Prochlorperazine-rectal

Yes

Side effects associated with prochlorperazine treatment include:

• Drowsiness
• Dizziness
• Amenorrhea (absence of menstruation)
• Blurred vision
• Skin reactions
• Low blood pressure

The following also have been reported are movement disorders (extrapyramidal symptoms) including:

• Motor restlessness
• Dystonias
• Pseudo-parkinsonism
• Tardive dyskinesia

Additionally, cardiac (heart) and liver abnormalities have occurred in some patients.

Children are prone to develop extrapyramidal reactions more than adults.

Prochlorperazine is not approved for use in psychotic conditions related to dementia. Prochlorperazine may increase the risk of death in older adults with dementia-related conditions.

You should not use prochlorperazine if you have recently used alcohol, sedatives, tranquilizers, or narcotic medications.

Do not give this medicine to a child younger than 2 years old or weighting less than 20 pounds. Do not use prochlorperazine in a child of any age without medical advice.

Usual Adult Dose for Nausea/Vomiting:

Severe Nausea and Vomiting:
Oral:
-Usual dose: 5 to 10 mg orally 3 to 4 times a day
-Maximum dose: 40 mg/day

Parenteral:
IM:
-Usual dosage: 5 to 10 mg IM, repeated every 3 to 4 hours as necessary.
-Maximum dose: 40 mg/day

IV:
-Usual dose: 2.5 to 10 mg slow IV injection or infusion at a rate not exceeding 5 mg/min
-Maximum dose: 10 mg (single dose); 40 mg/day

Rectal:
-Usual dose: 25 mg rectally 2 times a day

Adult Surgery (Severe Nausea and Vomiting):
Parenteral:
IM:
-Usual dose: 5 to 10 mg IM 1 to 2 hours before anesthesia OR to control acute symptoms during/after surgery, repeated once (in 30 minutes) if necessary
-Maximum dose: 40 mg/day

IV:
-Usual dose: 5 to 10 mg slow IV injection or infusion (at a rate not exceeding 5 mg/min) 15 to 30 minutes before anesthesia OR to control acute symptoms during/after surgery, repeated once if necessary
-Maximum dose: 10 mg (single dose)

Comments:
-Resistant cases may require oral doses exceeding 40 mg/day.
-Patients receiving parenteral formulations may be more likely to experience hypotension.
-This drug may be given as an undiluted or diluted IV solution; however, bolus IV injections should be avoided.

Use: Control of severe nausea and vomiting

Usual Adult Dose for Anxiety:

Oral:
-Usual dose: 5 mg orally 3 to 4 times a day
-Maximum dose: 20 mg/day
-Duration of therapy: Up to 12 weeks

Use: Short-term treatment of generalized non-psychotic anxiety

Usual Adult Dose for Psychosis:

Mild psychotic disorders:
-Usual dose: 5 to 10 mg orally 3 to 4 times a day

Moderate to severe psychotic disorders:
Oral:
-Initial dose: 10 mg orally 3 to 4 times a day, increasing the dose in small increments every 2 to 3 days until symptoms are controlled or side effects become bothersome
-Maintenance dose: 50 to 75 mg/day for some patients; 100 to 150 mg/day for patients with more severe disturbances

Parenteral:
-Initial dose: 10 to 20 mg IM, repeated every 2 to 4 hours (or every hour in resistant cases), if necessary
-Prolonged therapy: 10 to 20 mg IM every 4 to 6 hours

Comments:
-Many patients respond after the first injection; more than 3 to 4 IM doses are seldom required.
-Once patients are controlled on parenteral formulations, oral formulations should be used at the same dose or higher. Prolonged IM therapy should be used in rare cases.

Use: Treatment of schizophrenia

Usual Adult Dose for Schizophrenia:

Mild psychotic disorders:
-Usual dose: 5 to 10 mg orally 3 to 4 times a day

Moderate to severe psychotic disorders:
Oral:
-Initial dose: 10 mg orally 3 to 4 times a day, increasing the dose in small increments every 2 to 3 days until symptoms are controlled or side effects become bothersome
-Maintenance dose: 50 to 75 mg/day for some patients; 100 to 150 mg/day for patients with more severe disturbances

Parenteral:
-Initial dose: 10 to 20 mg IM, repeated every 2 to 4 hours (or every hour in resistant cases), if necessary
-Prolonged therapy: 10 to 20 mg IM every 4 to 6 hours

Comments:
-Many patients respond after the first injection; more than 3 to 4 IM doses are seldom required.
-Once patients are controlled on parenteral formulations, oral formulations should be used at the same dose or higher. Prolonged IM therapy should be used in rare cases.

Use: Treatment of schizophrenia

Usual Pediatric Dose for Nausea/Vomiting:

Less than 2 years or less than 9 kg: Use is contraindicated

2 years and older:
Oral:
9 to 13 kg: 2.5 mg orally 1 to 2 times a day; maximum dose is 7.5 mg/day
13 to 18 kg: 2.5 mg orally 2 to 3 times a day; maximum dose is 10 mg/day
18 to 39 kg: 2.5 mg orally 3 times a day OR 5 mg orally 2 times a day; maximum dose is 15 mg/day

Parenteral:
-Usual dose: 0.132 mg/kg IM once

Comments:
-At moderate doses, pediatric patients may be more prone to extrapyramidal reactions. Patients should receive the lowest effective dose.
-Continued oral treatment after day 1, and parenteral treatment after the first dose is usually not necessary.

Use: Control of severe nausea and vomiting

Usual Pediatric Dose for Schizophrenia:

Less than 2 years or less than 9 kg: Use is contraindicated

2 to 12 years:
Oral:
-Initial dose: 2.5 mg orally 2 to 3 times a day
-Maximum dose: 20 mg/day (2 to 5 years); 25 mg/day (6 to 12 years)

Parenteral:
-Usual dose: 0.132 mg/kg IM once

Comments:
-Patients should not receive more than 10 mg of the oral formulation on the first day of treatment. Dose adjustments may be made after the first day.
-At moderate doses, pediatric patients may be more prone to extrapyramidal reactions. Patients should receive the lowest effective dose.
-When symptoms are controlled with the IM formulation, patients should be switched to oral formulations at the same dose or higher.

Use: Treatment of schizophrenia

Use prochlorperazine exactly as directed by your doctor. Do not use more of it, do not use it more often, and do not use it for a longer time than your doctor ordered.

Do not take rectal suppositories by mouth or use it in the vagina.

To use the suppository:

• If the suppository is too soft to insert, chill it in the refrigerator for 20 to 30 minutes or run cold water over it before removing the wrapper.
• Remove the wrapper and moisten the suppository with cool water.
• Lie down on your side and use your finger to push the suppository well up into the rectum.
• Make sure to wash your hands with soap and water before and after using prochlorperazine.

Dosing

The dose of prochlorperazine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of prochlorperazine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For rectal dosage form (suppository):
  • For severe nausea and vomiting:
    • Adults—25 milligrams (mg) 2 times a day.
    • Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of prochlorperazine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

You may store the suppositories in the refrigerator, but do not freeze them.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Drowsiness, dizziness, lightheadedness, blurred vision, constipation, or dry mouth may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

To relieve dry mouth, suck (sugarless) hard candy or ice chips, chew (sugarless) gum, drink water, or use a saliva substitute.

To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if you have any serious side effects, including: mental/mood changes (such as agitation, restlessness), unusual/uncontrolled movements (such as fixed upward stare, neck twisting, tongue movements, muscle spasms), shaking (tremor), difficulty urinating, enlarged/tender breasts, unusual breast milk production, weakness, easy bleeding/bruising, signs of infection (such as fever, persistent sore throat), severe stomach/abdominal pain, persistent nausea/vomiting, yellowing eyes/skin.

Get medical help right away if you have any very serious side effects, including: seizures.

This medication may rarely cause a very serious condition called neuroleptic malignant syndrome (NMS). Get medical help right away if you have any of the following symptoms: fever, muscle stiffness/pain/tenderness/weakness, severe tiredness, severe confusion, sweating, fast/irregular heartbeat, dark urine, signs of kidney problems (such as change in the amount of urine).

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US -

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.