additionally, it is thought to depress the reticular activating system, hence affecting basal metabolism, wakefulness, body temperature, vasomotor tone and emesis. Onset: 30-40 minutes (oral); 10-20 minutes (IM); approx 60 minutes (rectal). Duration: 3-4 hours (oral, IM); 3-12 hours (rectal). Pharmacokinetics: Absorption: Bioavailability: 12.5% (oral). Time to peak plasma concentration: 1.5-5 hours. Distribution: Volume of distribution: 1,400-1,548 L. Metabolism: Metabolised mainly in the liver into major active metabolite, N-desmethyl prochlorperazine. Excretion: Mainly via faeces. Elimination half-life: Oral: 6-10 hours (single dose); 14-22 hours (repeated dosing). IV: 6-10 hours.
Chemical Structure
Prochlorperazine Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 4917, Prochlorperazine. https://pubchem.ncbi.nlm.nih.gov/compound/Prochlorperazine. Accessed Jan. 27, 2025.
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