Version July 2025
Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Analyses of 17 placebo-controlled trials (modal duration of 10 weeks), largely in patients taking atypical antipsychotic drugs, revealed a risk of death in drug-treated patients between 1.6 and 1.7 times the risk of death in placebo-treated patients. Over the course of a typical 10-week controlled trial, the rate of death in drug-treated patients was approximately 4.5% compared with a rate of approximately 2.6% in the placebo group. Although the causes of death were varied, most of the deaths appeared to be either cardiovascular (eg, heart failure, sudden death) or infectious (eg, pneumonia) in nature. Observational studies suggest that, similar to atypical antipsychotic drugs, treatment with conventional antipsychotic drugs may increase mortality. The extent to which the findings of increased mortality in observational studies may be attributed to the antipsychotic drug as opposed to some characteristic(s) of the patients is not clear. Prochlorperazine is not approved for the treatment of patients with dementia-related psychosis.
Anxiety:
Note: Although included as a labeled use, other contemporary therapies have replaced the use of prochlorperazine in the management of anxiety. Treatment guidelines do not include prochlorperazine as a recommended therapy in the management of anxiety (Ref).
Oral: 5 mg 3 or 4 times daily. Maximum dose: 20 mg/day. Do not use for >12 weeks.
Chemotherapy-induced nausea and vomiting (off-label use):
IV chemotherapy agents: Low emetogenic risk (10% to 30% risk of emesis), prevention (alternative agent):
IV, Oral: 5 to 10 mg once prior to chemotherapy (Ref).
Oral chemotherapy agents: Low/minimal emetogenic risk (<30%), treatment and/or prevention:
Oral: 10 mg every 6 hours as needed (Ref).
Breakthrough nausea or vomiting, rescue therapy (adjunctive therapy) (alternative agent):
IV, Oral: 5 to 10 mg every 4 to 6 hours as needed (Ref); maximum: 40 mg/day.
Nausea and/or vomiting, acute:
Note: May use short term (eg, up to 48 to 72 hours) for symptom relief in conditions associated with self-limiting nausea/vomiting (eg, acute vertigo, opioid withdrawal, viral gastroenteritis) (Ref).
Oral: 5 to 10 mg every 6 to 8 hours as needed; maximum: 40 mg/day.
IM: 5 to 10 mg every 3 to 4 hours as needed; maximum: 40 mg/day.
IV: 2.5 to 10 mg every 3 to 4 hours as needed; maximum: 40 mg/day (Ref).
Rectal:
25 mg suppository: 25 mg every 12 hours as needed.
10 mg suppository [Canadian product]: 5 to 10 mg 3 to 4 times/day as needed.
Nausea and vomiting, pregnancy associated (off-label use):
Note: May be considered for adjunctive treatment when symptoms persist following initial pharmacologic therapy (Ref).
Oral, IV, IM: 5 to 10 mg every 6 to 8 hours as needed (Ref).
Rectal: 25 mg every 12 hours as needed (Ref).
10 mg suppository [Canadian product]: 5 to 10 mg 3 to 4 times/day.
Radiation therapy–associated nausea and vomiting, rescue therapy (off-label use):
Low-emetogenic risk radiation therapy (head and neck, thorax, or pelvis irradiation):
Oral, IV: 5 to 10 mg once if needed after each radiation treatment, then 5 to 10 mg every 6 to 8 hours if needed (maximum: 40 mg/day). Depending on symptom severity and remaining duration of therapy, patients can receive subsequent rescue therapy as needed or begin prophylactic therapy (Ref).
Minimal-emetogenic risk radiation therapy (extremities, breast irradiation):
Oral, IV: 5 to 10 mg once if needed after each radiation treatment (Ref).
Schizophrenia:
Note: Although included as a labeled use, other contemporary therapies have replaced the use of prochlorperazine in the management of schizophrenia. Treatment guidelines do not include prochlorperazine as a recommended therapy in the management of schizophrenia or acute agitation associated with psychosis (Ref).
IM: Initial: 10 to 20 mg; may repeat based on response and tolerability every 1 to 4 hours. Transition to oral medication as soon as possible. If continued IM dosing is needed, administer 10 to 20 mg every 4 to 6 hours.
Oral: Initial: 5 to 10 mg 3 to 4 times daily. May increase based on response and tolerability every 2 to 3 days up to 50 to 75 mg daily in divided doses. Some patients may require up to 150 mg/day.
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.
Altered kidney function: Mild to severe impairment: No dosage adjustment necessary (minimal renal clearance (Ref).
Hemodialysis, intermittent (thrice weekly): Unlikely to be dialyzed (large Vd): No supplemental dose or dosage adjustment necessary (Ref).
Peritoneal dialysis: Unlikely to be dialyzed (large Vd): No dosage adjustment necessary (Ref).
CRRT: No dosage adjustment necessary (Ref).
PIRRT (eg, sustained, low-efficiency diafiltration): No dosage adjustment necessary (Ref).
There are no dosage adjustments provided in the manufacturer's labeling; systemic exposure may be increased as drug undergoes hepatic metabolism.
Note: Avoid for behavioral problems associated with dementia or delirium unless alternative nonpharmacologic therapies have failed and patient may harm self or others. If used, consider deprescribing attempts to assess continued need and/or lowest effective dose (Beers Criteria [AGS 2023]).
Initiate at lower end of dosage range; increase dose slowly and cautiously. Refer to adult dosing.
(For additional information see "Prochlorperazine: Pediatric drug information")
Dosage guidance:
Safety: Use lowest possible dose in pediatric patients to decrease incidence of extrapyramidal reactions; may consider concomitant diphenhydramine to decrease risk of dystonic adverse effects.
Chemotherapy-induced nausea and vomiting (CINV); refractory, treatment: Limited data available: Note: Due to safety concerns, use of prochlorperazine for breakthrough or refractory CINV is not routinely recommended (Ref); however, use may be necessary in some patients.
Children ≥2 years weighing ≥9 kg and Adolescents:
Oral: 0.1 mg/kg/dose every 6 hours; maximum dose: 10 mg/dose (Ref).
IV: 0.1 to 0.15 mg/kg/dose every 3 to 4 hours; maximum dose: 10 mg/dose; maximum daily dose: 40 mg/day (Ref).
Migraine, intractable: Limited data available: Children ≥7 years and Adolescents: IV (as edisylate): 0.15 mg/kg as a single dose; maximum dose: 10 mg/dose; dosing based on multicenter, prospective, double-blind, randomized ketorolac comparative trial (prochlorperazine group, n=33) (Ref) and several retrospective trials (Ref).
Nausea and vomiting, severe; treatment:
Note: Prochlorperazine has been used as an antiemetic for various presenting conditions. In most clinical situations, routine use has been replaced by alternate agents from other therapeutic classes with a more favorable safety profile (Ref); however, prochlorperazine may be useful in severe situations (Ref).
Oral:
Fixed dosing:
Children ≥2 years weighing ≥9 kg and Adolescents:
9 to 13 kg: Oral: 2.5 mg every 12 to 24 hours as needed; maximum daily dose: 7.5 mg/day.
>13 to 18 kg: Oral: 2.5 mg every 8 to 12 hours as needed; maximum daily dose: 10 mg/day.
>18 to 39 kg: Oral: 2.5 mg every 8 hours or 5 mg every 12 hours as needed; maximum daily dose: 15 mg/day.
>39 kg: Oral: 5 to 10 mg every 6 to 8 hours; usual maximum daily dose: 40 mg/day.
Weight-directed dosing: Limited data available: Children ≥2 years weighing >10 kg and Adolescents: Oral: 0.4 mg/kg/day divided every 6 to 8 hours; maximum dose: 10 mg/dose (Ref).
Parenteral: Prochlorperazine edisylate: Limited data available for IV route of administration: Children ≥2 years weighing ≥9 kg and Adolescents: IM (preferred), IV: 0.1 to 0.2 mg/kg/dose; maximum single dose: 10 mg/dose; frequency of administration typically every 8 to 12 hours based upon patient response (Ref).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling; systemic exposure may be increased as drug undergoes hepatic metabolism.
Phenothiazines, including prochlorperazine, may cause anticholinergic adverse effects such as blurred vision, confusion, constipation, dry eye, urinary retention, and xerostomia. Prochlorperazine is included in the Beers Criteria of Potentially Inappropriate Medication Use in Older Adults (Ref). Prochlorperazine is considered a low anticholinergic burden drug (Ref).
Mechanism: Dose-related; related to the pharmacologic action (ie, muscarinic receptor antagonism) (Ref).
Risk factor:
• Age ≥65 years (Ref)
• Concurrent use of other anticholinergic agents (Ref)
Prochlorperazine use has been associated with dizziness, drowsiness, motor dysfunction (motor sensory instability), and sedated state. Pediatric patients are particularly susceptible to prochlorperazine-induced sedation (Ref). Prochlorperazine-related CNS depression has been associated with an increased risk of falling and femoral neck fracture in older patients (Ref). Prochlorperazine is included in the Beers Criteria of Potentially Inappropriate Medication Use in Older Adults (Ref).
Onset: Rapid; typically occurs within the first 24 hours of therapy initiation (Ref).
Risk factors:
• Pediatric patients and older adults (Ref)
• Concurrent use of other CNS depressants (eg, alcohol, opioids)
Extrapyramidal reactions (EPS), including akathisia, acute dystonia, drug-induced parkinsonism, and tardive dyskinesia, have occurred with the use of prochlorperazine and other dopamine receptor antagonist neuroleptic agents in adult and pediatric patients. Symptoms of EPS may be confused with other conditions, such as Reye syndrome or other encephalopathy. Acute akathisia is typically transient and resolves with drug discontinuation, but delayed akathisia may be permanent (Ref). Resolution of acute dystonia occurs quickly after drug discontinuation and/or with treatment (Ref). Symptoms of drug-induced parkinsonism typically resolve within 7 weeks of drug discontinuation but may persist for 18 months or longer (Ref). The use of dopamine receptor antagonists, such as prochlorperazine, may unmask undiagnosed idiopathic Parkinson disease (Ref). Tardive dyskinesia may be irreversible; earlier drug discontinuation increases the likelihood of symptom resolution (Ref). Tardive dyskinesia is uncommon in pediatric patients (Ref).
Mechanism: Dose-related; due to antagonism of dopaminergic D2 receptors in nigrostriatal pathways (Ref).
Onset:
• Akathisia: Rapid; usually occurs within the first 72 hours of therapy initiation (Ref); however, delayed (tardive) akathisia may occur (Ref)
• Acute dystonia: Rapid; usually occurs within the first 7 days after therapy initiation or a dosage increase (Ref)
• Drug-induced parkinsonism: Varied; onset may be delayed from days to weeks, with 50% to 75% of cases occurring within the first month and 90% within the first 3 months of therapy (Ref)
• Tardive dyskinesia: Delayed; symptoms usually occur after at least 3 months of therapy and may occur up to 3 months after therapy discontinuation (Ref)
Risk factors (antiemetic use in general):
• Akathisia
- Age ≤18 years (increasing with decreasing age) (Ref)
- IV administration (Ref)
- Pregnancy (Ref)
• Acute dystonia
- Age <19 years (increasing with decreasing age) (Ref)
- Males (Ref)
- Use of agents with high dopamine D2 receptor affinity (Ref)
- History of acute dystonia (Ref)
- Underweight or normal body weight (Ref)
- Cocaine use (Ref)
- Pediatric:
• Acute illnesses (eg, chickenpox, CNS infections, measles, gastroenteritis)
• Dehydration
• Drug-induced parkinsonism
- Age >60 years (Ref)
- Females (Ref)
- Preexisting movement disorder (Ref)
- Cigarette smoking (Ref)
- Genetic variants (Ref)
• Tardive dyskinesia
- Higher cumulative doses (Ref)
- Longer durations of therapy (Ref)
- Age ≥65 years (Ref)
- Females (Ref)
- Diabetes (Ref)
Neuroleptic Malignant Syndrome (NMS), has been associated with the use of dopamine receptor antagonist neuroleptics, including prochlorperazine. Recovery generally occurs after drug discontinuation and with supportive care and treatment; however, some cases have been fatal (Ref). Cases of NMS with prochlorperazine have included patients with a recent history of antipsychotic-induced NMS or use of higher prochlorperazine doses (Ref).
Mechanism: Non–dose-related; idiosyncratic (Ref).
Onset: Varied; usually occurs within the first 2 weeks of therapy initiation (Ref) but may also occur with the first dose (Ref) or after years of therapy (Ref).
Risk factors:
• Higher doses (suggested risk factor, but development of NMS is not dose-dependent) (Ref)
• Rapid dose escalation (Ref)
• History of NMS with other dopamine antagonists (Ref)
• Use of agents with high D2 receptor affinity (Ref)
• IV administration (Ref)
• Genetic polymorphism (Ref)
Phenothiazines, including prochlorperazine, may cause orthostatic hypotension. Orthostatic hypotension may increase the risk for falls in older patients; this risk may be augmented by the sedative effects of prochlorperazine.
Mechanism: Dose-related; related to the pharmacologic action (ie, alpha1-adrenergic receptor blockade and anticholinergic effects) (Ref).
Risk factors:
• Age ≥65 years
• Higher doses
• Parenteral administration
• Concurrent use of thiazide diuretics
• Mitral insufficiency
• Pheochromocytoma
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Reactions listed are based on reports for other agents in this same pharmacologic class and may not be specifically reported for prochlorperazine.
Frequency not defined:
Cardiovascular: ECG abnormality (Q wave and T wave distortions), hypotension, orthostatic hypotension, peripheral edema
Dermatologic: Contact dermatitis, eczema, erythema of skin, exfoliative dermatitis, pruritus, skin pigmentation, urticaria
Endocrine & metabolic: Amenorrhea, galactorrhea not associated with childbirth, gynecomastia, hyperglycemia, hypoglycemia, menstrual disease, weight gain
Gastrointestinal: Atony of colon, cholestasis, constipation, increased appetite, intestinal obstruction, nausea, obstipation, vomiting, xerostomia
Genitourinary: Ejaculatory disorder, glycosuria, impotence, priapism, urinary retention
Hematologic & oncologic: Aplastic anemia, eosinophilia, hemolytic anemia, pancytopenia
Hepatic: Cholestatic jaundice
Hypersensitivity: Nonimmune anaphylaxis
Nervous system: Agitation, altered cerebrospinal proteins, anticholinergic syndrome (including cognitive impairment), brain edema, catatonia, coma, confusion, decreased cough reflex, disruption of body temperature regulation, dizziness, drowsiness, headache, insomnia, jitteriness, motor dysfunction (motor sensory instability), restlessness (motor)
Neuromuscular & skeletal: Lupus-like syndrome
Ophthalmic: Blurred vision, corneal deposits, deposits on or around the surface of the eye (lenticular), epithelial keratopathy, miosis, mydriasis, oculogyric crisis, retinitis pigmentosa
Respiratory: Laryngeal edema, nasal congestion
Miscellaneous: Fever (mild; intramuscular administration)
Postmarketing:
Cardiovascular: Atrial fibrillation (Ref), atrial flutter (Ref)
Dermatologic: Skin photosensitivity (Ref)
Gastrointestinal: Esophageal motility disorder (Ref), paralytic ileus (Ref)
Hematologic & oncologic: Agranulocytosis (in reports with antipsychotic use; risk factors may include preexisting low WBC or history of drug-induced leuko-/neutropenia (Ref)), immune thrombocytopenia (in reports with antipsychotic use; risk factors may include preexisting low WBC or history of drug-induced leuko-/neutropenia (Ref)), leukopenia (in reports with antipsychotic use; risk factors may include preexisting low WBC or history of drug-induced leuko-/neutropenia (Ref))
Hepatic: Jaundice (Ref)
Hypersensitivity: Angioedema (Ref)
Nervous system: Extrapyramidal reaction (akathisia, dyskinesia, dystonia, hyperpyrexia, hyperreflexia, opisthotonos, parkinsonism, tardive dyskinesia) (Ref), falling (Ref), neuroleptic malignant syndrome (Ref), sedated state (Ref), seizure (Ref)
Neuromuscular & skeletal: Femoral neck fracture (Ref)
Respiratory: Asthma (including exacerbation of asthma [can be severe]) (Ref), pulmonary aspiration (Ref)
Known hypersensitivity to phenothiazines; coma or presence of large amounts of CNS depressants (eg, alcohol, opioids, barbiturates); postoperative management of nausea/vomiting following pediatric surgery; use in infants and children <2 years or <9 kg; pediatric conditions for which dosage has not been established
Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Canadian labeling: Additional contraindications (not in the US labeling): Presence of circulatory collapse; severe cardiovascular disorders; altered state of consciousness; concomitant use of high dose hypnotics; severe depression; presence of blood dyscrasias, hepatic or renal impairment, or pheochromocytoma; suspected or established subcortical brain damage with or without hypothalamic damage
Concerns related to adverse effects:
• Altered cardiac conduction: May alter cardiac conduction (life-threatening arrhythmias have occurred with therapeutic doses of phenothiazines).
• Aspiration of vomit: Aspiration of vomit has occurred in postsurgical patients who have received prochlorperazine as an antiemetic (case reports). Although no causal relationship has been established, this possibility should be considered during post-surgical care.
• Blood dyscrasias: Leukopenia, neutropenia, and agranulocytosis (sometimes fatal) have been reported in clinical trials and postmarketing reports with antipsychotic use; presence of risk factors (eg, preexisting low WBC or history of drug-induced leuko-/neutropenia) should prompt periodic blood count assessment. Discontinue therapy at first signs of blood dyscrasias or if absolute neutrophil count <1,000/mm3.
• Esophageal dysmotility/Aspiration: Antipsychotic use has been associated with esophageal dysmotility and aspiration; risks increase with age. Use with caution in patients at risk for aspiration pneumonia (ie, Alzheimer disease), particularly in patients >75 years (Herzig 2017; Maddalena 2004).
• Hyperprolactinemia: Use associated with increased prolactin levels; a potential association between chronic administration of prolactin-increasing antipsychotics and breast cancer has been reported.
• Ocular effects: May cause pigmentary retinopathy, and lenticular and corneal deposits, particularly with prolonged therapy.
• Temperature regulation: Impaired core body temperature regulation may occur; caution with strenuous exercise, heat exposure, dehydration, and concomitant medication possessing anticholinergic effects.
Disease-related concerns:
• Bariatric surgery: Presurgical assessment of the indication for use, symptoms, and goals of therapy should be documented to enable postsurgical assessment. All antipsychotics are associated with metabolic syndrome, which includes weight gain; the syndrome occurs in varying degrees with first generation (typical) antipsychotics (Baptista 1999). No studies evaluating the short-term use of prochlorperazine (eg, nausea and vomiting therapy) on weight gain are available. Monitor weight closely postoperatively and consider changing agent to alternative agent if weight loss goals are not being met.
• Cardiovascular disease: Use with caution in patients with severe cardiovascular disease.
• GI motility: Use with caution in patients with decreased GI motility (eg, paralytic ileus) as anticholinergic effects may exacerbate underlying condition.
• Hepatic impairment: Use with caution in patients with hepatic impairment.
• Ophthalmic conditions: Use with caution in patients with certain ophthalmic conditions (eg, visual problems) as anticholinergic effects may exacerbate underlying condition.
• Renal impairment: Use with caution in patients with renal impairment.
• Reye syndrome: Avoid use in patients with signs/symptoms suggestive of Reye syndrome.
• Seizure disorder: Use with caution in patients at risk of seizures, including those with a history of seizures, head trauma, brain damage, alcoholism, or concurrent therapy with medications which may lower seizure threshold.
• Urinary tract conditions: Use with caution in patients with urinary retention or benign prostatic hyperplasia as anticholinergic effects may exacerbate underlying condition.
Dosage form specific issues:
• Benzyl alcohol and derivatives: Some dosage forms may contain benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol with caution in neonates. See manufacturer's labeling.
• Sodium sulfite: Some dosage forms may contain sodium sulfite.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution, Injection, as edisylate [strength expressed as base]:
Generic: 10 mg/2 mL (2 mL); 50 mg/10 mL (10 mL [DSC])
Suppository, Rectal:
Compro: 25 mg (12 ea) [contains coconut oil (copra/cocos nucifera oil)]
Generic: 25 mg (1 ea, 12 ea, 1000 ea [DSC])
Tablet, Oral, as maleate [strength expressed as base]:
Generic: 5 mg, 10 mg
Yes
Solution (Prochlorperazine Edisylate Injection)
10 mg/2 mL (per mL): $2.12 - $11.10
Suppository (Compro Rectal)
25 mg (per each): $12.58
Suppository (Prochlorperazine Rectal)
25 mg (per each): $12.26
Tablets (Prochlorperazine Maleate Oral)
5 mg (per each): $0.59 - $0.60
10 mg (per each): $0.89 - $0.90
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Suppository, Rectal:
Generic: 10 mg (10 ea)
Tablet, Oral, as maleate [strength expressed as base]:
Generic: 5 mg, 10 mg
IM: Inject by deep IM into outer quadrant of buttocks. Avoid skin contact with injection solution, contact dermatitis has occurred. Do not administer SUBQ; may cause local irritation.
IV: May be administered diluted or undiluted by slow IV push or by IV infusion at a maximum rate of 5 mg/minute. To reduce the risk of hypotension, patients receiving IV prochlorperazine must remain lying down and be observed for at least 30 minutes following administration. Avoid skin contact with injection solution, contact dermatitis has occurred. Do not administer SUBQ; may cause local irritation.
Rectal: Do not remove from wrapper until ready to use.
Oral: Administer with food or water.
Parenteral: Note: Avoid skin contact with injection solution; contact dermatitis has occurred; do not administer subcutaneously; may cause local irritation.
IM: Preferred route; inject by deep IM injection into the outer quadrant of buttocks.
IV: Route typically avoided; if necessary, may be administered by slow IV push by direct IV injection at a rate not to exceed 5 mg/minute. To reduce the risk of hypotension, patients receiving IV prochlorperazine must remain lying down and be observed for at least 30 minutes following administration.
Rectal: Do not remove from wrapper until ready for use. Note: Appropriate dosage form for rectal administration in pediatric patients is no longer available in the US.
Anxiety: Management of anxiety.
Nausea and/or vomiting, acute: Management of severe nausea and vomiting.
Schizophrenia: Management of schizophrenia.
Chemotherapy-induced nausea and vomiting; Migraine, moderate to severe, acute treatment (emergency setting); Postoperative nausea and/or vomiting, prevention; Postoperative nausea and/or vomiting, treatment or rescue therapy; Pregnancy-associated nausea and vomiting; Radiation therapy–associated nausea and vomiting, rescue therapy
Prochlorperazine may be confused with chlorproMAZINE.
Compazine may be confused with Copaxone, Coumadin.
Beers Criteria: Antipsychotics are identified in the Beers Criteria as potentially inappropriate medications to be avoided in patients ≥65 years of age due to an increased risk of stroke and a greater rate of cognitive decline and mortality in patients with dementia. Evidence also suggests there may be an increased risk of mortality with use independent of dementia. Avoid antipsychotics for behavioral problems associated with dementia or delirium unless alternative nonpharmacologic therapies have failed and patient may harm self or others. In addition, antipsychotics should be used with caution in older adults due to their potential to cause or exacerbate syndrome of inappropriate antidiuretic hormone secretion or hyponatremia; monitor sodium closely with initiation or dosage adjustments in older adults. Prochlorperazine is identified in the Beers Criteria as a potentially inappropriate medication in patients ≥65 years of age due to its strong anticholinergic properties resulting in increased risk of confusion, dry mouth, constipation, and other anticholinergic effects or toxicity. Use of antipsychotics may be appropriate for labeled indications including schizophrenia, bipolar disorder, Parkinson disease psychosis, adjunctive therapy in major depressive disorder, or for short-term use as an antiemetic (Beers Criteria [AGS 2023]).
Antipsychotics are identified in the Screening Tool of Older Person's Prescriptions (STOPP) criteria as a potentially inappropriate medication in older adults (≥65 years of age) for treatment of sleep disorder. Phenothiazines are not recommended as first-line treatment of psychosis or non-cognitive symptoms of dementia. Additional disease states of concern include parkinsonism, recurrent falls, dysphagia, QTc prolongation, and coronary, cerebral, or peripheral vascular disease (O’Mahony 2023).
KIDs List: Dopamine antagonists, when used in pediatric patients <18 years of age, are identified on the Key Potentially Inappropriate Drugs in Pediatrics (KIDs) list; use should be avoided in infants and used with caution in children and adolescents due to risk of acute dystonia (dyskinesia), and with intravenous administration an increased risk of respiratory depression, extravasation, and death (strong recommendation; moderate quality of evidence) (PPA [Meyers 2020]).
CPZ (occasional abbreviation for Compazine) is an error-prone abbreviation (mistaken as chlorproMAZINE).
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Acetylcholinesterase Inhibitors: May decrease therapeutic effects of Agents with Clinically Relevant Anticholinergic Effects. Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects of Acetylcholinesterase Inhibitors. Risk C: Monitor
Aclidinium: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk X: Avoid
Acrivastine: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor
Acrivastine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Agents With Seizure Threshold Lowering Potential: May increase adverse/toxic effects of Prochlorperazine. Specifically, the risk of seizures may be increased. Risk C: Monitor
Alcohol (Ethyl): CNS Depressants may increase CNS depressant effects of Alcohol (Ethyl). Risk C: Monitor
Alizapride: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Amifampridine: Agents With Seizure Threshold Lowering Potential may increase neuroexcitatory and/or seizure-potentiating effects of Amifampridine. Risk C: Monitor
Aminolevulinic Acid (Systemic): Photosensitizing Agents may increase photosensitizing effects of Aminolevulinic Acid (Systemic). Risk X: Avoid
Aminolevulinic Acid (Topical): Photosensitizing Agents may increase photosensitizing effects of Aminolevulinic Acid (Topical). Risk C: Monitor
Amisulpride (Oral): Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Amisulpride (Oral). Specifically, the risk of seizures may be increased. Risk C: Monitor
Amisulpride (Oral): May increase adverse/toxic effects of Antipsychotic Agents. Specifically, the risk of neuroleptic malignant syndrome or increased QTc interval may be increased. Risk C: Monitor
Amisulpride (Oral): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Antacids: May decrease absorption of Antipsychotic Agents (Phenothiazines). Risk C: Monitor
Anti-Parkinson Agents (Dopamine Agonist): Antipsychotic Agents (First Generation [Typical]) may decrease therapeutic effects of Anti-Parkinson Agents (Dopamine Agonist). Management: Avoid concomitant therapy if possible. If antipsychotic use is necessary, consider using atypical antipsychotics such as clozapine, quetiapine, or ziprasidone at lower initial doses, or a non-dopamine antagonist (eg, pimavanserin). Risk D: Consider Therapy Modification
ARIPiprazole Lauroxil: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of ARIPiprazole Lauroxil. Specifically, the risk of seizures may be increased. Risk C: Monitor
ARIPiprazole: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of ARIPiprazole. Specifically, the risk of seizures may be increased. Risk C: Monitor
Articaine: May increase CNS depressant effects of CNS Depressants. Management: Consider reducing the dose of articaine if possible when used in patients who are also receiving CNS depressants. Monitor for excessive CNS depressant effects with any combined use. Risk D: Consider Therapy Modification
Asenapine: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Asenapine. Specifically, the risk of seizures may be increased. Risk C: Monitor
Azelastine (Nasal): May increase CNS depressant effects of CNS Depressants. Risk X: Avoid
Benperidol: Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects of Benperidol. Risk C: Monitor
Benperidol: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Benperidol. Specifically, the risk of seizures may be increased. Risk C: Monitor
Benperidol: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Benzgalantamine-Galantamine: May increase neurotoxic (central) effects of Antipsychotic Agents. Risk C: Monitor
Benztropine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Benztropine. Risk C: Monitor
Beta-Blockers: Antipsychotic Agents (Phenothiazines) may increase hypotensive effects of Beta-Blockers. Beta-Blockers may decrease metabolism of Antipsychotic Agents (Phenothiazines). Antipsychotic Agents (Phenothiazines) may decrease metabolism of Beta-Blockers. Risk C: Monitor
Biperiden: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Biperiden. Risk C: Monitor
Blonanserin: CNS Depressants may increase CNS depressant effects of Blonanserin. Management: Use caution if coadministering blonanserin and CNS depressants; dose reduction of the other CNS depressant may be required. Strong CNS depressants should not be coadministered with blonanserin. Risk D: Consider Therapy Modification
Bornaprine: May increase adverse/toxic effects of Antipsychotic Agents. Specifically, tardive dyskinesia symptoms may be potentiated. Risk C: Monitor
Botulinum Toxin-Containing Products: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor
Brexanolone: CNS Depressants may increase CNS depressant effects of Brexanolone. Risk C: Monitor
Brexpiprazole: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Brexpiprazole. Specifically, the risk of seizures may be increased. Risk C: Monitor
Brimonidine (Topical): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Bromopride: May increase adverse/toxic effects of Antipsychotic Agents. Risk X: Avoid
Bromperidol: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid
Buclizine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Buclizine. Risk C: Monitor
Buclizine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Buprenorphine: CNS Depressants may increase CNS depressant effects of Buprenorphine. Management: Consider reduced doses of other CNS depressants, and avoiding such drugs in patients at high risk of buprenorphine overuse/self-injection. Initiate buprenorphine at lower doses in patients already receiving CNS depressants. Risk D: Consider Therapy Modification
BuPROPion: May increase neuroexcitatory and/or seizure-potentiating effects of Agents With Seizure Threshold Lowering Potential. Risk C: Monitor
BusPIRone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Cabergoline: May decrease therapeutic effects of Antipsychotic Agents. Risk X: Avoid
Cannabinoid-Containing Products: Agents with Clinically Relevant Anticholinergic Effects may increase tachycardic effects of Cannabinoid-Containing Products. Risk C: Monitor
Cannabinoid-Containing Products: CNS Depressants may increase CNS depressant effects of Cannabinoid-Containing Products. Risk C: Monitor
Cariprazine: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Cariprazine. Specifically, the risk of seizures may be increased. Risk C: Monitor
Cetirizine (Systemic): May increase CNS depressant effects of CNS Depressants. Management: Consider avoiding this combination if possible. If required, monitor for excessive sedation or CNS depression, limit the dose and duration of combination therapy, and consider CNS depressant dose reductions. Risk D: Consider Therapy Modification
Chloral Hydrate/Chloral Betaine: CNS Depressants may increase CNS depressant effects of Chloral Hydrate/Chloral Betaine. Management: Consider alternatives to the use of chloral hydrate or chloral betaine and additional CNS depressants. If combined, consider a dose reduction of either agent and monitor closely for enhanced CNS depressive effects. Risk D: Consider Therapy Modification
Chlormethiazole: May increase CNS depressant effects of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used. Risk D: Consider Therapy Modification
Chlorphenesin Carbamate: May increase adverse/toxic effects of CNS Depressants. Risk C: Monitor
ChlorproMAZINE: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of ChlorproMAZINE. Specifically, the risk of seizures may be increased. Risk C: Monitor
Chlorprothixene: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Chlorprothixene. Risk C: Monitor
Cimetropium: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Cimetropium. Risk X: Avoid
Clothiapine: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Clothiapine. Specifically, the risk of seizures may be increased. Risk C: Monitor
CloZAPine: Agents with Clinically Relevant Anticholinergic Effects may increase constipating effects of CloZAPine. Management: Consider alternatives to this combination whenever possible. If combined, monitor closely for signs and symptoms of gastrointestinal hypomotility and consider prophylactic laxative treatment. Risk D: Consider Therapy Modification
CNS Depressants: May increase adverse/toxic effects of CNS Depressants. Risk C: Monitor
Cyclizine: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor
Dantrolene: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Daridorexant: May increase CNS depressant effects of CNS Depressants. Management: Dose reduction of daridorexant and/or any other CNS depressant may be necessary. Use of daridorexant with alcohol is not recommended, and the use of daridorexant with any other drug to treat insomnia is not recommended. Risk D: Consider Therapy Modification
Darifenacin: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Darifenacin. Risk C: Monitor
Deferoxamine: May increase adverse/toxic effects of Prochlorperazine. Specifically, prolonged loss of consciousness has been reported. Management: Consider alternatives to prochlorperazine in patients receiving deferoxamine, due to a risk of temporary impairment of consciousness (potentially lasting for days) with the combination. Risk D: Consider Therapy Modification
Deutetrabenazine: May increase adverse/toxic effects of Antipsychotic Agents. Specifically, the risk for akathisia, parkinsonism, or neuroleptic malignant syndrome may be increased. Risk C: Monitor
DexmedeTOMIDine: CNS Depressants may increase CNS depressant effects of DexmedeTOMIDine. Management: Monitor for increased CNS depression during coadministration of dexmedetomidine and CNS depressants, and consider dose reductions of either agent to avoid excessive CNS depression. Risk D: Consider Therapy Modification
Dexmethylphenidate-Methylphenidate: Antipsychotic Agents may increase adverse/toxic effects of Dexmethylphenidate-Methylphenidate. Dexmethylphenidate-Methylphenidate may increase adverse/toxic effects of Antipsychotic Agents. Specifically, the risk of extrapyramidal symptoms may be increased when these agents are combined. Risk C: Monitor
Dicyclomine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Dicyclomine. Risk C: Monitor
Difelikefalin: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Difenoxin: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Dihydralazine: CNS Depressants may increase hypotensive effects of Dihydralazine. Risk C: Monitor
Dimethindene (Systemic): Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Dimethindene (Systemic). Risk C: Monitor
Dimethindene (Topical): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Dofetilide: Prochlorperazine may increase serum concentration of Dofetilide. Risk X: Avoid
Donepezil: May increase neurotoxic (central) effects of Antipsychotic Agents. Risk C: Monitor
Dothiepin: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Doxylamine: CNS Depressants may increase CNS depressant effects of Doxylamine. Risk C: Monitor
DroNABinol: Agents with Clinically Relevant Anticholinergic Effects may increase tachycardic effects of DroNABinol. Risk X: Avoid
DroPERidol: May increase CNS depressant effects of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Risk D: Consider Therapy Modification
Eluxadoline: Agents with Clinically Relevant Anticholinergic Effects may increase constipating effects of Eluxadoline. Risk X: Avoid
Emedastine (Systemic): May increase CNS depressant effects of CNS Depressants. Management: Consider avoiding this combination if possible. If required, monitor for excessive sedation or CNS depression, limit the dose and duration of combination therapy, and consider CNS depressant dose reductions. Risk C: Monitor
Entacapone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Esketamine (Nasal): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Fesoterodine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Fesoterodine. Risk C: Monitor
Flunarizine: CNS Depressants may increase CNS depressant effects of Flunarizine. Risk X: Avoid
Flunitrazepam: CNS Depressants may increase CNS depressant effects of Flunitrazepam. Management: Reduce the dose of CNS depressants when combined with flunitrazepam and monitor patients for evidence of CNS depression (eg, sedation, respiratory depression). Use non-CNS depressant alternatives when available. Risk D: Consider Therapy Modification
Flupentixol: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Flupentixol. Specifically, the risk of seizures may be increased. Risk C: Monitor
FluPHENAZine: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of FluPHENAZine. Specifically, the risk of seizures may be increased. Risk C: Monitor
FluPHENAZine: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor
Gastrointestinal Agents (Prokinetic): Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects of Gastrointestinal Agents (Prokinetic). Risk C: Monitor
Gepotidacin: May decrease anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor
Glucagon: Agents with Clinically Relevant Anticholinergic Effects may increase adverse/toxic effects of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased. Risk C: Monitor
Glycopyrrolate (Oral Inhalation): Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Glycopyrrolate (Oral Inhalation). Risk X: Avoid
Glycopyrrolate (Systemic): Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Glycopyrrolate (Systemic). Risk C: Monitor
Glycopyrronium (Topical): May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk X: Avoid
Guanethidine: Antipsychotic Agents may decrease therapeutic effects of Guanethidine. Risk C: Monitor
Haloperidol: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Haloperidol. Specifically, the risk of seizures may be increased. Risk C: Monitor
Huperzine A: May increase neurotoxic (central) effects of Antipsychotic Agents. Risk C: Monitor
HydrOXYzine: May increase CNS depressant effects of CNS Depressants. Management: Consider a decrease in the CNS depressant dose, as appropriate, when used together with hydroxyzine. Increase monitoring of signs/symptoms of CNS depression in any patient receiving hydroxyzine together with another CNS depressant. Risk D: Consider Therapy Modification
Iloperidone: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Iloperidone. Specifically, the risk of seizures may be increased. Risk C: Monitor
Iohexol: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Iohexol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iohexol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic antiseizure drugs. Risk D: Consider Therapy Modification
Iomeprol: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Iomeprol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iomeprol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic antiseizure drugs. Risk D: Consider Therapy Modification
Iopamidol: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Iopamidol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iopamidol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic antiseizure drugs. Risk D: Consider Therapy Modification
Ipratropium (Nasal): May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor
Ipratropium (Oral Inhalation): May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk X: Avoid
Itopride: Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects of Itopride. Risk C: Monitor
Ixabepilone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Kava Kava: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Ketotifen (Systemic): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Kratom: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid
Lemborexant: May increase CNS depressant effects of CNS Depressants. Management: Dosage adjustments of lemborexant and of concomitant CNS depressants may be necessary when administered together because of potentially additive CNS depressant effects. Close monitoring for CNS depressant effects is necessary. Risk D: Consider Therapy Modification
Levocetirizine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Levosulpiride: Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects of Levosulpiride. Risk X: Avoid
Lithium: May increase neurotoxic effects of Antipsychotic Agents. Lithium may decrease serum concentration of Antipsychotic Agents. Specifically noted with chlorpromazine. Risk C: Monitor
Lofepramine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Lofexidine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Loxapine: CNS Depressants may increase CNS depressant effects of Loxapine. Management: Consider reducing the dose of CNS depressants administered concomitantly with loxapine due to an increased risk of respiratory depression, sedation, hypotension, and syncope. Risk D: Consider Therapy Modification
Lumateperone: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Lumateperone. Specifically, the risk of seizures may be increased. Risk C: Monitor
Lurasidone: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Lurasidone. Specifically, the risk of seizures may be increased. Risk C: Monitor
Magnesium Sulfate: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Maprotiline: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Maprotiline. Risk C: Monitor
Melitracen [INT]: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Melperone: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor
Mequitazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Metergoline: Antipsychotic Agents may decrease therapeutic effects of Metergoline. Metergoline may decrease therapeutic effects of Antipsychotic Agents. Risk C: Monitor
Metergoline: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Methotrimeprazine: CNS Depressants may increase CNS depressant effects of Methotrimeprazine. Methotrimeprazine may increase CNS depressant effects of CNS Depressants. Management: Reduce the usual dose of CNS depressants by 50% if starting methotrimeprazine until the dose of methotrimeprazine is stable. Monitor patient closely for evidence of CNS depression. Risk D: Consider Therapy Modification
Methoxsalen (Systemic): Photosensitizing Agents may increase photosensitizing effects of Methoxsalen (Systemic). Risk C: Monitor
Methoxyflurane: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Methscopolamine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Methscopolamine. Risk C: Monitor
Metoclopramide: May increase adverse/toxic effects of Antipsychotic Agents. Risk X: Avoid
MetyroSINE: CNS Depressants may increase sedative effects of MetyroSINE. Risk C: Monitor
MetyroSINE: May increase adverse/toxic effects of Antipsychotic Agents. Specifically, the risk for extrapyramidal symptoms and excessive sedation may be increased. Risk C: Monitor
Minocycline (Systemic): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Mirabegron: Agents with Clinically Relevant Anticholinergic Effects may increase adverse/toxic effects of Mirabegron. Risk C: Monitor
Molindone: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Molindone. Specifically, the risk of seizures may be increased. Risk C: Monitor
Moxonidine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Nabilone: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid
Nalfurafine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Nitroglycerin: Agents with Clinically Relevant Anticholinergic Effects may decrease absorption of Nitroglycerin. Specifically, anticholinergic agents may decrease the dissolution of sublingual nitroglycerin tablets, possibly impairing or slowing nitroglycerin absorption. Risk C: Monitor
Noscapine: CNS Depressants may increase adverse/toxic effects of Noscapine. Risk X: Avoid
OLANZapine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of OLANZapine. Risk C: Monitor
OLANZapine: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of OLANZapine. Specifically, the risk of seizures may be increased. Risk C: Monitor
Olopatadine (Nasal): May increase CNS depressant effects of CNS Depressants. Risk X: Avoid
Opicapone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Opioid Agonists: CNS Depressants may increase CNS depressant effects of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Risk D: Consider Therapy Modification
Opipramol: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor
Opipramol: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Orphenadrine: CNS Depressants may increase CNS depressant effects of Orphenadrine. Risk X: Avoid
Oxatomide: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk X: Avoid
Oxomemazine: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid
Oxybate Salt Products: CNS Depressants may increase CNS depressant effects of Oxybate Salt Products. Management: Consider alternatives to this combination when possible. If combined, dose reduction or discontinuation of one or more CNS depressants (including the oxybate salt product) should be considered. Interrupt oxybate salt treatment during short-term opioid use Risk D: Consider Therapy Modification
OxyBUTYnin: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of OxyBUTYnin. Risk C: Monitor
OxyCODONE: CNS Depressants may increase CNS depressant effects of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Risk D: Consider Therapy Modification
Paliperidone: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Paliperidone. Specifically, the risk of seizures may be increased. Risk C: Monitor
Paliperidone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Paraldehyde: CNS Depressants may increase CNS depressant effects of Paraldehyde. Risk X: Avoid
Perampanel: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Perazine: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor
Periciazine: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Periciazine. Specifically, the risk of seizures may be increased. Risk C: Monitor
Periciazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Perphenazine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Perphenazine. Risk C: Monitor
Perphenazine: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Perphenazine. Specifically, the risk of seizures may be increased. Risk C: Monitor
Pimozide: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Pimozide. Specifically, the risk of seizures may be increased. Risk C: Monitor
Pipamperone: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Pipamperone. Specifically, the risk of seizures may be increased. Risk X: Avoid
Piribedil: Antipsychotic Agents may decrease therapeutic effects of Piribedil. Piribedil may decrease therapeutic effects of Antipsychotic Agents. Management: Use of piribedil with antiemetic neuroleptics is contraindicated, and use with antipsychotic neuroleptics, except for clozapine, is not recommended. Risk X: Avoid
Pizotifen: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Polyethylene Glycol-Electrolyte Solution: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Polyethylene Glycol-Electrolyte Solution. Specifically, the risk of seizure may be increased. Risk C: Monitor
Porfimer: Photosensitizing Agents may increase photosensitizing effects of Porfimer. Risk X: Avoid
Potassium Chloride: Agents with Clinically Relevant Anticholinergic Effects may increase ulcerogenic effects of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride. Risk X: Avoid
Potassium Citrate: Agents with Clinically Relevant Anticholinergic Effects may increase ulcerogenic effects of Potassium Citrate. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium citrate. Risk X: Avoid
Pramlintide: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. These effects are specific to the GI tract. Risk X: Avoid
Procarbazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Promazine: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Promazine. Specifically, the risk of seizures may be increased. Risk C: Monitor
Promethazine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Promethazine. Risk C: Monitor
Propantheline: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Propantheline. Risk C: Monitor
Propiverine: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor
QUEtiapine: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of QUEtiapine. Specifically, the risk of seizures may be increased. Risk C: Monitor
Quinagolide: Antipsychotic Agents may decrease therapeutic effects of Quinagolide. Risk C: Monitor
QuiNIDine: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor
Ramosetron: Agents with Clinically Relevant Anticholinergic Effects may increase constipating effects of Ramosetron. Risk C: Monitor
Revefenacin: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Revefenacin. Risk X: Avoid
Rilmenidine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
RisperiDONE: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of RisperiDONE. Specifically, the risk of seizures may be increased. Risk C: Monitor
Rivastigmine: Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects of Rivastigmine. Rivastigmine may decrease therapeutic effects of Agents with Clinically Relevant Anticholinergic Effects. Management: Use of rivastigmine with an anticholinergic agent is not recommended unless clinically necessary. If the combination is necessary, monitor for reduced anticholinergic effects. Risk D: Consider Therapy Modification
Ropeginterferon Alfa-2b: CNS Depressants may increase adverse/toxic effects of Ropeginterferon Alfa-2b. Specifically, the risk of neuropsychiatric adverse effects may be increased. Management: Avoid coadministration of ropeginterferon alfa-2b and other CNS depressants. If this combination cannot be avoided, monitor patients for neuropsychiatric adverse effects (eg, depression, suicidal ideation, aggression, mania). Risk D: Consider Therapy Modification
Saquinavir: Antipsychotic Agents (Phenothiazines) may increase arrhythmogenic effects of Saquinavir. Risk X: Avoid
Scopolamine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Scopolamine. Risk C: Monitor
Secretin: Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects of Secretin. Management: Avoid concomitant use of anticholinergic agents and secretin. Discontinue anticholinergic agents at least 5 half-lives prior to administration of secretin. Risk D: Consider Therapy Modification
Serotonergic Agents (High Risk): May increase adverse/toxic effects of Antipsychotic Agents. Specifically, serotonergic agents may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotic Agents may increase serotonergic effects of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Risk C: Monitor
Sertindole: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Sertindole. Specifically, the risk of seizures may be increased. Risk C: Monitor
Sodium Phosphates: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Sodium Phosphates. Specifically, the risk of seizure or loss of consciousness may be increased in patients with significant sodium phosphate-induced fluid or electrolyte abnormalities. Risk C: Monitor
Sofpironium: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Sofpironium. Risk X: Avoid
Sulpiride: Antipsychotic Agents may increase adverse/toxic effects of Sulpiride. Risk X: Avoid
Suvorexant: CNS Depressants may increase CNS depressant effects of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended. Risk D: Consider Therapy Modification
Tetrabenazine: May increase adverse/toxic effects of Antipsychotic Agents. Specifically, the risk for NMS and extrapyramidal symptoms may be increased. Risk C: Monitor
Thalidomide: CNS Depressants may increase CNS depressant effects of Thalidomide. Risk X: Avoid
Thiazide and Thiazide-Like Diuretics: Agents with Clinically Relevant Anticholinergic Effects may increase serum concentration of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor
Thiopental: Antipsychotic Agents (Phenothiazines) may increase adverse/toxic effects of Thiopental. Risk C: Monitor
Thioridazine: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Thioridazine. Specifically, the risk of seizures may be increased. Risk C: Monitor
Thiothixene: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Thiothixene. Risk C: Monitor
Thiothixene: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Thiothixene. Specifically, the risk of seizures may be increased. Risk C: Monitor
Tiapride: Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects of Tiapride. Risk C: Monitor
Tiotropium: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Tiotropium. Risk X: Avoid
Tolterodine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Tolterodine. Risk C: Monitor
Topiramate: Agents with Clinically Relevant Anticholinergic Effects may increase adverse/toxic effects of Topiramate. Risk C: Monitor
Trifluoperazine: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Trifluoperazine. Specifically, the risk of seizures may be increased. Risk C: Monitor
Trimeprazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Trimethobenzamide: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Trimethobenzamide. Risk C: Monitor
Trospium: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Trospium. Risk C: Monitor
Umeclidinium: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk X: Avoid
Valerian: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Verteporfin: Photosensitizing Agents may increase photosensitizing effects of Verteporfin. Risk C: Monitor
Ziprasidone: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Ziprasidone. Specifically, the risk of seizures may be increased. Risk C: Monitor
Zolpidem: CNS Depressants may increase CNS depressant effects of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol. Risk D: Consider Therapy Modification
Zuclopenthixol: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Zuclopenthixol. Risk C: Monitor
Zuclopenthixol: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Zuclopenthixol. Specifically, the risk of seizures may be increased. Risk C: Monitor
Zuranolone: May increase CNS depressant effects of CNS Depressants. Management: Consider alternatives to the use of zuranolone with other CNS depressants or alcohol. If combined, consider a zuranolone dose reduction and monitor patients closely for increased CNS depressant effects. Risk D: Consider Therapy Modification
Use may interfere with pregnancy tests, causing false positive results.
Jaundice or hyper- or hyporeflexia have been reported in newborn infants following maternal use of phenothiazines. Antipsychotic use during the third trimester of pregnancy has a risk for abnormal muscle movements (extrapyramidal symptoms [EPS]) and withdrawal symptoms in newborns following delivery. Symptoms in the newborn may include agitation, feeding disorder, hypertonia, hypotonia, respiratory distress, somnolence, and tremor; these effects may be self-limiting or require hospitalization.
The use of prochlorperazine may be considered for adjunctive treatment of nausea and vomiting in pregnant patients when symptoms persist following initial pharmacologic therapy (ACOG 2018).
It is not known if prochlorperazine is present in breast milk. Other phenothiazines are excreted in breast milk.
Increase dietary intake of riboflavin; should be administered with food or water. Rectal suppositories may contain coconut and palm oil.
|
Monitoring parameter |
Frequency of monitoring |
Comments |
|---|---|---|
|
a For all monitoring parameters, it is appropriate for check at baseline and when clinically relevant (based on symptoms or suspected adverse reactions) in addition to the timeline. b ADA 2004; APA [Keepers 2020]; Landi 2005; Seppala 2018; manufacturer's labeling. c Risk factors for extrapyramidal symptoms (EPS) include prior history of EPS, high doses of antipsychotics, young age (children and adolescents at higher risk than adults), and dopaminergic affinity of individual antipsychotic. d Risk factors for tardive dyskinesia include age >55 years; females; White or African ethnicity; presence of a mood disorder, intellectual disability, or CNS injury; and past or current EPS. | ||
|
Adherence |
Every visit |
|
|
Blood chemistries (electrolytes, renal function, liver function, thyroid-stimulating hormone) |
As clinically indicated |
|
|
CBC |
As clinically indicated |
Check frequently during the first few months of therapy in patients with preexisting low WBC or history of drug-induced leukopenia/neutropenia. |
|
Extrapyramidal symptoms |
Every visit; 4 weeks after initiation and dose change; annually. Use a formalized rating scale at least annually or every 6 months if high risk.c |
|
|
Fall risk |
As clinically indicated |
Evaluate regularly in patients ≥60 years of age. |
|
Fasting plasma glucose/HbA1c |
4 months after initiation; annually |
Check more frequently than annually if abnormal. Follow diabetes guidelines. |
|
Lipid panel |
4 months after initiation; annually |
Check more frequently than annually if abnormal. Follow lipid guidelines. |
|
Mental status and alertness |
Every visit |
|
|
Metabolic syndrome history |
Annually |
Evaluate for personal and family history of obesity, diabetes, dyslipidemia, hypertension, or cardiovascular disease. |
|
Ocular exam |
As clinically indicated |
Particularly important for those taking thioridazine or chlorpromazine, or those with diabetes and other conditions that impact sight. |
|
Prolactin |
Ask about symptoms at every visit until dose is stable. Check prolactin level if symptoms are reported. |
Hyperprolactinemia symptoms: Changes in menstruation, libido, gynecomastia, development of galactorrhea, and erectile and ejaculatory function. |
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Tardive dyskinesia |
Every visit; annually. Use a formalized rating scale at least annually or every 6 months if high risk.d |
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Vital signs (BP, orthostatics, temperature, pulse, signs of infection) |
As clinically indicated |
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Weight/Height/BMI |
Every visit for first 6 months, then quarterly |
Consider monitoring waist circumference at baseline and annually, especially in patients with or at risk for metabolic syndrome. Consider changing antipsychotic if BMI increases by ≥1 unit. |
Prochlorperazine is a piperazine phenothiazine antipsychotic which blocks postsynaptic mesolimbic dopaminergic D1 and D2 receptors in the brain, including the chemoreceptor trigger zone; exhibits a strong alpha-adrenergic and anticholinergic blocking effect and depresses the release of hypothalamic and hypophyseal hormones; believed to depress the reticular activating system, thus affecting basal metabolism, body temperature, wakefulness, vasomotor tone and emesis
Onset of action: Oral: 30 to 40 minutes; IM: 10 to 20 minutes; Rectal: ~60 minutes
Peak antiemetic effect: IV: 30 to 60 minutes
Duration: Rectal: 3 to 12 hours; IM, Oral: 3 to 4 hours
Distribution: Vd: 1400 to 1548 L (Taylor 1987)
Metabolism: Primarily hepatic; N-desmethyl prochlorperazine (major active metabolite)
Bioavailability: Oral: 12.5% (Isah 1991)
Half-life elimination: Oral: 6 to 10 hours (single dose), 14 to 22 hours (repeated dosing) (Isah 1991); IV: 6 to 10 hours (Isah 1991; Taylor 1987)
Excretion: Mainly in feces
