Compazine: Effective Relief for Severe Nausea and Psychotic Disorders
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Synonyms | |||
Compazine (prochlorperazine) is a prescription medication belonging to the phenothiazine class of antipsychotics. It is primarily indicated for the management of severe nausea and vomiting, as well as for the treatment of schizophrenia and non-psychotic anxiety. With its potent dopamine antagonist activity, Compazine works by blocking receptors in the chemoreceptor trigger zone (CTZ) of the brain, effectively reducing emetic signals and alleviating psychotic symptoms. It is available in multiple formulations, including tablets, suppositories, and injectable solutions, allowing for tailored treatment approaches based on clinical need and patient tolerance. Healthcare providers often reserve its use for cases where first-line antiemetics or antipsychotics have proven insufficient, given its specific side effect profile.
Features
- Active ingredient: Prochlorperazine maleate or edisylate
- Available formulations: Oral tablets (5 mg, 10 mg), rectal suppositories (25 mg), injectable solution (5 mg/mL)
- Pharmacologic class: Phenothiazine derivative, dopamine D2 receptor antagonist
- Onset of action: Oral: 30–40 minutes; IM: 10–20 minutes; IV: rapid; rectal: 60 minutes
- Duration of effect: 3–4 hours (IV/IM), 4–6 hours (oral), up to 12 hours (rectal)
- Half-life: Approximately 6–8 hours
- Metabolism: Hepatic, via CYP2D6
- Excretion: Primarily renal
Benefits
- Provides rapid and effective control of severe nausea and vomiting, including that associated with chemotherapy, surgery, or migraine
- Offers antipsychotic efficacy for acute and chronic psychotic disorders such as schizophrenia
- Reduces symptoms of non-psychotic anxiety and tension when other treatments are not suitable
- Multiple administration routes allow for use in patients unable to take oral medication
- May be used adjunctively with other antiemetic or psychotropic agents under medical supervision
Common use
Compazine is commonly prescribed for the management of severe, intractable nausea and vomiting in both inpatient and outpatient settings. It is frequently used in oncology for chemotherapy-induced nausea, post-operatively to prevent emesis, and in emergency departments for acute migraine-associated vomiting. In psychiatric practice, it is employed for the short-term management of psychotic disorders, including acute exacerbations of schizophrenia, and for severe anxiety where sedation and antipsychotic effects are warranted. Off-label uses may include treatment of vertigo and behavioral symptoms in dementia, though these are less common and require careful risk-benefit assessment.
Dosage and direction
Dosage must be individualized based on indication, severity of symptoms, patient response, and tolerability. For severe nausea and vomiting in adults: Oral: 5–10 mg 3–4 times daily; IM: 5–10 mg every 3–4 hours, not to exceed 40 mg/day; Rectal: 25 mg twice daily. For psychiatric indications: Oral: 5–10 mg 3–4 times daily; IM: 10–20 mg every 2–4 hours until controlled, then switch to oral therapy. Maximum daily dose should generally not exceed 40 mg for nausea/vomiting or 150 mg for psychiatric use. Elderly or debilitated patients should receive lower initial doses. Administration with food may reduce gastrointestinal upset. Do not abruptly discontinue after prolonged use.
Precautions
Use with caution in patients with cardiovascular disease, glaucoma, prostate hypertrophy, or seizures. May cause drowsiness; advise against driving or operating machinery until response is known. Avoid alcohol and CNS depressants. Orthostatic hypotension may occur, especially with parenteral administration. Periodic monitoring of CBC, liver function, and electrolytes is advised during prolonged therapy. Neuroleptic malignant syndrome (NMS) and tardive dyskinesia (TD) are potential risks, especially with long-term use. Not recommended during pregnancy unless clearly needed; use during lactation should be avoided due to secretion in breast milk.
Contraindications
Hypersensitivity to prochlorperazine or other phenothiazines; comatose or severely depressed states; bone marrow suppression; pediatric patients under 2 years of age or under 20 lbs; use in children and adolescents for nausea/vomiting is generally avoided due to extrapyramidal risk. Avoid in patients with suspected or established subcortical brain damage. Contraindicated in patients with hepatic impairment or severe renal dysfunction.
Possible side effect
Common: Drowsiness, dizziness, dry mouth, blurred vision, constipation. Less common: Extrapyramidal symptoms (e.g., dystonia, akathisia, parkinsonism), orthostatic hypotension, tachycardia, photosensitivity. Serious: Neuroleptic malignant syndrome (hyperthermia, muscle rigidity, autonomic instability), tardive dyskinesia, agranulocytosis, seizures, jaundice. Injectable form may cause pain at injection site. Report any involuntary movements, fever, or sore throat immediately.
Drug interaction
May potentiate effects of CNS depressants (e.g., opioids, benzodiazepines, alcohol). Concurrent use with antihypertensives may increase hypotension. CYP2D6 inhibitors (e.g., fluoxetine, paroxetine) may increase prochlorperazine levels. Anticholinergic drugs may increase risk of adverse effects. May antagonize effects of levodopa and other dopamine agonists. Use cautiously with QT-prolonging agents.
Missed dose
If a dose is missed, take it as soon as remembered unless it is nearly time for the next dose. Do not double the dose to catch up. Resume regular dosing schedule. For as-needed use, take only when symptoms occur as directed.
Overdose
Symptoms may include severe drowsiness, coma, hypotension, extrapyramidal symptoms, agitation, restlessness, convulsions, ECG changes. Treatment is supportive and symptomatic; there is no specific antidote. Gastric lavage may be considered if ingestion was recent. Maintain airway and cardiovascular support. Avoid epinephrine in hypotension management. Extrapyramidal symptoms may be treated with diphenhydramine or benztropine.
Storage
Store at room temperature (15–30°C or 59–86°F) away from light and moisture. Do not freeze. Keep all medications out of reach of children and pets. Do not use suppositories if melted or discolored. Discard unused injectable solution according to institutional guidelines.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider for diagnosis and individualized treatment recommendations. Do not initiate, adjust, or discontinue medication without professional guidance.
Reviews
Clinical studies and decades of use support Compazine’s efficacy in managing severe nausea and vomiting, as well as its role in acute psychosis. Many clinicians note its rapid onset, especially with injectable forms, though side effects—particularly extrapyramidal symptoms—limit its use in some populations. Patient experiences vary; some report significant relief where other antiemetics failed, while others discontinue due to sedation or movement disorders. It remains a valuable option in specific clinical scenarios under careful supervision.