462-306-02 Prochlorperazine Insert Size: 9” x 13 1/4” USA Submission - 1 8-Oct-2010 030602 DOSAGE AND ADMINISTRATION 462-306-02 General of fatty changes in the livers of patients who have died while receiving the drug. No causal relationship has All Print PMS 287 NOTE ON INJECTION: For intramuscular administration, inject deeply into the upper, outer An encephalopathic syndrome (characterized by weakness, lethargy, fever, tremulousness and been established. quadrant of the buttock. confusion, extrapyramidal symptoms, leukocytosis, elevated serum enzymes, BUN and FBS) Leukopenia and agranulocytosis have occurred. Warn patients to report the sudden appearance of sore Subcutaneous administration is not advisable because of local irritation. has occurred in a few patients treated with lithium plus an antipsychotic. In some instances, the throat or other signs of infection. If white blood cell and differential counts indicate leukocyte depression, Prochlorperazine syndrome was followed by irreversible brain damage. Because of a possible causal relationship stop treatment and start antibiotic and other suitable therapy. Stability This solution should be protected from light. Slight yellowish discoloration will not alter potency. only between these events and the concomitant administration of lithium and antipsychotics, Neuromuscular (Extrapyramidal) Reactions If markedly discolored, solution should be discarded. Edisylate Injection, USP patients receiving such combined therapy should be monitored closely for early evidence of These symptoms are seen in a significant number of hospitalized mental patients. They may be characterized neurologic toxicity and treatment discontinued promptly if such signs appear. This encephalo- Compatibility by motor restlessness, be of the dystonic type, or they may resemble parkinsonism. pathic syndrome may be similar to or the same as neuroleptic malignant syndrome (NMS). It is recommended that Prochlorperazine Edisylate Injection not be mixed with other agents in the WARNING Depending on the severity of symptoms, dosage should be reduced or discontinued. If therapy is syringe. Patients with bone marrow depression or who have previously demonstrated a hypersensitivity reinstituted, it should be at a lower dosage. Should these symptoms occur in children or pregnant Increased Mortality in Elderly Patients with Dementia-Related Psychosis reaction (e.g., blood dyscrasias, jaundice) with a phenothiazine should not receive any Adults patients, the drug should be stopped and not reinstituted. In most cases barbiturates by suitable route Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at phenothiazine, including prochlorperazine, unless in the judgment of the physician the potential (For children’s dosage and administration, see below.) Dosage should be increased more gradually of administration will suffice, or injectable diphenhydramine may be useful. an increased risk of death. Analyses of seventeen placebo-controlled trials (modal benefits of treatment outweigh the possible hazards. in debilitated or emaciated patients. duration of 10 weeks), largely in patients taking atypical antipsychotic drugs, revealed a In more severe cases, the administration of an antiparkinsonism agent, except levodopa, usually produces Prochlorperazine may impair mental and/or physical abilities, especially during the first few ELDERLY PATIENTS risk of death in drug-treated patients of between 1.6 to 1.7 times the risk of death in rapid reversal of symptoms. Suitable supportive measures such as maintaining a clear airway and adequate days of therapy. Therefore, caution patients about activities requiring alertness (e.g., operating In general, dosages in the lower range are sufficient for most elderly patients. Since they appear to placebo-treated patients. Over the course of a typical 10-week controlled trial, the rate of hydration should be employed. vehicles or machinery). be more susceptible to hypotension and neuromuscular reactions, such patients should be observed death in drug-treated patients was about 4.5%, compared to a rate of about 2.6% in the Motor Restlessness closely. Dosage should be tailored to the individual, response carefully monitored, and dosage adjusted placebo group. Although the causes of death were varied, most of the deaths appeared Phenothiazines may intensify or prolong the action of central nervous system depressants (e.g., alcohol, Symptoms may include agitation or jitteriness and sometimes insomnia. These symptoms often disappear accordingly. Dosage should be increased more gradually in elderly patients. to be either cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., anesthetics, narcotics). spontaneously. At times these symptoms may be similar to the original neurotic or psychotic symptoms. TO CONTROL SEVERE NAUSEA AND VOMITING pneumonia) in nature. Observational studies suggest that, similar to atypical anti- Pregnancy Dosage should not be increased until these side effects have subsided. Adjust dosage to the response of the individual. Begin with lowest recommended dosage. psychotic drugs, treatment with conventional antipsychotic drugs may increase NON-TERATOGENIC EFFECTS If these symptoms become too troublesome, they can usually be controlled by a reduction of dosage or mortality. The extent to which the findings of increased mortality in observational studies Neonates exposed to antipsychotic drugs, during the third trimester of pregnancy are at risk for extrapyra- change of drug. Treatment with antiparkinsonian agents, benzodiazepines or propranolol may be helpful. IM Dosage midal and/or withdrawal symptoms following delivery. There have been reports of agitation, hypertonia, Initially 5 mg to 10 mg (1 to 2 mL) injected into the upper, outer quadrant of the buttock. If may be attributed to the antipsychotic drug as opposed to some characteristic(s) of the Dystonia deeply hypotonia, tremor, somnolence, respiratory distress and feeding disorder in these neonates. These necessary, repeat every 3 or 4 hours. Total IM dosage should not exceed 40 mg per day. patients is not clear. Prochlorperazine Edisylate Injection, USP is not approved for the Class effect: Symptoms of dystonia, prolonged abnormal contractions of muscle groups, may occur in complications have varied in severity; while in some cases symptoms have been self-limited, in other treatment of patients with dementia-related psychosis (see WARNINGS). susceptible individuals during the first few days of treatment. Dystonic symptoms include: spasm of the neck IV Dosage cases neonates have required intensive care unit support and prolonged hospitalization. 2.5 mg to 10 mg (0.5 to 2 mL) by slow IV injection or infusion at a rate not to exceed 5 mg per minute. muscles, sometimes progressing to tightness of the throat, swallowing difficulty, difficulty breathing, and/or Prochlorperazine Edisylate should be used during pregnancy only if the potential benefit justifies the protrusion of the tongue. While these symptoms can occur at low doses, they occur more frequently and Prochlorperazine Edisylate Injection may be administered either undiluted or diluted in isotonic solution. DESCRIPTION potential risk to the fetus. A single dose of the drug should not exceed 10 mg; total IV dosage should not exceed 40 mg per day. Prochlorperazine edisylate, 2-Chloro-10-[3-(4-methyl-1-piperazinyl)propyl]phenothiazine 1,2-ethanedisul- with greater severity with high potency and at higher doses of first generation antipsychotic drugs. An Usage in Pregnancy When administered IV, do not use bolus injection. Hypotension is a possibility if the drug is given by IV fonate (1:1), has the following structural formula: elevated risk of acute dystonia is observed in males and younger age groups. CH3 Safety for the use of prochlorperazine during pregnancy has not been established. Therefore, prochlor- injection or infusion. Pseudoparkinsonism perazine is not recommended for use in pregnant patients except in cases of severe nausea and vomiting Subcutaneous administration is not advisable because of local irritation. N Symptoms may include mask-like facies, drooling, tremors, pillrolling motion, cogwheel rigidity, and that are so serious and intractable that, in the judgment of the physician, drug intervention is required and shuffling gait. Reassurance and sedation are important. In most cases, these symptoms are readily ADULT SURGERY (FOR SEVERE NAUSEA AND VOMITING) potential benefits outweigh possible hazards. Total parenteral dosage should not exceed 40 mg per day. Hypotension is a possibility if the drug is given controlled when an antiparkinsonism agent is administered concomitantly. Antiparkinsonism agents N There have been reported instances of prolonged jaundice, extrapyramidal signs, hyperreflexia or should be used only when required. Generally, therapy of a few weeks to two or three months will suffice. by IV injection or infusion. CH2SO2OH hyporeflexia in newborn infants whose mothers received phenothiazines. • l After this time, patients should be evaluated to determine their need for continued treatment. (Note: IM Dosage CH2CH2CH2 CH2SO2OH Nursing Mothers Levodopa has not been found effective in pseudoparkinsonism.) Occasionally, it is necessary to lower the 5 mg to 10 mg (1 to 2 mL) 1 to 2 hours before induction of anesthesia (repeat once in 30 minutes, if CI There is evidence that phenothiazines are excreted in the breast milk of nursing mothers. Caution should be dosage of prochlorperazine or to discontinue