Compazine

Prochlorperazine is a highly potent neuroleptic, which is 10 to 20-times more potent than chlorpromazine. It is a typical antipsychotic drug of the phenothiazine class sold under the names Compazine®, Buccastem® and Stemetil®. more...

It is now relatively seldom used for the treatment of psychosis and the manic phase of bipolar disorder. It has a prominent antiemetic/antivertignoic activity and is more often used for the (short-time) treatment of nauses/emesis and vertigo as follows:

1.To alleviate the symptoms of vertigo

2. As an antiemetic, particularly for nausea and vomiting caused by cancer treatment and in the pre- and postoperative setting

3. Quite recently, in the UK prochlorperazine maleate has been made available as Buccastem M® in buccal form as an OTC-treatment for migraine. In this indication it blocks the CTZ (Chemical Trigger Zone) in the brain, which is responsible for causing severe nausea and emesis. Its OTC use is strictly restricted to a maximum of 2 days, because of the potentially severe side-effects of Procloperazine, which mandate supervision by a health care provider.

Prochlorperazine is available as an oral liquid, tablets, and suppositories, as well as in an injectable form.

Following i.m.-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).

Due to the short duration of treatment it is usually well tolerated. It shares in general all side-effects of chlorpromazine, but these are seen less frequently so and are less disturbing to the patient, particularly as most patients with the aforementioned conditions are hospitalized. In the treatment of nauses/emesis it might be given together with an antiparkinsonian drug to prevent extrapyramidal side effects of prochlorperazine.

If treating psychotic conditions on a long-term basis, the high incidence of early and late (tardive dyskinesia) extrapyramidal side-effects should be considered carefully. Prochlorperazine has in the long-term treatment approximately the same incidence and severity of extrapyramidal side-effects as haloperidol.

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