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Treatment Name: Prochlor­perazine (Compazine®)

Prochlor­perazine (Compazine®) is a Supportive Care Therapy to prevent or treat Nausea and Vomiting

How does prochlorperazine (Compazine®) work?
Prochlorperazine (Compazine®) for nausea is designed to block dopamine (DA) receptors in your brain responsible for the feeling of nausea and the action of vomiting. When chemotherapy is given, it can cause dopamine to be released and when dopamine binds to DA receptors in the brain, it can trigger vomiting. Prochlorperazine (Compazine®) binds to dopamine receptors instead of dopamine, and thereby stops the reflex to vomit.

Goals of therapy:
Prochlorperazine (Compazine®) can be taken on a scheduled basis to prevent nausea and vomiting before chemotherapy, or can be given on an as needed basis to treat nausea or vomiting when they occur. When a medicine is given to prevent nausea and vomiting, it is known as prophylaxis.

Schedule

Prochlorperazine (Compazine®) is usually taken at home for breakthrough nausea or vomiting. Prochlorperazine may also be given in an outpatient infusion center before chemotherapy to prevent nausea and vomiting.

  • Usual prochlorperazine (Compazine®) starting dose at home:
    • Prochlorperazine 5 to 10 mg oral tablet by mouth every 6 hours as needed for nausea and vomiting
      • Elderly patients should consider using lower doses to minimize side effects from prochlorperazine
      • Total daily dosages should not exceed 40 mg in a 24-hour period, unless specifically directed by your doctor

  • Usual prochlorperazine (Compazine®) starting dose just before chemotherapy:
    • Prochlorperazine 5 to 10 mg oral tablet by mouth approximately 30 minutes before chemotherapy
    • Prochlorperazine 5 to 10 mg intravenous push (I.V. push) approximately 30 - 60 minutes before chemotherapy

Compazine® for nausea is typically taken on an as needed basis or given scheduled until chemotherapy treatment is complete. Duration of therapy depends upon response, tolerability, and number of cycles chemotherapy prescribed.

The dosage should be tailored to the individual using prochlorperazine, with a focus on using the lowest dose that prevents or treats nausea or vomiting.

Store prochlorperazine (Compazine®) at room temperature (68° - 77°F).

Side Effects

In the prescribing label information [prochlorperazine (Compazine®) package insert], the most commonly reported side effects from prochlorperazine (Compazine®) are shown here:

Common:

  • Drowsiness

Uncommon:

  • Dizziness
  • Blurred vision
  • Skin changes
  • Irregular menstrual cycle
  • Constipation
  • Low blood pressure
  • Low white blood cell count
  • Uncontrollable muscle movements
  • Difficulty swallowing
  • Agitation
  • Jitteriness
  • Trouble sleeping
  • Dry mouth
  • Headache
  • Nasal congestion
  • Trouble urinating
  • Liver damage
  • Fluid retention
  • High or low blood sugar

Prochlorperazine should be used in pregnant women only if the potential benefits to the mother outweigh the potential risks to the unborn baby.

Note: The exact percentages of patients that will experience prochlorperazine side effects is unknown because it has been used under widely varying patient populations in a variety of clinical trials.

Side effect videos Side Effect Videos
Nausea and VomitingNausea and VomitingFatigue Fatigue

Monitoring

How often is monitoring needed?
Labs (blood tests) typically do not need to be monitored for prochlorperazine, but may be checked before each chemotherapy treatment.

How often is imaging needed?
Although not required for everyone, your doctor may recommend an electrocardiogram (“ECG” or “EKG”) to check your heart rhythm as prochlorperazine can prolong the QTc interval and increase the risk of a heart arrhythmia.

How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue prochlorperazine as planned, add additional medications for nausea or vomiting, or switch to an alternative therapy if side effects are experienced and thought to be related to prochlorperazine.

ChemoExperts Tips

  • Compazine for nausea is a medication that needs a prescription from your doctor; it is not an over-the-counter drug
  • It is important not to wait until the nausea gets too severe to take your dose as it takes approximately 30 minutes for the drug to work and if vomiting occurs before then, you may end up vomiting up your dose of prochlorperazine
  • Prochlorperazine (Compazine®) may cause muscle spasms or twitching in certain individuals. These involuntary movements are collectively referred to as “extrapyramidal symptoms", or “EPS.” A sub-type of EPS are called “dystonias.” which are muscle spasms of head or neck muscles, or tongue. Dystonias occur shortly after taking the first dose of prochlorperazine or in the first few days of treatment
    • If muscle spasms occur, stop taking prochlorperazine and take the antidote diphenhydramine (Benadryl®) available over-the-counter. Diphenhydramine may be taken by following the directions on the package until the muscle spasms go away
    • You should still contact your doctor if you experience any uncontrollable shaking or muscle movements, as this could be a sign of a serious side effect from prochlorperazine
  • If possible, it is best to limit the amount of prochlorperazine and the duration it is taken to decrease the risk of a symptom known as tardive dyskinesia, which may be irreversible
  • Do not take prochlorperazine more frequently than prescribed as this increases the risk of experiencing side effects. You may use other anti-nausea medications such as ondansetron (Zofran®) if you are still experiencing nausea after taking prochlorperazine
  • Drowsiness is a common side effect of prochlorperazine and may increase your risk of falling down and getting injured. Do NOT operate vehicles or machinery after taking a dose of prochlorperazine until you know how your body reacts to the medication. Consider taking other non-drowsy anti-nausea medications such as ondansetron if you plan on being active (Zofran®)
  • The safety of prochlorperazine in women who are pregnant has not been established. Only use during pregnancy if your doctor has determined that the risks of uncontrolled nausea and vomiting are so severe that the potential benefits of taking prochlorperazine outweigh these risks Use caution in patients with a history of glaucoma
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately

Patient Assistance & Co-payment Coverage

Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Prochlor­perazine (Compazine®), we have provided links that may help.

Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Prochlor­perazine (Compazine®). Depending upon your income, they may be able to help cover the cost of:

  • Prochlor­perazine (Compazine®)

For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

  • If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Prochlor­perazine (Compazine®) and are the best source to help you understand drug cost.

  • Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

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References

1) Prochlorperazine (Compazine®) package insert. Drug label information.

Created: July 23, 2017 Updated: November 8, 2018

What is Nausea and Vomiting?

Nausea is the sensation that there is a need to vomit. Nausea can be acute and short-lived, or it can be prolonged. When prolonged, it is a debilitating symptom. Nausea (and vomiting) can be psychological or physical in origin.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

What is an I.V. Push?

An intravenous medication that is usually prepared in a syringe and infused by vein over a short period of time, such as 15 minutes or less

What is the QTc interval?

The time it takes your heart to make one beat can be measured using an electrocardiogram (ECG, or EKG) and is reported as the QTc interval. Prochlorperazine (Compazine®) is generally safe to give when the QTc interval for men is less than 450 milliseconds per beat, and for women, less than 460 milliseconds per beat.

The QTc interval is prolonged if the heart takes too long to make the next beat, and could lead to a dangerous heartbeat known as an arrhythmia.

Certain medications, in addition to prochlorperazine, may prolong the QTc interval. The list includes: ondansetron (Zofran®), Levofloxacin or ciprofloxacin antibiotics. Make sure your pharmacist checks all new medications to make sure they do not prolong the QTc interval to a level considered unsafe.

What is Tardive Dyskinesia?

A syndrome of potentially irreversible involuntary muscle movements that often appears in the muscles involving the mouth. Tardive dyskinesia can result from taking medications that block dopamine chronically for extended periods of time, such as weeks or months.

Tardive dyskinesia should not be confused with an extrapyramidal symptom (EPS) known as “dystonias”, which are also involuntary movements of head or neck muscles, or tongue. Dystonias occur shortly after taking the first dose of prochlorperazine or in the first few days of treatment and are almost always reversible.