Prochlorperazine Side Effects

It is possible that some side effects of prochlorperazine may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.

For the Consumer

Applies to prochlorperazine: oral tablets, parenteral injection, rectal suppositories

Side effects include:

Drowsiness, dizziness, amenorrhea, blurred vision, skin reactions, hypotension.

For Healthcare Professionals

Applies to prochlorperazine: compounding powder, injectable solution, oral capsule extended release, oral syrup, oral tablet, rectal suppository

Nervous system

Nervous system side effects have been associated with the use of prochlorperazine. Most commonly, patients may experience sedation or dizziness. Extrapyramidal reactions may occur in less than 1% of patients receiving prochlorperazine. More commonly patients have reported akathisia and anxiety.[Ref]

Sedation has been reported in up to 75% of patients treated with prochlorperazine. Extrapyramidal reactions have occasionally included torticollis, opisthotonos, carpopedal spasm, trismus, oculogyric crisis, and tongue protrusion. Dystonias usually resolve after neuroleptic discontinuation, but may require anticholinergic therapy if symptoms are severe.

Patients have also experienced pseudoparkinsonism reactions including mask-like facies, drooling, cogwheel rigidity, and shuffling gait. Pseudoparkinsonism symptoms may respond to judicious use of one or more of the following: benztropine, trihexyphenidyl, biperiden or diphenhydramine.

Occasionally, patients have experienced spasmodic contractions involving the mouth, difficulty swallowing, and pain in the jaw and neck. In a few severe cases, patients have experienced temporal mandibular joint subluxation.

Tardive dyskinesia, as with all phenothiazines, is possible with long-term use of prochlorperazine. Tardive dyskinesia involves involuntary, dyskinetic, repetitive movements and may be more common in elderly women receiving prochlorperazine. Tardive dyskinesia may be irreversible and is related to both the duration of therapy and the total amount of drug consumed.[Ref]

Gastrointestinal

Gastrointestinal side effects have included mild to moderate diarrhea.[Ref]

Hepatic

Hepatic side effects have included the development of cholestasis (which has been chronic in at least two patients).[Ref]

Hematologic

Hematologic side effects associated with prochlorperazine have rarely included leukopenia and agranulocytosis.[Ref]

Postmarketing safety experience suggests elderly patients may have an increased incidence of agranulocytosis compared to younger patients receiving prochlorperazine.[Ref]

Cardiovascular

Cardiovascular side effects have occasionally included hypotension during intravenous administration of prochlorperazine.[Ref]

Elderly patients may experience an increased sensitivity to the hypotensive effects of chlorperazine.[Ref]

Other

Other side effects have included cases of the neuroleptic malignant syndrome with other phenothiazines and in at least one patient treated with prochlorperazine.[Ref]

Fever, altered consciousness, autonomic dysfunction, and muscle rigidity are the hallmarks of the neuroleptic malignant syndrome. The neuroleptic malignant syndrome is associated with a case fatality rate of about 20%. Immediate discontinuation of neuroleptic therapy and intensive monitoring and supportive care are indicated.[Ref]

Dermatologic

Dermatologic side effects associated with prochlorperazine have included at least two cases of recurrent lip ulceration.[Ref]

References

1. Fleishman SB, Lavin MR, Sattler M, Szarka H "Antiemetic-induced akathisia in cancer patients receiving chemotherapy." Am J Psychiatry 151 (1994): 763-5

2. Lamont S "Acute reactions to phenothiazine derivatives." Br J Anaesth 44 (1972): 539-40

3. Olver IN, Laidlaw CR, Matthews JP, Bishop JF, Hayes AM, Wolf M, Toner GC "A randomised double blind crossover study of domperidone and prochlorperazine suppositories for controlling emesis in outpatients receiving chemotherapy." Eur J Cancer 30a (1994): 426-9

4. Boston Collaborative Drug Surveillance Program "Drug-induced extrapyramidal symptoms." JAMA 224 (1973): 889-91

5. Schumock GT, Martinez E "Acute oculogyric crisis after administration of prochlorperazine." South Med J 84 (1991): 407-8

6. Edelstein H, Knight RT "Severe parkinsonism in two AIDS patients taking prochlorperazine." Lancet 2 (1987): 341-2

7. Reecer MV, Clinchot DM, Tipton DB "Drug-induced dystonia in a patient with C4 quadriplegia. Case report." Am J Phys Med Rehabil 72 (1993): 97-8

8. Drotts DL, Vinson DR "Prochlorperazine induces akathisia in emergency patients." Ann Emerg Med 34 (1999): 469-75

9. Hiatt WR, Schwartz RA "Spontaneous dislocation of the mandible during prochlorperazine therapy: report of case." J Oral Surg 24 (1966): 365-6

10. Carr BI, Bertrand M, Browning S, Doroshow JH, Presant C, Pulone B, Hill LR "A comparison of the antiemetic efficacy of prochlorperazine and metoclopramide for the treatment of cisplatin-induced emesis: a prospective, randomized, double-blind study." J Clin Oncol 3 (1985): 1127-32

11. Jones J, Sklar D, Dougherty J, White W "Randomized double-blind trial of intravenous prochlorperazine for the treatment of acute headache." JAMA 261 (1989): 1174-6

12. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.

13. Sheppard C, Merlis S "Drug-induced extrapyramidal symptoms: their incidence and treatment." Am J Psychiatry 123 (1967): 886-9

14. Weiden P "Akathisia from prochlorperazine." JAMA 253 (1985): 635

15. Ryan M, LaDow C "Subluxation of the temporomandibular joint after administration of prochlorperazine: report of two cases." J Oral Surg 26 (1968): 646-8

16. Baker FM, Cook P "Compazine complications: a review." J Natl Med Assoc 73 (1981): 409-12

17. Lok AS, Ng IO "Prochlorperazine-induced chronic cholestasis." J Hepatol 6 (1988): 369-73

18. Manser TJ, Warner JF "Neuroleptic malignant syndrome associated with prochlorperazine." South Med J 83 (1990): 73-4

19. Duxbury AJ, Ead RD, Turner EP "Erosive cheilitis related to prochlorperazine maleate." Br Dent J 153 (1982): 271-2

20. Reilly GD, Wood ML "Prochlorperazine--an unusual cause of lip ulceration." Acta Derm Venereol 64 (1984): 270-1

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