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Back to Psychiatry Drug Index

Back to Phenothiazines (Antimanic drugs)

Name: Prochlorperazine

Pregnancy Category C

Drug classes

  • Phenothiazine (piperazine)
  • Dopaminergic blocking drug
  • Antipsychotic drug
  • Antiemetic drug
  • Antianxiety drug

Therapeutic actions

Mechanism of action not fully understood: antipsychotic drugs block postsynaptic dopamine receptors in the brain, but this may not be necessary and sufficient for antipsychotic activity; depresses the reticular activating system, including the parts of the brain involved with wakefulness and emesis; anticholinergic, antihistaminic (H1), and alpha-adrenergic blocking activity also may contribute
to some of its therapeutic (and adverse) actions.

Indications

  1. Management of manifestations of psychotic disorders
  2. Control of severe nausea and vomiting
  3. Short-term treatment of nonpsychotic anxiety (not drug of choice)

Contraindications/cautions

Contraindicated in the presence of coma or severe CNS depression, bone marrow depression, blood dyscrasia, circulatory collapse, subcortical brain damage, Parkinson's disease, liver damage, cerebral arteriosclerosis, coronary disease, severe hypotension or hypertension.

Use caution in the presence of respiratory disorders, glaucoma, prostatic hypertrophy, epilepsy, breast cancer (elevations in prolactin may stimulate a prolactin-dependent tumor), thyrotoxicosis, peptic ulcer, decreased renal function, myelography within previous 24 h or scheduled within 48 h, exposure to heat or phosphorous insecticides, pregnancy, lactation, children younger 12 y, especially those with chickenpox, CNS infections (children are especially susceptible to dystonias that may confound the diagnosis of Reye's syndrome).

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Adverse effects

  • CNS: Drowsiness, insomnia, vertigo, headache, weakness, tremor, ataxia, slurring, cerebral edema, seizures, exacerbation of psychotic symptoms, extrapyramidal syndromes-pseudoparkinsonism; dystonias; akathisia, tardive dyskinesias, potentially irreversible; neuroleptic malignant syndrome
  • CV: Hypotension, orthostatic hypotension, hypertension, tachycardia, bradycardia, cardiac arrest, CHF, cardiomegaly, refractory arrhythmias (some fatal), pulmonary edema
  • Respiratory: Bronchospasm, laryngospasm, dyspnea; suppression of cough reflex and potential for aspiration
  • Hematologic: Eosinophilia, leukopenia, leukocytosis, anemia; aplastic anemia; hemolytic anemia; thrombocytopenic or nonthrombocytopenic purpura; pancytopenia
  • Hypersensitivity: Jaundice, urticaria, angioneurotic edema, laryngeal edema, photosensitivity, eczema, asthma, anaphylactoid reactions, exfoliative dermatitis
  • EENT: Glaucoma, photophobia, blurred vision, miosis, mydriasis, deposits in the cornea and lens (opacities), pigmentary retinopathy
  • Endocrine: Lactation, breast engorgement in females, galactorrhea; SIADH; amenorrhea, menstrual irregularities; gynecomastia in males; changes in libido; hyperglycemia or hypoglycemia; glycosuria; hyponatremia; pituitary tumor with hyperprolactinemia; inhibition of
    ovulation, infertility, pseudopregnancy; reduced urinary levels of gonadotropins, estrogens, progestins
  • Autonomic: Dry mouth, salivation, nasal congestion, nausea, vomiting, anorexia, fever, pallor, flushed facies, sweating, constipation, paralytic ileus, urinary retention, incontinence, polyuria, enuresis, priapism, ejaculation inhibition, male impotence
  • Other: Urine discolored pink to red-brown
 

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