PROCHLORPERAZINE
Drugs in Pregnancy and Lactation.
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Name: PROCHLORPERAZINE
Class: Tranquilizer/Antiemetic
Risk Factor: C
Fetal Risk Summary
Prochlorperazine is a piperazine phenothiazine. In one rat study, prochlorperazine produced significant postnatal weight decrease, increased fetal mortality, and minor behavioral changes, but no structural defects (1). In a second rat study, an increased incidence of cleft palate, a few anencephalic fetuses, and one double monster was observed (2).
The drug readily crosses the placenta (3). Prochlorperazine has been used to treat nausea and vomiting of pregnancy. Most studies have found the drug to be safe for this indication (see also Chlorpromazine) (4,5 and 6).
The Collaborative Perinatal Project (CPP) monitored 50,282 mother-child pairs, 877 of which had 1st trimester exposure to prochlorperazine (6). For use anytime during pregnancy, 2,023 exposures were recorded. No evidence was found in either group to suggest a relationship to malformations or an effect on perinatal mortality rate, birth weight, or intelligence quotient scores at 4 years of age.
In a separate study using data from the CPP, offspring of psychotic or neurotic mothers who had consumed prochlorperazine for 1–2 months during gestation (N=30) were significantly taller than nonexposed controls (N=71) at 4 months and at 1 year of age (7). Those who had been exposed for longer than 2 months (N=8) were also taller than controls at both ages, but not significantly so. Offspring (N=21) of normal women, who had taken the drug for more than 2 months during pregnancy, were significantly taller than nonexposed controls (N=68) at 1 year of age but no difference was measured at 7 years of age. Moreover, the mean weight of exposed children of normal mothers was significantly greater than controls at 1 year of age, but not at 7 years of age. The mechanisms behind these effects were not clear, but may have been related to the dopamine receptor-blocking action of the drug.
Five infants exposed to prochlorperazine, and, in some cases, to multiple other drugs, during the 1st trimester are described below:
Cleft palate, micrognathia, congenital heart defects, skeletal defects (8)
Thanatophoric dwarfism (short limb anomaly) (9)
Hypoplasia of radium and ulnar bones with a vestigial wrist and hand (10)
Below-the-elbow amputation in one arm and small atrophic hand attached to the stump (11)
Below-the-knee amputation in one limb, with rudimentary foot attached to stump (one twin) (11)
The relationship between prochlorperazine and the above defects is unknown. The case of dwarfism was probably caused by genetic factors. No evidence of amniotic bands were observed in the two cases involving amputations, both of whom were exposed during the mothers' treatment for hyperemesis gravidarum (11).
A 1963 report described phocomelia of the upper limbs in a male infant exposed to two phenothiazines during gestation (12). The mother had not taken prochlorperazine until approximately the 13th week of gestation, so no association between the drug and the defect is possible. However, the other agent, trifluoperazine, was taken early in pregnancy (see also Trifluoperazine). In another study, no increase in defects or pattern of malformations were observed in 76 infants (2 sets of twins) exposed in utero to the antiemetic (13).
In a surveillance study of Michigan Medicaid recipients involving 229,101 completed pregnancies conducted between 1985 and 1992, 704 newborns had been exposed to prochlorperazine during the 1st trimester (F. Rosa, personal communication, FDA, 1993). A total of 24 (3.4%) major birth defects were observed (29 expected). Specific data were available for six defect categories, including (observed/expected) 6/7 cardiovascular defects, 1/1 oral clefts, 0/0 spina bifida, 1/2 polydactyly, 1/1 limb-reduction defects, and 0/2 hypospadias. These data do not support an association between the drug and congenital defects.
In summary, although there are isolated reports of congenital defects in children exposed to prochlorperazine in utero, the majority of the evidence indicates that this drug and the general class of phenothiazines are safe for both mother and fetus if used occasionally in low doses. Other reviewers have also concluded that the phenothiazines are not teratogenic (14,15).
Breast Feeding Summary
No reports describing the excretion of prochlorperazine into breast milk have been located, but the drug has been found in the milk of lactating dogs (16). Because other phenothiazines appear in human milk (e.g., chlorpromazine), excretion of prochlorperazine should be expected. Sedation is a possible effect in the nursing infant. Although prochlorperazine was listed as compatible with breast feeding in the American Academy of Pediatrics' 1983 statement (17), the agent was not included in the 1989 or 1994 revisions.
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References
- Vorhees CV, Brunner RL, Butcher RE. Psychotropic drugs as behavioral teratogens. Science 1979;205:1220–5. As cited in Shepard TH. Catalog of Teratogenic Agents. 6th ed. Baltimore, MD: Johns Hopkins University Press, 1989:525–6.
- Roux C. Action teratogene de la prochlorpemazine. Arch Fr Pediatr 1959;16:968–71. As cited in Shepard TH. Catalog of Teratogenic Agents. 6th ed. Baltimore, MD: Johns Hopkins University Press, 1989:525–6.
- Moya F, Thorndike V. Passage of drugs across the placenta. Am J Obstet Gynecol 1962;84:1778–98.
- Reider RO, Rosenthal D. Wender P, Blumenthal H. The offspring of schizophrenics. Fetal and neonatal deaths. Arch Gen Psychiatry 1975;32:200–11.
- Milkovich L, Van den Berg BJ. An evaluation of the teratogenicity of certain antinauseant drugs. Am J Obstet Gynecol 1976;125:244–8.
- Slone D, Siskind V, Heinonen OP, Monson RR, Kaufman DW, Shapiro S. Antenatal exposure to the phenothiazines in relation to congenital malformations, perinatal mortality rate, birth weight, and intelligence quotient score. Am. J Obstet Gynecol 1977;128:486–8.
- Platt JE, Friedhoff AJ, Broman SH, Bond RN, Laska E, Lin SP. Effects of prenatal exposure to neuroleptic drugs on children's growth. Neuropsychopharmacology 1988;1:205–12.
- Ho CK, Kaufman RL, McAlister WH. Congenital malformations. Cleft palate, congenital heart disease, absent tibiae, and polydactyly. Am J Dis Child 1975;129:714–6.
- Farag RA, Ananth J. Thanatophoric dwarfism associated with prochlorperazine administration. NY State J Med 1978;78:279–82.
- Freeman R. Limb deformities: possible association with drugs. Med J Aust 1972;1:606–7.
- Rafla N. Limb deformities associated with prochlorperazine. Am J Obstet Gynecol 1987;156:1557.
- Hall G. A case of phocomelia of the upper limbs. Med J Aust 1983;1:449–50.
- Mellin GW. Report of prochlorperazine during pregnancy from the fetal life study bank (abstract). Teratology 1975;11:28A.
- Ayd FJ Jr. Children born of mothers treated with chlorpromazine during pregnancy. Clin Med 1964;71:1758–63.
- Ananth J. Congenital malformations with psychopharmacologic agents. Compr Psychiatry 1975;16:437–45.
- Knowles JA. Excretion of drugs in milk–a review. J Pediatr 1965;66:1068–82.
- Committee on Drugs, American Academy of Pediatrics. The transfer of drugs and other chemicals into human breast milk. Pediatrics 1983;72:375–83.
Q&A about Prochlorperazine
i was in hospital a few weeks ago with a severe vomiting virus and i was 27 weeks pregnant, when in there they prescribed and gave me, prochlorperazine (Buccastem dissovable tablets), but when i got home, i checked out on the net that its not good to take during pregnancy, so where do i stand?
Old Ob Doc
My dad takes these tablets as he had cancer 3 years ago what are the side effects?
tramadol....analgesic (pain)..........side effect dizziness, headache, somnolence, constipation, nausea
prochlorperazine.........aniemetics, anitpsychotics........side effects extrapyramidal reactions, blurred vision, dry eyes, constipation, dry mouth
loperamide..........antidiarrheals....... effect drowsiness, constipation
the side effects i listed are the most common.
the donperidone and mebeverine are not listed in my book....check your spelling.........will be glad to look them up for you
its for an inner ear infection. its says on the packet to avoid alcohol. now does this mean none at all or would i be alright for one or two drinks as i'm off out later to a really crappy club to see me mates band play and a couple of pints of the ol' guiness will take the edge off!! p.s no im not an 'alcky'
You shouldn't drink with this drug because it is really hard on the liver. When people are on it long term them will monitor for liver damage. In the small dose you are probably taking liver damage should not be an issue. That is unless you drink. Alcohol even in small doses puts your liver into overdrive putting even more strain on it than the prochlorperazine alone. Also the alcohol will slow the livers ability to breakdown the prochlorperazine and cause it to build up to toxic levels in the body. So for the sake of your liver don't drink!
I suffer from severe OCD which comes along with a fear of vomitting. As a result, my psychiatrist perscribed me the anti-nasuea medicine Compazine to just take if I feel the onset of a stomach ache. This morning I woke with a stomach ache and diarhea, so for percaustion i took the 25 MG suppository. My problem is it says only take it twice a day. I was unaware of that because i have the pill form as well which is supposed to be taken 3 times a day, so I took the next dose 8 hours after the first instead of 12. Im worried i will get sick if i dont take another dose, so im wondering if i can take the pill which is 10 MG.
When i researched online it said to take 2 doses of the suppository (50 MG)
but the pill for says max (40mg)
im confused on whether or not i can take the pill, or if it could casue me harm.
In addition, the pill can also be taken for schizophrenia, and you can take up to 175 MG for that, does that mean it cannot harm me to take 60 mg?will it ust make me drowsy?
2. Most hospitals have a 24-hour call line for information. Is your doctor associated with a hospital? Is there a hospital that you could call? This is more complicated than just "taking a little extra compazine". You're probably on other drugs too, right? They all interact with each other.
3. Taking more usually just means a greater risk of getting the side effects. It certainly won't kill you--as you noted, higher dosages are common with different diseases. This isn't going to be a 100% 10mg extra will kill you or cause whatever problem. It's going to be an increased chance of crappy stuff happening. Most likely, this is something like a 0.00001% chance of more crappy stuff happening, but other drugs interacting with it, etc., could factor into it. It's increased risk, not increased disease.
4. Whatever you decide to do, call your doctor as soon as his/her office opens tomorrow. Explain the situation and what you decided to do. If there was a risk, s/he should be able to explain it. If there wasn't, s/he should be able to put your mind at ease.
Dextropropoxyphene Hydrochloride (Darvon, Deprancol), to suppress breathing)
phenobarbital (to cause unconsciousness)
midazolam (to induce sleep)
Metoclopramide (to counter emesis).
The midazolam may be substituted with another potent benzodiazepine such as alprazolam (Xanax), or both may be used. The midazolam-alprazolam combination be substituted for a combination of lorazepam and zopiclone. Sometimes Metoclopramide is replaced by Prochlorperazine.
The cocktail is unpleasant to the taste and will not work unless mixed in correct quantities, not least because of the risk of emesis.[Vomiting]
as for the measurements im guessing all the people who have made it and tryed it our our probly dead so wont be able to yell you
ive been given cyclazine and prochlorperazine. Are these safe?
There's no such thing as "safe during pregnancy," especially since the safest drug with trillions of safe uses was sued off the market back in the '80's. The drugs you've been prescribed, especially the prochlorperazine, have a long and solid history of use in pregnancy, fetal effects are all but inconsequential, and adverse effects are reasonable. People also use newer drugs like ondansetron (Zofran) and metaclopramide (Reglan), but they don't have the track record of prochlorperazine.
Hi Stephen I take prochlorperazine 10mg from my doctor and it is not stopping my Sever Nausa and Vomiting. I been taking this medicine on and off for over a year for cronic nausa. I have it real bad now because I have Bronchitis and I am choking my brains out and it is making my vomit like crazy. Can the doctor give me something else? Or should I try an take Naturally Nausa Medicine like ginger root from a health food store. Help me I am in so much nausa pain I am loosing hope. I fell like I am dyeing and this is the end. I do not know why they would not admit me when I went to the ER the other day just gave me a whole bunch of meds. I even offered to pay for my stay out of my pocket and they would not let me. Why is the er doc and my Family doc who saw me in the er beging so crewl. I really feel like this is the end someone please help me out
diclofenac sodium-
prolase-
bisacodyl-
calcium lactate-
mefenamic acid-
prochlorperazine maleate-
cloxacillin-
hyoscine n-butylbromide-
magnesium trisilicate-
bromhex hcl-
erythromycin ethylsuccinate-
paracetamol-
indomethacin-
bromhexine-
thanks!
Digestive enzyme - aids digestion
Laxative
Antacid
NSAID - commonly used for dysmenorrhoea
Antypsychotic but is more commonly used as an antiemetic
Antibiotic
Antispasmodic
Food additive
Expectorant
Antibiotic
Analgesic
NSAID
Expectorant
Has anyone else used Buccastem (prochlorperazine) to treat HG? I'm 19 weeks tomorrow and have been offered this by a doctor.
Check out this website for more tips on how to cope with this condition, I have had it for two pregnancies now and I know exactly how you feel, it's complete hell and hope you get better soon.
http://www.hyperemesis.org.uk/
