A1,
A2,
B,
C1,
C2,
D,
E,
F,
G-H,
I-K,
L,
M,
N,
O,
P1,
P2,
Q-R,
S,
T,
U-V,
W-Z
Compazine Side Effects, and Drug Interactions - Prochlorperazine
Compazine Side Effects, and Drug Interactions - Prochlorperazine
SIDE EFFECTS
Drowsiness, dizziness,
amenorrhea, blurred
vision, skin reactions,
and hypotension may occur.
Cholestatic jaundice
has occurred. If fever
with grippe-like symptoms occurs, appropriate
liver studies should be
conducted. If tests indicate an abnormality, stop treatment. There
have been a few observations of fatty changes in the livers of patients
who have died while receiving the drug. No causal relationship has
been established.
Leukopenia and agranulocytosis
have occurred. Warn patients to report the sudden appearance
of sore throat
or other signs of infection. If white blood cell
and differential
counts indicate leukocyte
depression, stop
treatment and start antibiotic
and other suitable therapy.
Neuromuscular (Extrapyramidal) REACTIONS
These symptoms are seen in a significant
number of hospitalized
mental patients. They may be characterized by motor
restlessness, be of the dystonic type, or they may resemble parkinsonism.
Depending on the severity of symptoms, dosage
should be reduced or discontinued. If therapy
is reinstituted, it should be at a lower dosage. Should these symptoms
occur in children or pregnant
patients, the drug should
be stopped and not reinstituted. In
most cases barbiturates
by suitable route of administration will suffice. (Or, injectable
diphenhydramine hydrochloride
may be useful.) In more severe cases, the administration
of an antiparkinsonism agent, except levodopa, usually produces
rapid reversal of symptoms.
Suitable supportive measures such
as maintaining a clear airway
and adequate hydration should be employed.
Motor Restlessness
Symptoms may include agitation
or jitteriness and sometimes insomnia. These symptoms often disappear
spontaneously. At times these
symptoms may be similar to the original neurotic
or psychotic symptoms.
Dosage should not be increased until these side
effects have subsided.
If this phase becomes
too troublesome, the symptoms can usually be controlled by a reduction
of dosage or concomitant
administration
of a barbiturate.
Dystonias
Symptoms may include: spasm
of the neck muscles, sometimes
progressing to torticollis; extensor
rigidity of back
muscles, sometimes progressing to opisthotonos; carpopedal
spasm, trismus, swallowing
difficulty, oculogyric crisis, and protrusion
of the tongue.
These usually subside within a few hours, and almost always within
24 to 48 hours, after the drug
has been discontinued.
In mild cases, reassurance or a barbiturate is often sufficient.
In moderate cases, barbiturates
will usually bring rapid
relief. In more severe adult
cases, the administration
of an antiparkinsonism agent,
except levodopa, usually produces rapid reversal
of symptoms. In children,
reassurance and barbiturates will
usually control symptoms.
(Or, injectable diphenhydramine
hydrochloride may be useful.
Note: See diphenhydramine hydrochloride
prescribing information for appropriate
children's dosage.) If appropriate
treatment with antiparkinsonism
agents or diphenhydramine hydrochloride
fails to reverse the signs and symptoms, the diagnosis
should be reevaluated.
Pseudoparkinsonism
Symptoms may include: mask-like faces; drooling;
tremors; pillrolling motion; cogwheel rigidity, and shuffling gait.
Reassurance and sedation
are important. In most cases
these symptoms are readily controlled when an antiparkinsonism agent
is administered concomitantly. Antiparkinsonism agents should be
used only when required. Generally, therapy
of a few weeks to two or three months will
suffice. After this time
patients should be evaluated to determine their need
for continued treatment. (Note: levodopa has not been found
effective in pseudoparkinsonism.) Occasionally it is necessary to
lower the dosage of prochlorperazine
or to discontinue the drug.
Tardive Dyskinesia
As with all antipsychotic agents, tardive
dyskinesia may appear
in some patients on long-term therapy
or may appear after drug
therapy has been discontinued.
The syndrome can also
develop, although much less frequently, after relatively brief treatment
periods at low doses. This syndrome
appears in all age groups.
Although its prevalence
appears to be highest among elderly patients, especially elderly
women, it is impossible to rely upon prevalence estimates to predict
at the inception of
neuroleptic treatment
which patients are likely to develop the syndrome. The symptoms
are persistent and in some patients appear to be irreversible. The
syndrome is characterized
by rhythmical involuntary
movements of the tongue, face, mouth,
or jaw (e.g., protrusion
of tongue, puffing of cheeks, puckering of mouth,
chewing movements). Sometimes these may be accompanied by involuntary
movements of extremities. In
rare instances, these involuntary
movements of the extremities are the only manifestations of tardive
dyskinesia. A variant
of tardive dyskinesia, tardive
dystonia, has also
been described.
There is no known effective
treatment for tardive
dyskinesia; antiparkinsonism agents do not alleviate
the symptoms of this syndrome. It is suggested that all antipsychotic
agents be discontinued if these symptoms appear. Should it be necessary
to reinstitute treatment,
or increase the dosage of the agent,
or switch to a different
antipsychotic agent, the
syndrome may be masked.
It has been reported that fine vermicular
movements of the tongue
may be an early sign of
the syndrome and if
the medication is
stopped at that time the syndrome
may not develop.
Contact Dermatitis
Avoid getting the injection
solution on hands or
clothing because of
the possibility of contact
dermatitis.
Adverse Reactions Reported with Prochlorperazine or Other Phenothiazine
Derivatives
Adverse reactions with different phenothiazines
vary in type, frequency, and mechanism
of occurrence, i.e., some are dose-related, while others involve
individual patient sensitivity.
Some adverse reactions may be more likely to occur, or occur with
greater intensity, in patients with special medical problems, e.g.,
patients with mitral
insufficiency
or phenochromocytoma have experienced severe hypotension
following recommended doses of certain phenothiazines.
Not all of the following adverse reactions have been observed with
every phenothiazine derivative, but they have been reported with
one or more and should be borne in mind
when drugs of this class
are administered: extrapyramidal symptoms (opisthotonos, oculogyric
crisis, hyperreflexia, dystonia, akathisia,
dyskinesia, parkinsonism)
some of which have lasted months and even years, particularly in
elderly patients with previous brain damage; grand mal
and petit mal convulsions;
particularly in patients with EEG abnormalities or history
of such disorders; altered
cerebrospinal
fluid proteins; cerebral edema; intensification and prolongation
of the action of central
nervous system
depressants (opiates, analgesics, antihistamines, barbiturates,
alcohol), atropine, heat, organophosphorus insecticides; autonomic
reactions (dryness of mouth,
nasal congestion, headache,
nausea, constipation, obstipation, adynamic ileus,
ejaculatory disorders/impotence,
priapism, atonic colon, urinary
retention; miosis and
mydriasis); reactivation of psychotic
processes, catatonic-like states; hypotension
(sometimes fatal); cardiac arrest, blood
dyscrasias (pancytopenia, thrombocytopenic purpura, leukopenia,
agranulocytosis,
eosinophilia, hemolytic
anemia, aplastic anemia);
liver damage (jaundice, biliary
stasis); endocrine
disturbances (hyperglycemia, hypoglycernia, glycosuria,
lactation, galactorrhea,
gynecomastia, menstrual
irregularities, false positive
pregnancy tests);
skin disorders (photosensitivity,
itching, erythema,
urticaria, eczema
up to exfoliative dermatitis); other allergic reactions (asthma,
laryngeal edema,
angioneurotic edema, anaphylactoid
reactions); peripheral
edema; reversed epinephrine
effect, hyperpyrexia; mild fever
after large IM doses; increased appetite; increased weight, a systemic
lupus erythematosus-like
syndrome; pigmentary
retinopathy, with
prolonged administration
of substantial doses, skin
pigmentation, epithelial
keratopathy, and lenticular
and corneal deposits.
EKG changes, particularly nonspecific, usually reversible
Q and T wave distortions, have been observed in some patients receiving
phenothiazine tranquilizers.
Although phenothiazines
cause neither psychic
nor physical dependence,
sudden discontinuance in long-term psychiatric
patients may cause temporary
symptoms, e.g., nausea
and vomiting, dizziness,
tremulousness.
Note: There have been occasional reports of sudden death
in patients receiving phenothiazines. In
some cases, the cause
appeared to be cardiac arrest or asphyxia
due to failure of the
cough reflex.
DRUG INTERACTIONS
Thiazide diuretics may accentuate the orthostatic
hypotension that
may occur with phenothiazines.
Antihypertensive effects of guanethidine and related compounds
may be counteracted when phenothiazines
are used concomitantly.
Concomitant administration
of propranolol with phenothiazines
results in increased plasma
levels of both drugs.
(See also PRECAUTIONS ).
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