Prochlorperazine Interactions
. Amantadine
. Amoxapine
Antacids
Anticonvulsants
Antimuscarinics
Anxiolytics, Sedatives, and Hypnotics
. Attapulgite
. Bromocriptine
. Buprenorphine
. Butorphanol
. Cabergoline
. Cetrorelix
. Citalopram
. Clozapine
. Cyclobenzaprine
. Dasatinib
. Deferoxamine
. Disopyramide
. Dofetilide
. Dronabinol, THC
. Entacapone
. Entecavir
. Escitalopram
. Ethanol
. Fluoxetine
. Ganirelix
General Anesthetics
. Goserelin
. Kaolin; Pectin
. Leuprolide
. Levodopa
. Lithium
. Maprotiline
Monoamine oxidase inhibitors (MAOIs)
. Nabilone
. Nalbuphine
. Olanzapine
. Ondansetron
Opiate agonists
Oral contraceptives
. Orphenadrine
. Palonosetron
. Paroxetine
. Pentazocine
Phenothiazines
Photosensitizing Agents
. Pregabalin
Quinolones
Radiopaque Contrast Agents
. Ranolazine
Retinoids
Sedating H1-blockers
. Sertraline
. Sodium Phosphate Monobasic Monohydrate; Sodium Phosphate Dibasic Anhydrous
Sulfonamides
Sulfonylureas
Tetracyclines
Thiazide diuretics
. Tolcapone
. Tramadol
Tricyclic antidepressants
. Trimethobenzamide
. Triptorelin
. Vorinostat
Prochlorperazine Interactions
Where possible, the use of prochlorperazine with other phenothiazines is not generally recommended. Additive cardiac effects (e.g., prolonged QT interval), CNS effects, or antimuscarinic effects may occur. Clinicians should note that antimuscarinic effects might be seen not only on GI smooth muscle, but also on bladder function, the eye, and temperature regulation.
Depending on the specific agent, additive anticholinergic effects may be seen when phenothiazines are used concomitantly with other drugs with antimuscarinic activity. The following drugs are known to possess anticholinergic properties and should be used together cautiously: antimuscarinics; amantadine, amoxapine, clozapine, cyclobenzaprine, disopyramide, maprotiline, olanzapine, orphenadrine, sedating H1-blockers, and tricyclic antidepressants. Clinicians should note that antimuscarinic effects may be seen not only on GI smooth muscle, but also on bladder function, the eye, and temperature regulation. With some drugs listed, additive drowsiness, hypotension or other additive CNS effects may also occur. Tricyclic antidepressants may cause additive cardiac effects (e.g., QT prolongation) in some cases.
Prochlorperazine is a phenothiazine-derivative and thus may interact with drugs for Parkinson’s disease like levodopa, entacapone or tolcapone. Clinicians should note that additive CNS effects (e.g., sedation) also may occur if prochlorperazine is administered concomitantly with some of these drugs.
Clinicians should note that additive CNS effects (e.g., oversedation, respiratory depression, and hypotension) may occur if prochlorperazine is administered concomitantly with ethanol and other anxiolytics, sedatives, and hypnotics. Similar additive CNS effects with barbiturates, benzodiazepines, dronabinol, THC, opiate agonists, buprenorphine, butorphanol, nabilone, nalbuphine, pentazocine, pregabalin, general anesthetics, and tramadol may also occur. In addition, phenothiazine therapy may be associated with an increased risk of seizures when given concurrently with tramadol.
Sodium phosphate monobasic monohydrate; sodium phosphate dibasic anhydrous should be used with caution in patients using concomitant medications that may lower the seizure threshold such as prochlorperazine.
Many patients have received phenothiazines and lithium without any adverse outcomes, but isolated reports of encephalopathy exist. An acute encephalopathy (resembling neuroleptic malignant syndrome) consisting of delirium, tremulousness, seizures, leukocytosis, weakness, hyperpyrexia, confusion, extrapyramidal symptoms, elevated serum enzymes, blood urea nitrogen and fasting blood sugar, followed by irreversible brain damage, has occurred when lithium was administered with ‘typical’ antipsychotics and phenothiazines. Patients receiving lithium and phenothiazines concomitantly should be closely monitored and the clinician should consider withdrawing one or both drugs if neurotoxicity becomes evident.
The phenothiazines can lower the seizure threshold. Adequate dosages of anticonvulsants should be continued when a phenothiazine is added; patients should be monitored for clinical evidence of loss of seizure control or the need for dosage adjustments of either the phenothiazine or the anticonvulsant. Concomitant administration of prochlorperazine can inhibit the metabolism of phenytoin, thereby increasing the risk of phenytoin toxicity if these agents are given concomitantly. Phenobarbital enhances the renal excretion of prochlorperazine, resulting in pharmacokinetic changes and a decreased therapeutic response to prochlorperazine, so dosages may need to be adjusted.
Phenothiazines, such as prochlorperazine, can elevate serum prolactin concentrations and may interfere with the action of bromocriptine or cabergoline on prolactin secretion. Dopamine antagonism stimulates prolactin release. Bromocriptine and cabergoline impair prolactin release by agonism of dopamine, which stimulates the release of prolactin inhibiting factor.
Thiazide diuretics may cause photosensitivity and may increase the photosensitization effects of drugs like phenothiazines. Prevention of photosensitivity includes adequate protection from sources of UV radiation (e.g., avoiding sun exposure and tanning booths) and the use of protective clothing and sunscreens on exposed skin. Electrolyte disturbances (e.g., hypokalemia, hypomagnesemia, hypercalcemia) may occur with administration of thiazide diuretics, electrolyte disturbances may increase the potential for proarrhythmic effects (e.g., QT prolongation, torsade de pointes) of selected phenothiazines (e.g., mesoridazine, thioridazine). In the absence of electrolyte imbalances, these agents can be used together safely with appropriate monitoring; clinicians should monitor for evidence of electrolyte disturbances or cardiac-related patient complaints. Thiazide diuretics may potentiate the orthostatic hypotension that can be seen with the use of the phenothiazine antipsychotics.
Phenothiazines may increase the photosensitizing effects of photosensitizing agents used during photodynamic therapy. Other medications may also cause additive photosensitization with phenothiazines including oral contraceptives, quinolones , retinoids, sulfonamides, sulfonylureas, tetracyclines, and thiazide diuretics. Patients should take care and use proper techniques to limit sunlight and UV exposure. Prevention of photosensitivity includes adequate protection from sources of UV radiation (e.g., avoiding sun exposure and tanning booths) and the use of protective clothing and sunscreens on exposed skin.
All inhibitors of renal cationic secretion, including prochlorperazine, are contraindicated with dofetilide. In a population pharmacokinetic analysis of plasma dofetilide concentrations, the mean dofetilide clearance of dofetilide was 15% lower in patients receiving inhibitors of tubular organic cation transport.
In the absence of relevant data and as a precaution, drugs that cause hyperprolactinemia, such as antipsychotics, should not be administered concomitantly with gonadotropin releasing hormone (GnRH) analogs (cetrorelix, ganirelix, goserelin, leuprolide, or triptorelin) since hyperprolactinemia downregulates the number of pituitary GnRH receptors.
When prescribing SSRI-type drugs to patients already receiving phenothiazine therapy, close monitoring is essential and dose reduction may become necessary for either the phenothiazine or the SSRI in chronic use. Fluoxetine, paroxetine, and sertraline impair metabolism of the CYP2D6 pathway at therapeutic doses and may result in increased serum phenothiazine concentrations. However, citalopram and escitalopram are only weak inhibitors of CYP2D6 and may be less likely to interact. Significant interactions are unlikely if the phenothiazine is administered for a brief duration as an antiemetic.
The concurrent use of trimethobenzamide with other medications that cause CNS depression (e.g., phenothiazines like prochlorperazine) may potentiate the CNS effects of either trimethobenzamide or the other medication. These drugs may represent duplicate therapies for emesis as well.
Concurrent treatment with deferoxamine and prochlorperazine may lead to a temporary impairment of consciousness. The mechanism of the interaction is not clear.
Phenothiazines have been reported to prolong the QT interval and should be used cautiously in combination with palonosetron. However, the incidence of QT interval prolongation with palonosetron is rare and this potential additive interaction has not been specifically studied.
Antacids may reduce the oral bioavailability of the phenothiazines. Limited data also suggests the adsorbent antidiarrheal attapulgite may inhibit the GI absorption of phenothiazines leading to reduced serum concentrations. Although no data exists, this reaction may also occur with kaolin; pectin. To avoid any possible interactions, administer the phenothiazine at least 1 hour before or 2 hours after an antacid or absorbent antidiarrheal medication.
Use of medications that lower the seizure threshold should be carefully evaluated when considering the use of intrathecal radiopaque contrast agents. Prochlorperazine should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Both entecavir and prochlorperazine are secreted by active tubular secretion. In theory, coadministration of entecavir with prochlorperazine may increase the serum concentrations of either drug due to competition for the drug elimination pathway. The manufacturer of entecavir recommends monitoring for adverse effects when these drugs are coadministered.
Ranolazine is associated with dose and plasma concentration dependent increases in the QTc interval. Phenothiazines have been reported to prolong the QT interval. Prochlorperazine should be used cautiously in combination with ranolazine. However, this potential additive interaction has not been specifically studied.
Conflicting data exist about combining monoamine oxidase inhibitors (MAOIs) and phenothiazines. While some drug references warn of the potential for additive sedative, hypotensive, and anticholinergic effects, clinical data are very limited. The anticholinergic activity of monoamine oxidase inhibitors (MAOIs) is minimal; however, anticholinergic effects sometimes occur. It is recommended that the concurrent use of MAOIs with drugs possessing anticholinergic activity be avoided, since their effects and those of other anticholinergic drugs are potentiated and may become severe. Concurrent use of phenothiazines and MAOIs may also prolong or intensify the hypotensive, anticholinergic, or sedative effects of either agent. In some cases extrapyramidal reactions are increased when a MAOI was added to phenothiazine therapy.
Phenothiazines have been reported to prolong the QT interval. Prochlorperazine should be used cautiously in combination with other drugs with potential to prolong the QT interval such as dasatinib .
Phenothiazines have been reported to prolong the QT interval. Prochlorperazine should be used cautiously in combination with other drugs with potential to prolong the QT interval such as ondansetron.
Phenothiazines have been reported to prolong the QT interval. Prochlorperazine should be used cautiously in combination with other drugs with potential to prolong the QT interval such as vorinostat.
[ Last revised: 11/3/2006 2:15:00 PM ]
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