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Phenothiazine Antiemetic / Antipsychotic

Prochlorperazine

Brand names: Stemetil, Buccastem (buccal)

Prochlorperazine is a phenothiazine antiemetic used for nausea, vomiting and vertigo (including labyrinthine causes); this page covers its use in older people, in whom adverse effects are more likely.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

It blocks dopamine D2 receptors, including those in the chemoreceptor trigger zone, producing antiemetic and antivertigo effects.

Prescribing in practice

  • In older people it carries a high risk of extrapyramidal effects, parkinsonism and falls, and antipsychotics are associated with increased stroke and mortality risk in those with dementia, so use the lowest effective dose for the shortest time.
  • It can prolong the QT interval and cause postural hypotension and sedation; review concurrent QT-prolonging and CNS-depressant drugs.
  • Avoid in Parkinson's disease and dementia with Lewy bodies, where it can markedly worsen motor and cognitive symptoms.

Monitoring

Monitor older patients for extrapyramidal symptoms, drowsiness, postural blood pressure and the continued need for treatment.

Counselling the patient

  • It can cause drowsiness and dizziness, especially on standing.
  • Report abnormal movements, stiffness or restlessness promptly.

Evidence & guidelines

MHRA warnings on antipsychotics in dementia and general geriatric guidance support cautious, short-term use of prochlorperazine in older adults.

Reference: STOPP/START v3; AGS Beers Criteria 2023; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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