Prochlorperazine
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| Clinical data | |
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| AHFS/Drugs.com | Monograph |
| MedlinePlus | a682116 |
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| Routes of administration | Oral, buccal, rectal, IM |
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| Pharmacokinetic data | |
| Bioavailability | not exactly known, but substantial |
| Protein binding | 91–99% |
| Metabolism | Mainly hepatic (CYP2D6 and/or CYP3A4) |
| Elimination half-life | 4–8 hoursS, differs with the method of administration |
| Excretion | Biliary, (colored) inactive metabolites in urine |
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| CompTox Dashboard (EPA) | |
| ECHA InfoCard | 100.000.345 |
| Chemical and physical data | |
| Formula | C20H24ClN3S |
| Molar mass | 373.943 g/mol g·mol−1 |
| 3D model (JSmol) | |
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Prochlorperazine (Compazine, Stemzine, Buccastem, Stemetil, Phenotil) is a dopamine (D2) receptor antagonist that belongs to the phenothiazine class of antipsychotic agents that are used for the antiemetic treatment of nausea and vertigo. It is also a highly potent typical antipsychotic, 10–20× more potent than chlorpromazine. It is also used to treat migraine headaches. Intravenous administration can be used to treat status migrainosus.
Indications
Prochlorperazine is a phenothiazine drug. Most drugs in this category are used as anti-psychotics (neuroleptics).[2] Neuroleptic means "nerve seizing", and describes the semi-paralyzing effect these drugs have on the brain and nervous system. Stemetil is no longer being manufactured for sale in Canada as an anti-psychotic, but it is still available for treatment of nausea.
It is now relatively seldom used for the treatment of psychosis and the manic phase of bipolar disorder. It has a prominent antiemetic/antivertiginoic activity and is most often used for the (short-time) treatment of nausea and vomiting and vertigo as follows:
- To alleviate the symptoms of vertigo[3]
- As an antiemetic, particularly for nausea and vomiting caused by chemotherapy, radiation therapy and in the pre- and postoperative setting[4]
- In the UK, prochlorperazine maleate is available as Buccastem M in buccal form as an over-the-counter treatment for migraine.[5] In this indication it blocks the chemoreceptor trigger zone (CTZ) in the brain, which is responsible for causing severe nausea and vomiting. Its OTC use is strictly restricted to a maximum of 2 days, because of the potentially severe side effects of prochlorperazine, which mandate supervision by a health care provider.
- In the UK prochlorperazine maleate has been prescribed to alleviate the symptoms of labyrinthitis, which include not only nausea and vertigo, but spatial and temporal 'jerking' and distortion[6]
Pharmacology
Prochlorperazine is thought to exert its antipsychotic effects by blocking dopamine receptors.[7]
Prochlorperazine is analogous to chlorpromazine, both of these agents antagonize dopaminergic D2 receptors in various pathways of the central nervous system. This D2 blockade results in antipsychotic, antiemetic and other effects. Hyperprolactinaemia is a side effect of dopamine antagonists as blockade of D2 receptors within the tuberoinfundibular pathway results in increased plasma levels of prolactin.
Formulations and pharmacokinetics
Prochlorperazine is available as an oral liquid, tablets, cream for trans dermal (compounding pharmacy), and suppositories, as well as in an injectable form.
Following intramuscular injection the antiemetic action is evident within 5 to 10 minutes and lasts for 3 to 4 hours. Rapid action is also noted after buccal treatment. With oral dosing the start of action is delayed but the duration somewhat longer (approximately 6 hours).
It is available in Egypt under the brand name Emedrotec buccal adhesive tablets by Eva pharma.
There is an inhaled form of prochlorperazine under development by Alexza Pharmaceuticals, currently[when?] in Phase II clinical trials.[8]
Side effects
Nervous system side effects have been associated with the use of prochlorperazine. Extrapyramidal side effects such as acute dystonic reactions, pseudoparkinsonism, or akathisia can affect 2% of patients at low doses, whereas higher doses may affect as many as 40% of patients.[9][10]
Prochlorperazine can also cause a life-threatening condition called neuroleptic malignant syndrome (NMS). Some symptoms of NMS include: A high fever, stiff muscles, confusion, irregular pulse or blood pressure, a fast heart rate (tachycardia), sweating, irregular heart rhythms (arrhythmias). VA and FDA research shows injection site reaction.
References
- ^ "FDA-sourced list of all drugs with black box warnings (Use Download Full Results and View Query links.)". nctr-crs.fda.gov. FDA. Retrieved 22 Oct 2023.
- ^ Casey JF, Lasky JJ, Klett CJ, Hollister LE (August 1960). "Treatment of schizophrenic reactions with phenothiazine derivatives. A comparative study of chlorpromazine, triflupromazine, mepazine, prochlorperazine, perphenazine, and phenobarbital". American Journal of Psychiatry. 117: 97–105. doi:10.1176/appi.ajp.117.2.97. PMID 13808146.
{{cite journal}}: Unknown parameter|doi_brokendate=ignored (|doi-broken-date=suggested) (help)CS1 maint: multiple names: authors list (link) - ^ Benson AJ (June 1969). "Effect of diphenidol and prochlorperazine on semicircular canal function in man". Aerospace Medicine. 40 (6): 589–95. PMID 4891872.
- ^ Gralla RJ; Osoba D; Kris MG; et al. (September 1999). "Recommendations for the use of antiemetics: evidence-based, clinical practice guidelines". Journal of Clinical Oncology. 17 (9): 2971–94. PMID 10561376. Retrieved 2009-06-21.
{{cite journal}}: Unknown parameter|author-separator=ignored (help) - ^ Siow HC, Young WB, Silberstein SD (April 2005). "Neuroleptics in headache". Headache. 45 (4): 358–71. doi:10.1111/j.1526-4610.2005.05074.x. PMID 15836574.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Coatesworth AP (November 2000). "Assessment and treatment of dizziness". Journal of Neurology, Neurosurgery, and Psychiatry. 69 (5): 706. doi:10.1136/jnnp.69.5.706. PMC 1763384. PMID 11184241.
- ^ Manuchair S. Ebadi, Desk reference of clinical pharmacology. 2007
- ^ "Alexza Announces Agreement to Acquire Symphony Allegro, Including All Rights to AZ-004, AZ-104 and AZ-002" (Press release). Alexza Pharmaceuticals. 2009-06-15. Retrieved 2009-11-29.
- ^ Brown, Thomas Markham; Stoudemire, Alan (1998). "Antipsychotics". Psychiatric Side Effects of Prescription and Over-The-Counter Medications. American Psychiatric Publishing. p. 1946. Retrieved 2013-01-18.
- ^ Drugs.com
External links
- Prochlorperazine. MedlinePlus. U.S. National Library of Medicine. National Institutes of Health.
- AZ-001 (Staccato prochlorperazine) (original article) Press release pertaining to phase IIb clinical trial of inhaled prochlorperazine for migraine headache
- Prochlorperazine edisylate Injection prescribing information Drugs.com
- Prochlorperazine. Hazardous Substances Data Bank (HSDB). U.S. National Library of Medicine. National Institutes of Health.
- "Suspicious Behavior". Snap Judgment. Episode 405. Public Radio Exchange and NPR. Retrieved May 19, 2014.
{{cite episode}}: Unknown parameter|serieslink=ignored (|series-link=suggested) (help) The segment "Hands Up" relates an anecdote about the side effects of prochlorperazine.