Prochlorperazine Contraindications and Precautions
- agranulocytosis
- phenothiazine hypersensitivity
- bone marrow suppression
- breast-feeding
- children
- elderly
- GI obstruction
- glaucoma
- hepatic disease
- hypotension
- ileus
- jaundice
- neutropenia
- Parkinson’s disease
- pheochromocytoma
- pregnancy
- prostatic hypertrophy
- radiographic contrast administration
- seizure disorder
- tardive dyskinesia
- urinary retention
Prochlorperazine Contraindications and Precautions
Prochlorperazine is contraindicated for use in patients with known phenothiazine hypersensitivity. Cross-sensitivity may occur. This contraindication includes patients who have experienced agranulocytosis, blood dyscrasias, or jaundice due to phenothiazine therapy. Prochlorperazine is relatively contraindicated in patients with preexisting bone marrow suppression. Marrow depression is rare with prochlorperazine, but preexisting neutropenia could be worsened by administration of a phenothiazine. Post-marketing safety experience suggests that the incidence of agranulocytosis may be higher in geriatric patients compared to younger individuals who received prochlorperazine.
All phenothiazines, including prochlorperazine can cause neuromuscular reactions, particularly dystonias. Children with acute illnesses, including varicella-zoster infections, CNS infections, measles, gastroenteritis, or dehydration, may be more susceptible to developing extrapyramidal symptoms, particularly dystonias.
Prochlorperazine can worsen conditions in patients with organic or traumatic brain damage. This is a relative contraindication, and the exact cause of this phenomenon is unknown. Patients with underlying temperature dysregulation can have this condition amplified by prochlorperazine.
In patients with underlying tardive dyskinesia, prochlorperazine can worsen the condition in the long term. An alternative antiemetic or antipsychotic should be considered. Similarly, patients who have experienced extrapyramidal symptoms with dopamine antagonists in the past can do so again with prochlorperazine. Prochlorperazine should be used cautiously in patients with Parkinson’s disease.
Clinical studies of prochlorperazine did not include a sufficient number of elderly patients to determine whether they respond differently then younger subjects. Geriatric patients are more sensitive to the side effects of antipsychotics. These adverse events include hypotension, anticholinergic effects, and neuromuscular reactions. Also, post-marketing reports suggest that the incidence of agranulocytosis may be higher in geriatric patients compared to younger individuals who received prochlorperazine. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function. Prochlorperazine can cause hypotension in any patient, not just the elderly, so patients with cardiovascular disorders could have exacerbation of their conditions if administered prochlorperazine.
Phenothiazines can lower the seizure threshold and should be used with caution in patients with a seizure disorder. Because of a potential increased risk of seizures, phenothiazines should not be used during intrathecal radiographic contrast administration. Phenothiazines should be discontinued 48 hours before the myelography and should not be resumed until at least 24 hours after the procedure. Prochlorperazine should not be used for the control of nausea and vomiting associated with these procedures.
Because of mild anticholinergic activity, patients with glaucoma, urinary retention, and benign prostatic hypertrophy can experience exacerbation of symptoms when given prochlorperazine.
Prochlorperazine is hepatically metabolized. Hepatic disease could compromise prochlorperazine’s metabolism, leading to excessive toxicity. Prochlorperazine can cause cholestatic jaundice and could exacerbate any underlying cholestatic dysfunction.
Prochlorperazine should be used cautiously in patients with pheochromocytoma because the prochlorperazine-induced buildup of neurotransmitters can have a cardiotoxic effect in these patients.
Limited information exists on prochlorperazine’s effects during pregnancy or breast-feeding. Prochlorperazine is classifies as pregnancy category C. Caution should be used and this drug given only if the benefits outweigh the possible birth defects or other effects in the infant.
The use of phenothiazines in patients with GI obstruction or ileus can mask the symptoms of their condition (i.e., vomiting). Phenothiazines should be used cautiously in these patients.
Related entries
Syndicate
|
