Phenothiazine Antiemetic / Antipsychotic Pregnancy: Avoid in pregnancy unless clearly necessary; neonatal extrapyramidal effects

Prochlorperazine

Brand names: Stemetil, Buccastem (buccal)

Adult dose

Dose: 5-10 mg three times daily (oral); 3-6 mg twice daily (buccal)

Route: Oral / Buccal / IM

Frequency: Two to three times daily

Max: 40 mg/day

Buccal formulation (Buccastem 3 mg) useful when oral route unavailable due to vomiting

Dose: Seek specialist opinion N/A/kg

Route: Oral

Frequency: Seek specialist opinion

Max: Seek specialist opinion

Seek specialist opinion

Renal

Use with caution

Hepatic

Avoid in hepatic impairment

Paediatric weight-based calculator

Patient weight (kg)

Seek specialist opinion

STOPP v3: Prochlorperazine is potentially inappropriate in elderly — causes extrapyramidal side effects and postural hypotension; increases falls risk
Avoid in Parkinson's disease and Lewy body dementia — exacerbates Parkinsonism severely; use domperidone instead for PD-related nausea
For vertigo and nausea in elderly, consider alternatives: betahistine (Meniere's), cyclizine (short-term), or ondansetron for chemotherapy-related nausea
Extrapyramidal reactions are more common and severe in elderly and may persist — tardive dyskinesia can be irreversible
Can cause false-positive pregnancy tests (due to dopamine antagonism raising prolactin)

Extrapyramidal symptoms (acute dystonia, Parkinsonism, akathisia, tardive dyskinesia)
Postural hypotension and falls
Sedation
Anticholinergic effects
QT prolongation
Photosensitivity

Reference: BNFc; BNF 90; STOPP/START v3; AGS Beers Criteria 2023. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways