Prochlorperazine

CLINICAL USE

Nausea and vomiting Labyrinthine disorders Psychoses Severe anxiety

DOSE IN NORMAL RENAL FUNCTION

Oral: 5–10 mg 2–3 times daily Buccal: 1–2 tablets twice daily IM/IV: 12.5 mg (unlicensed IV) Psychoses: Oral: 75–100 mg daily, IM: 12.5–25 mg 2–3 times dailySevere anxiety: 15–20 mg daily by mouth, in divided doses; maximum 40 mg daily

PHARMACOKINETICS

Molecular weight :373.9

%Protein binding :96

%Excreted unchanged in urine : Minimal

Volume of distribution (L/kg) :23

half-life – normal/ESRD (hrs) :6–9/–

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Dose as in normal renal function

<10 : Start with small doses, i.e. 6.25 mg IM or 5 mg orally

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Unlikely to be dialysed. Dose as in GFR <10 mL/min

HD :Unlikely to be dialysed. Dose as in GFR <10 mL/min

HDF/high flux :Unknown dialysability. Dose as in GFR <10 mL/min

CAV/VVHD :Unlikely to be dialysed. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Anaesthetics: enhanced hypotensive effect

Analgesics: increased risk of convulsions with tramadol; enhanced hypotensive and sedative effects with opioidsAnti-arrhythmics increased risk of ventricular arrhythmias with anti-arrhythmics that prolong the QT interval, e.g. procainamide, disopyramide and amiodarone – avoid concomitant use with amiodarone

Antibacterials: increased risk of ventricular arrhythmias with moxifloxacin – avoid concomitant use

Antidepressants: increase concentrations and additive antimuscarinic effects, notably with tricyclics

Anti-epileptics: antagonised (convulsive threshold lowered)

Antimalarials: avoid concomitant use with artemether/lumefantrine

Antipsychotics: increased risk of ventricular arrhythmias with pimozide – avoid concomitant use

Antivirals: concentration possibly increased with ritonavirAnxiolytics and hypnotics: increased sedative effects

Atomoxetine: increased risk of ventricular arrhythmias

Beta-blockers: enhanced hypotensive effect; increased risk of ventricular arrhythmias with sotalolDesferrioxamine: avoid concomitant use

Diuretics: enhanced hypotensive effect

Lithium: increased risk of extrapyramidal side effects and possibly neurotoxicity

Pentamidine: increased risk of ventricular arrhythmias

Sibutramine: increased risk of CNS toxicity – avoid concomitant use

ADMINISTRATION

Reconstition

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Route

IM, IV (unlicensed), oral, buccal

Rate of Administration

IM or IV over 3–4 minutes

Comments

Unlicensed IV administration methods: Either: dilute with water for injection —to 5 times its own volume, and administer slowly over not less than 5 minutes,Or dilute to 1 mg/mL and administer at —rate not greater than 1 mg/minute

OTHER INFORMATION

Increased CNS sensitivity in severe renal impairment.

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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