Compazine: Effective Relief for Severe Nausea and Psychotic Disorders
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Synonyms | |||
Compazine (prochlorperazine) is a prescription phenothiazine antipsychotic and antiemetic agent used for the management of severe nausea and vomiting, as well as for the control of manifestations of psychotic disorders. It functions primarily by blocking dopamine receptors in the chemoreceptor trigger zone of the brain, thereby reducing signals that trigger vomiting and helping to restore mental balance in psychotic conditions. Available in tablet, syrup, injection, and suppository forms, it is a versatile option in both inpatient and outpatient settings under careful medical supervision.
Features
- Active ingredient: Prochlorperazine
- Available formulations: Tablets (5 mg, 10 mg), extended-release capsules (10 mg, 15 mg, 30 mg), syrup (5 mg/5 mL), injection (5 mg/mL), suppositories (2.5 mg, 5 mg, 25 mg)
- Mechanism: Dopamine D2 receptor antagonist
- Onset of action: Oral: 30–40 minutes; IM: 10–20 minutes; IV: rapid; rectal: 60 minutes
- Half-life: Approximately 6–8 hours
- Metabolism: Hepatic, via CYP450 enzymes
- Excretion: Primarily renal
Benefits
- Provides rapid and effective control of severe nausea and vomiting not responsive to conventional antiemetics.
- Helps manage acute and chronic psychotic disorders, including schizophrenia, by reducing agitation, hallucinations, and delusions.
- Offers multiple administration routes (oral, IM, IV, rectal) for flexibility based on patient condition and clinical setting.
- Can be used as an adjunct therapy in certain cases of non-psychotic anxiety, though this is off-label and requires careful evaluation.
- Supports improved quality of life and functional capacity in patients with persistent emesis or psychosis.
- May reduce hospital readmission rates when appropriately used for symptom control in postoperative or chemotherapy-induced settings.
Common use
Compazine is commonly prescribed for the management of severe nausea and vomiting, including that associated with surgery, cancer chemotherapy, radiation therapy, or migraine. It is also indicated for the control of severe nausea and vomiting in adults. In psychiatric practice, it is used for the treatment of schizophrenia and non-psychotic anxiety, though its use in anxiety is less common today due to the availability of safer alternatives. Off-label uses may include treatment of vertigo and acute agitation in emergency settings, though evidence and guidelines vary.
Dosage and direction
Dosage must be individualized based on indication, severity of symptoms, patient response, and formulation used.
- For severe nausea/vomiting in adults:
- Oral: 5–10 mg 3–4 times daily.
- Extended-release capsules: 10–30 mg twice daily.
- IM: 5–10 mg every 3–4 hours, not to exceed 40 mg/day.
- IV: 2.5–10 mg, slow injection; maximum 40 mg/day.
- Rectal: 25 mg twice daily.
- For psychotic disorders in adults:
- Oral: 5–10 mg 3–4 times daily; may increase gradually. Maintenance: 50–150 mg/day in divided doses.
- IM: 10–20 mg every 2–4 hours until controlled, then switch to oral.
- Elderly/debilitated patients: Use lower doses; initiate at 2.5–5 mg 1–3 times daily and titrate cautiously.
- Pediatric use: Not recommended for children under 2 years or weighing less than 9 kg; for older children, dosage is weight-based and must be determined by a physician.
Administer with food or milk to minimize gastrointestinal upset. Avoid abrupt discontinuation.
Precautions
- May cause drowsiness, dizziness, or blurred vision; patients should avoid driving or operating machinery until response is known.
- Use with caution in patients with cardiovascular disease, glaucoma, seizures, Parkinson’s disease, or hepatic impairment.
- Risk of neuroleptic malignant syndrome (NMS): monitor for hyperpyrexia, muscle rigidity, altered mental status.
- Tardive dyskinesia may develop with long-term use; periodically reassess need for continued therapy.
- Orthostatic hypotension may occur, especially with initial dosing or rapid dose increases.
- May mask signs of toxicity in other conditions (e.g., intestinal obstruction, brain tumor).
- Avoid alcohol and CNS depressants during therapy.
- Pregnancy: Category C; use only if potential benefit justifies potential risk to the fetus.
- Lactation: Prochlorperazine is excreted in breast milk; use with caution.
Contraindications
- Hypersensitivity to prochlorperazine or other phenothiazines.
- Comatose or severely depressed states due to CNS depressants.
- Bone marrow suppression.
- Pediatric patients with signs/symptoms of Reye’s syndrome.
- Avoid in patients with suspected or established subcortical brain damage.
Possible side effect
Common side effects may include:
- Drowsiness, dizziness
- Dry mouth, blurred vision
- Constipation
- Orthostatic hypotension
Less common but serious side effects: - Extrapyramidal symptoms (e.g., dystonia, akathisia, parkinsonism)
- Tardive dyskinesia
- Neuroleptic malignant syndrome (NMS)
- Blood dyscrasias (e.g., agranulocytosis)
- Jaundice, hepatic dysfunction
- Seizures
- Allergic reactions
Drug interaction
- Enhanced CNS depression with alcohol, barbiturates, opioids, anxiolytics.
- Antihypertensive effects may be potentiated.
- May decrease effects of levodopa, bromocriptine.
- Concurrent use with QT-prolonging agents may increase arrhythmia risk.
- Anticholinergic drugs may increase side effects like dry mouth, constipation.
- CYP2D6 inhibitors (e.g., fluoxetine) may increase prochlorperazine levels.
Missed dose
If a dose is missed, take it as soon as remembered unless it is almost time for the next dose. Do not double the dose to catch up. Resume regular dosing schedule. If multiple doses are missed, contact a healthcare provider for guidance.
Overdose
Symptoms may include severe drowsiness, agitation, coma, hypotension, tachycardia, extrapyramidal symptoms, seizures, and respiratory depression. Management is supportive and symptomatic; there is no specific antidote. Gastric lavage may be considered if ingestion was recent. Maintain airway and provide IV fluids for hypotension. Avoid epinephrine for hypotension (may paradoxically worsen). Extrapyramidal symptoms may be treated with diphenhydramine or benztropine.
Storage
Store at room temperature (20–25°C/68–77°F), away from light, moisture, and heat. Keep all formulations out of reach of children. Do not freeze liquid forms. Do not use if discolored or containing particulate matter.
Disclaimer
This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or medication. Do not disregard professional medical advice or delay in seeking it because of something you have read here.
Reviews
“Compazine was a game-changer for my chemotherapy-induced nausea. Other antiemetics didn’t touch it, but within 20 minutes of an injection, I could finally keep fluids down.” – Maria T., 54
“Prescribed for acute psychotic episode. Sedating at first, but effective in controlling symptoms. Required dose adjustments due to extrapyramidal side effects.” – James L., 38
“Used postoperatively for vomiting. Worked quickly via IV, but caused significant drowsiness. Beneficial in controlled setting.” – Healthcare Professional
“Helped my chronic migraine-associated nausea when other options failed. Prefer the suppository form during severe episodes.” – Sandra P., 42
“Effective but caution needed in elderly patients—seen orthostatic hypotension and confusion with initial dosing.” – Geriatric Specialist