Pharmacological action Prochlorperazine
Prochlorperazine Antipsychotic (neuroleptic), piperazine phenothiazine derivatives. Provides an antipsychotic and sedative effects. Sedative effect and influence on the autonomic nervous system less pronounced than that of other phenothiazines, antiemetic and extrapyramidal effects – stronger. Weakens the psychotic symptoms – delusions and hallucinations at the same time providing an activating (stimulating energeziruyuschee) effect.
The dosage of Prochlorperazine
Inside, after eating, the initial daily dose – 12.5-25 mg, with gradual dose increase to 12.5-25 mg / day to a maximum daily dose of 150-300 mg. Duration of treatment – 2-3 months or more, after which the dose gradually to maintenance. Nausea and vomiting: 5-10 mg 3-4 times / day. Elderly patients, malnourished or debilitated patients usually require a lower initial dose, if necessary, taking into account the tolerance of gradually increased.
Prochlorperazine Drug Interactions
Amplifies the effects of anxiolytics, analgesics, funds for general anesthesia, sedatives, ethanol, and the side effects of hepato-and nephrotoxic funds.
Reduces the effects of anorectics drugs (except fenfluramine).
Reduces the effectiveness of the emetic action of apomorphine, enhances its inhibitory effect on the CNS. Increases the plasma concentrations of prolactin and bromocriptine prevents action.
In a joint application with tricyclic antidepressants, maprotiline, MAO inhibitors possible extension and enhancement of sedative and anticholinergic effects; with thiazide diuretics – strengthening of hyponatremia.
In an application with lithium therapy – decrease absorption from the gastrointestinal tract, increasing the clearance rate of lithium by the kidneys, increasing severity of extrapyramidal disorders, early symptoms of lithium toxicity (nausea and vomiting) may be masked antiemetic effect of phenothiazines.
When combined with beta-blockers enhances the hypotensive effect, increases the risk of irreversible retinopathy, cardiac arrhythmias, and tardive dyskinesia.
Concomitant use of alpha-and beta-agonists (epinephrine) and sympathomimetic (ephedrine) may lead to a paradoxical decrease in blood pressure.
Amitriptyline, amantadine, antihistamines, and other means to increase the anticholinergic effect of anticholinergic activity.
When concomitantly with anticonvulsants srezhstvami (including barbiturates), reducing their efficiency (lowering the threshold of convulsive readiness).
Antithyroid funds increase the risk of agranulocytosis.
Aluminum-and magnesium-containing antacids or adsorbents antidiarrhoeal reduce the absorption of prochlorperazine.
Side effects of Prochlorperazine
CNS and peripheral nervous system: drowsiness, dizziness, insomnia, extrapyramidal disorders (parkinsonism, tardive dyskinesia). Paradoxical reaction: hallucinations, psychomotor agitation.
From the digestive system: dry mouth, decrease or increase in appetite, nausea, vomiting, cholestatic jaundice.
From the sexual system: amenorrhea, hyperprolactinemia, decreased libido, dysmenorrhea, galactorrhea, ejaculation disorders, gynecomastia, false positive pregnancy tests.
From the hemopoietic system: inhibition of bone marrow blood (thrombocytopenia, leukopenia, anemia, pancytopenia, eosinophilia).
Allergic reactions: skin rash, urticaria, angioedema.
Other: weight gain, fatigue.
With the cardiovascular system: when taking neuroleptics phenothiazine were cases of sudden death (including possibly caused by cardiac causes) can lengthen the interval QT – risk of ventricular arrhythmias (especially against the background of the initial bradycardia, hypokalemia, lengthened QT) .
Indications Prochlorperazine
Schizophrenia, involutional psychosis (with a predominance in the clinical picture of weakness, apathy, fatigue, and substuporoznogo stuporoznogo states).
Nausea and vomiting.
Contraindications
Severe cardiovascular disease (decompensated chronic heart failure, hypotension), expressed as a function of the CNS depression and coma of any cause, brain injury, progressive systemic disease of the brain and spinal cord, pregnancy, lactation.
Cautions
C use caution with alcohol (a predisposition to hepatotoxic reactions), for violations of blood, breast cancer (due to phenothiazine-induced prolactin secretion increases the potential risk of disease progression and resistance to endocrine therapy and cytotoxic drugs), angle-closure glaucoma, prostatic hyperplasia with clinical manifestations , hepatic and / or renal failure, gastric ulcer and duodenal ulcer (in acute), diseases associated with an increased risk of thromboembolic complications in Parkinson’s disease (extrapyramidal effects are amplified), epilepsy, myxedema, chronic diseases, accompanied by respiratory failure (especially in children), Reye’s syndrome (increased risk of hepatotoxicity in children and adolescents), cachexia, vomiting (antiemetic effect of phenothiazines may mask vomiting associated with overdose of other drugs), in elderly patients.
Elderly patients may develop irreversible dyskinesia.
Effects on ability to drive vehicles and management mechanisms
During the period of treatment must be careful when driving a vehicle and are busy with other potentially hazardous activities that require high concentration of attention and quickness of psychomotor reactions.
