#compazine

or so i thought.

last night i was in the ER for a suspected medical crisis (i am fine, if still moderately ill), and i was given a dose of IV compazine, an antipsychotic sometimes also used to relieve nausea and vomiting. i get the IV out and go home, circa 2am, and relax into bed, exhausted and prepared for a cozy night's sleep following my nightmarish hospital experience.

the following is a non exhaustive list of the events that took place between my arrival home and my inevitable passing out (at least an hour if not two)

- i began to experience a physical sensation not unlike what i imagine the presence of hundreds of millions of bees filling my bones

- i started violently thrashing both legs in the air as though i was seizing, and were it not for the agony of awareness that i was fully conscious i may well have thought i was

- i found myself trapped between my mental state of heavy, mindless exhaustion and my physical state of MOVE GOTTA MOVE GOTTA RUN NOW, such that i would frequently sit bolt upright in bed and take a sip of water then immediately be laid flat again by my desperate need for sleep

- i started doing pushups. i am not a man who does pushups. in fact, broadly, i am not a man who exercises besides walking and moving books around at work, so you can imagine the gravity of the situation required for me to begin doing pushups in bed at 2:30am (approx.)

- my darling fiancee, having come with me to the ER and was now laying in bed next to me, happened to rotate onto her side. i took this as an opportunity to sit up, align my back perpendicular to hers, and reach my arm over her behind me, rotating almost a full 180 degrees to do so. fiancee, to her credit, seemed only to respond to this with a somewhat incredulous “oh, okay”

- at one point, fiancee dares to ask what she can do to help, as i wriggle in agony at her side. all i can offer in response is “get low”, which may sound like a crass joke in reference to lil jon and the east side boyz’ 2002 hit of the same title, but was instead a warning not to sit up or adjust her position from laying supine, as i had sat up and was now swinging my arms back and forth, wide, the way little kids do when they get in the pool and want to make a whirlpool

- when i finally began to simmer down a bit and start thinking in the general direction of sleep, i was suddenly hit with a wave of this stirring sensation in my body, and proceeded to roll against my lover, hot dog on a rotating grill style

Common Brand Names: Compazine

Therapeutic Class: Phenothiazine antiemetic and typical antipsychotic agent

Common Injectable Dosage Forms:

Injection (as edisylate): 5 mg/mL in ampules, vials, and prefilled syringes

Dosage Ranges:

For control of severe nausea and vomiting: The usual adult IV dose is 2.5-10 mg. Single doses should not exceed 10 mg, and total daily doses should not exceed 40 mg. The IM dose us 5-10 mg initially and may be repeated every 3-4 hours until the maximum daily dose of 40 mg is reached. In children older than 2 years and weighing more than 9 kg, the normal IM dose is 0.13 mg/kg, and a single dose is usually sufficient in most pediatric patients. IM and IV doses used in management of postoperative nausea and vomiting are 5-10 mg.

For the treatment of psychosis: In children, give 0.13 mg/kg/dose by IM route. In adults, give 10-20 mg IM, repeated, if necessary, every 1-4 hours. More than 3-4 doses are rarely necessary.

Administration and Stability: Prochlorperazine may be given undiluted (5 mg/mL) IM deeply into a large muscle and by direct IV injection at a rate not to exceed 5 mg/minute. For IV infusion, 20 mg should be diluted into a liter of a compatible solution (NS). pH 4.2-6.2

Pharmacology/Pharmacokinetics: The pharmacologic action of prochlorperazine as an antiemetic is not precisely understood. However, the drug inhibits apomorphine-induced vomiting and directly effects the chemoreceptor trigger zone (CTZ) by blocking dopamine receptors. Following IM administration, the onset of action is 10-20 minutes and duration is 3-4 hours. The drug is highly protein bound, extensively metabolized in the liver, and excreted via the urine and feces.

Drug and Lab Interactions: Additive effects, or potentiation, may occur when used concomitantly with other CNS depressants. Anticonvulsant dosage adjustments may be necessary when used with phenothiazines as they may lower the seizure threshold. The combination of lithium and phenothiazines may produce an acute encephalopathic syndrome. Some urinary metabolites of phenothiazines may cause false-positive results for urobilinogen, amylase, uroporphyrins, porphobilinogens, 5-hydroxyindolacetic acid, and phenylketonuria. Tests results for certain pregnancy tests (Gravidex, HCG, etc.) may also be false-positive.

Contraindications/Precautions: Prochlorperazine is contraindicated for use in children during surgery. The drug should be used with caution in patients whose jobs require mental alertness or physical coordination as it may impair their ability to function. Should also be used with caution in patients who have a history of seizure disorders, severe cardiovascular disorders, Reye’s syndrome, and/or hepatic or renal dysfunction. Pregnancy Category C.

Monitoring Parameters: Vital signs, lipid profile, fasting blood glucose/Hgb A1C, mental status, abnormal involuntary movement scale, EPS.

Adverse Effects: Marked CNS depression is the most common adverse effect, but other adverse effects may be numerous and involve almost all body systems. Other reported effects include extrapyramidal effects, tardive dyskinesia, hepatotoxicity, local dermatitis reactions, and agranulocytosis.