Prochlorperazine Metoclopramide

Droperidol, metoclopramide, prochlorperazine, promethazine, venlafaxine, and reserpine... 

Nausea - anti-emetic (not metoclopramide/prochlorperazine - due to risk of EPSE)... 

Fever, rigors, chills, malaise headaches, myalgia Nausea, emesis Neutropenia Hepatic enzyme elevation Cutaneous—alopecia, transient, mild rashlike reaction Acetaminophen (APAP). NSAID if APAP is not effective. Meperidine for severe chills and rigors. Bedtime administration. 5-HT3 antagonist, prochlorperazine, metoclopramide, fluids Weekly complete blood count reduce dose by 30-50% Liver function tests (LFTs) weekly withhold treatment until LFTs normalize restart at 30-50% dose reduction reversible on dose reduction or cessation. Interferon is contraindicated in patients with psoriasis because exacerbation of psoriasis has been noted during IFN therapy. 

Chlorpromazine, prochlorperazine, promethazine, methylprednisolone, lorazepam, metoclopramide, dexamethasone, or dronabinol may be used for adult patients. Around the clock dosing should be considered. The choice of specific agent should based on patient specific factors, including potential for adverse drug reactions, and cost. SSRIs are effective for breakthrough nausea and vomiting but they are not superior to the less expensive antiemetics above. 

These compounds belong to a broad class of pharmacological agents possessing D2-dopamine blocking properties which are responsible for dystonic reactions. Prochlorperazine, the most widely used phenothiazine, was more effective than placebo but did not offer advantage over the cannabinoids or butyrophenones [123], It was less effective than metoclopramide against cisplatin [81]. 

Meclizine (Antivert) Metoclopramide (Reglan, Clopra, Octamide) Nabilone (Cesamet) Ondansetron (Zofran, Zofran ODT) Palonosetron (Aloxi) Prochlorperazine (Compazine)... 

As first choice treatment a well-established antihistamine such as meclozine is recommended. Promethazine is another antihistamine which reduces nausea, but sedation is a not always desired adverse effect. Metoclopramide increases intestinal motility and could be used short term also early in pregnancy. A neuroleptic such as prochlorperazine reduces nausea but should only be used for shortterm treatment due to the risk of extrapyramidal adverse reactions. Serotonin receptor antagonists can be used in post-operahve nausea and during treatment with cytostatics. 

In addition, there are several drugs that are related to the antipsychotics that may also be prescribed to youths for other conditions. These include the antidepressant amoxapine and the preanesthetic droperidol. Metoclopramide and prochlorperazine are related agents that are marketed for their effects on the gastrointestinal system. 

Dopamine antagonists chlorpromazine hydrochloride metoclopramide hydrochloride perphenazine prochlorperazine prochlorperazine mesylate trifluoperazine hydrochloride... 

TD varies in presentation, and should always be considered in the differential diagnosis of any abnormal involuntary movements in patients exposed to antipsychotics or DA-receptor blocking agents used for other medical conditions (e.g., prochlorperazine or metoclopramide). 

Chlorpromazine Prochlorperazine Fluphenazine Butyrophenones Droperidol Domperidone Antihistamines Promethazine Diphenhydramine Benzamides Metoclopramide Serotonin antagonists Ondansetron Granisetron Tropisetron... 

Prochlorperazine (Compazine, and others) can be effective for prevention of vomiting due to cancer chemotherapy, but is generally less so than dexamethasone or metoclopramide. Phenothiazines can cause orthostatic hypotension, sedation, dystonic reactions, and akathisia. 

Hepatic adverse effects secondary to antiemetic therapy are usually asymptomatic. Metoclopramide has been reported as causing cholestasis and the formation of arteriovenous shunts in the liver [12]. The 5HTj-receptor antagonists have all been documented as occasionally causing mild increases in liver fimction tests. Cholestatic jaundice has been reported with cyclizine, prochlorperazine and promethazine, and hepatitis has been reported with cyclizine. 

Constipation is commonly encountered with cyclizine, owing to its anticholinergic effect. It is also a problem with the SHTj-receptor antagonists as a result of increased gastrointestinal transit time, although the incidence appears to be greater with ondansetron. Dry mouth is seen with cyclizine, prochlorperazine and promethazine. Metoclopramide has been documented as causing diarrhoea. 

Metoclopramide, domperidone and prochlorperazine can increase serum prolactin levels, leading to galactorrhoea, irregular periods and gynaecomastia. Raised plasma aldosterone levels have been reported with metoclopramide in both healthy individuals and cirrhotic patients with ascites. 

Alroe C, Bowen P. Metoclopramide and prochlorperazine the blue-tongue sign . Med J Aust 1989 150(12) 724-5. 

Agents Ondansetron Granisetron Dolasetron Prochlorperazine Droperidol Metoclopramide Promethazine... 

Adverse reactions Well tolerated with few side effects. Headache, especially at higher doses, is the most common adverse effect. Others include dizziness, fatigue, constipation, Gl upset, and elevations in hepatic transaminases. Metoclopramide and prochlorperazine may cause dystonic reactions or EPS at high doses. High doses of droperidol may cause QT(- prolongation. Others include sedation, dizziness, and dry mouth. 

Vomiting is triggered in the chemoreceptor trigger zone of the medulla, and nearly all dopamine receptor agonists (e.g. bromocriptine), and agents that increase dopamine in the brain (e.g. levodopa), cause vomiting. Conversely, many dopamine receptor antagonists (e.g. metoclopramide, and phenothiazines, e.g. chlorpromazine and prochlorperazine) have antiemetic activity. 

Thirty randomized, controlled trials from 1975 to 1996 were analyzed to quantify the antiemetic efficacy and adverse effects of cannabis when given to 1366 patients receiving chemotherapy. Oral nabUone, oral dronabinol, and intramuscular levonantradol were compared with conventional antiemetics (prochlorperazine, metoclopramide, chlor-promazine, thiethylperazine, haloperidol, domperidone, and aliza-pride) or placebo. Across all trials, cannabinoids were slightly more effective than active comparators and placebo when the chemotherapy regimen was of moderate emetogenic potential, and patients preferred them. No dose-response relationships were evident to the authors. The cannabinoids were also more toxic side effects included euphoria, drowsiness, sedation, somnolence, dysphoria, depression, hallucinations, and paranoia. The efficacy of cannabinoids as compared to SSRls has not been studied. Use of these agents should be considered when other regimens do not provide desired efficacy. 

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