Compazine: Effective Relief for Severe Nausea and Psychotic Disorders
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Synonyms | |||
Compazine (prochlorperazine) is a prescription phenothiazine antipsychotic medication used to manage severe nausea and vomiting, as well as certain psychiatric conditions. It works by blocking dopamine receptors in the brain, which helps control symptoms of nausea and regulates thought processes in psychotic disorders. Available in tablet, syrup, injection, and suppository forms, it is typically prescribed when other treatments have been ineffective or are not suitable. Compazine should be used under strict medical supervision due to its potential for significant side effects and interactions.
Features
- Active ingredient: Prochlorperazine maleate
- Available formulations: Tablets (5 mg, 10 mg), syrup, injectable solution, rectal suppositories
- Mechanism: Dopamine D2 receptor antagonist
- Onset of action: Oral—30–40 minutes; IM—10–20 minutes; IV—rapid; rectal—60 minutes
- Duration: 4–6 hours (oral), up to 12 hours (sustained-release)
- Prescription status: Rx-only in most jurisdictions
Benefits
- Provides rapid and effective control of severe nausea and vomiting not responsive to first-line antiemetics
- Helps manage acute psychotic episodes, including hallucinations, agitation, and disordered thinking
- Offers multiple administration routes for flexibility in clinical settings (e.g., IV for postoperative nausea, oral for maintenance)
- Can be used as an adjunct in migraine treatment to alleviate associated nausea and vomiting
- May reduce anxiety and tension in certain clinical contexts due to its sedative properties
- Effective short-term management of non-psychotic anxiety when other treatments are unsuitable
Common use
Compazine is primarily indicated for the control of severe nausea and vomiting. It is often used postoperatively, during cancer chemotherapy, or in radiation sickness where standard antiemetics prove inadequate. In psychiatric practice, it is employed for the short-term management of psychotic disorders, including schizophrenia and acute manic episodes, particularly when rapid tranquilization is required. Off-label, it is sometimes used for intractable hiccups and as an adjunct in migraine treatment.
Dosage and direction
Dosage varies significantly based on indication, formulation, and patient factors. For severe nausea/vomiting in adults: tablets—5–10 mg 3–4 times daily; syrup—5–10 mg every 6–8 hours; IM—5–10 mg every 3–4 hours (max 40 mg/day); IV—2.5–10 mg (slow infusion, max 10 mg/dose); suppositories—25 mg twice daily. For psychiatric disorders: initial 5–10 mg 3–4 times daily, may increase gradually to 50–100 mg/day in divided doses. Elderly/debilitated patients require lower doses. Always take with food or milk to minimize GI upset unless directed otherwise.
Precautions
Use with extreme caution in patients with cardiovascular disease, glaucoma, prostate hypertrophy, or seizure disorders. May impair mental/physical abilities required for hazardous tasks (e.g., driving). Avoid abrupt withdrawal after prolonged use. Risk of neuroleptic malignant syndrome (NMS) and tardive dyskinesia (TD). Orthostatic hypotension may occur, especially with parenteral administration. Not recommended during pregnancy unless potential benefits outweigh risks (Pregnancy Category C). Elderly patients with dementia-related psychosis treated with antipsychotics are at increased risk of death.
Contraindications
Absolute contraindications include known hypersensitivity to prochlorperazine or other phenothiazines; comatose states; significant CNS depression due to alcohol, barbiturates, opioids, etc.; bone marrow suppression; and pediatric patients under 2 years or weighing less than 9 kg. Relative contraindications include severe cardiac/hepatic impairment, Parkinson’s disease, epilepsy, phaeochromocytoma, and myasthenia gravis.
Possible side effect
Common: Drowsiness, dizziness, blurred vision, dry mouth, constipation, orthostatic hypotension. Less common: Extrapyramidal symptoms (dystonia, akathisia, parkinsonism), galactorrhoea, menstrual irregularities, weight gain. Serious: Tardive dyskinesia (often irreversible), neuroleptic malignant syndrome (hyperthermia, muscle rigidity, autonomic instability), agranulocytosis, seizures, jaundice, corneal and lenticular deposits. Contact healthcare provider immediately if experiencing muscle stiffness, high fever, irregular heartbeat, or involuntary movements.
Drug interaction
Potentiates CNS depressants (alcohol, opioids, sedatives). Concurrent use with antihypertensives may cause additive hypotension. May decrease effects of levodopa and other dopamine agonists. QT prolongation possible with other drugs that prolong QT interval (e.g., antiarrhythmics, certain antibiotics). Anticholinergic drugs may increase risk of paralytic ileus and hyperthermia. Phenobarbital may decrease prochlorperazine levels. Use cautiously with SSRIs/SNRIs due to potential serotonin syndrome.
Missed dose
If a dose is missed, take it as soon as remembered unless it is almost time for the next dose. Do not double the dose to catch up. If multiple doses are missed, contact healthcare provider for guidance, as abrupt discontinuation after prolonged use may cause withdrawal symptoms or recurrence of underlying condition.
Overdose
Symptoms include severe drowsiness, coma, hypotension, tachycardia, extrapyramidal symptoms, agitation, restlessness, convulsions, and cardiac arrhythmias. Management is supportive: gastric lavage if recent ingestion, activated charcoal, maintain airway, and treat symptoms. Hypotension should be managed with IV fluids and norepinephrine (avoid epinephrine). Extrapyramidal symptoms may respond to diphenhydramine or benztropine. There is no specific antidote.
Storage
Store at room temperature (15–30°C/59–86°F) in a tight, light-resistant container. Keep away from moisture and heat. Do not freeze liquid formulations. Keep all medications out of reach of children and pets. Do not use after expiration date printed on packaging. Dispose of unused medication via take-back programs or according to local guidelines.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before starting, changing, or stopping any medication. Individual response to Compazine may vary. Proper diagnosis and supervision are essential for safe and effective use. Do not share medication with others, even if they have similar symptoms.
Reviews
Clinical studies and patient reports indicate Compazine is highly effective for severe nausea/vomiting, with many noting rapid symptom relief, particularly with injectable forms. Psychiatric use shows good short-term efficacy for agitation and psychotic symptoms. Common criticisms include sedation and extrapyramidal side effects, which some find debilitating. Many experts emphasize that it should be reserved for cases where first-line options fail due to side effect profile. Overall, it remains a valuable tool in specific clinical scenarios when used judiciously.