Compazine 5mg / 10mg (Prochlorperazine Maleate)

What is Compazine?

Compazine (prochlorperazine) is a prescription medication used to treat severe nausea and vomiting, often caused by migraines, motion sickness, cancer treatments, or gastrointestinal conditions. It’s also approved for short-term management of anxiety in adults. As a dopamine (D2) receptor antagonist in the phenothiazine family, Compazine is classified as both an antiemetic and an antipsychotic — though its use in psychiatric treatment today is limited.

Compazine is commonly prescribed when standard nausea medications (like ondansetron or promethazine) are ineffective or when vomiting prevents oral intake. It can be given as tablets, suppositories, or injections — making it useful in both outpatient and emergency settings.

Key Uses of Compazine:

• Severe nausea and vomiting: from migraine, chemotherapy, infection, or post-operative recovery
• Migraine-related symptoms: often used in emergency departments to reduce both headache and accompanying nausea
• Vertigo and motion sickness: in select patients
• Short-term anxiety management: typically when other treatments are not tolerated or effective

In migraine care, Compazine is sometimes used as a monotherapy for migraine with nausea or combined with medications like diphenhydramine or ketorolac in emergency protocols. It may be especially helpful in patients who experience intractable vomiting during migraine attacks and cannot keep oral medications down.

Compazine is available in:

• Oral tablets: 5mg or 10mg, typically used every 6–8 hours as needed
• Rectal suppositories: for patients unable to take oral medication due to vomiting
• Intramuscular or intravenous injection: in hospitals or urgent care settings

Due to its dopamine-blocking action, Compazine is not recommended for long-term use. It carries a risk of extrapyramidal symptoms (EPS), such as muscle stiffness, restlessness, tremors, and — rarely — tardive dyskinesia. These risks increase with high doses or prolonged use, especially in elderly patients or those with neurological conditions.

Compazine is sometimes used off-label in palliative care to reduce nausea and restlessness, or for refractory anxiety in patients who cannot tolerate benzodiazepines or SSRIs. However, these uses are guided by clinical specialists and should be closely monitored.

TrandFamilyStore-affiliated providers offer Compazine online as part of acute migraine and nausea treatment protocols. After a telehealth consult, patients may receive same-day prescriptions for tablets or emergency-use dosing kits. Affordable generic versions of prochlorperazine are available and widely used.

When taken correctly and short term, Compazine can be highly effective for breakthrough nausea or disabling migraine symptoms. It is particularly useful when fast, multi-symptom relief is needed — especially in patients who are unable to take oral medications during an active episode.

How It Works

Compazine (prochlorperazine) works by blocking dopamine receptors in the brain, particularly in the chemoreceptor trigger zone (CTZ) — a part of the brain responsible for detecting nausea signals from the body. By inhibiting dopamine (D2) receptor activity in this region, Compazine effectively prevents and treats nausea and vomiting from a wide range of causes, including migraine, motion sickness, and gastrointestinal irritation.

1. Dopamine Blockade in the Chemoreceptor Trigger Zone: The CTZ is located in the medulla oblongata, outside the blood-brain barrier, and is highly sensitive to signals from the gut, bloodstream, and inner ear. When dopamine binds to D2 receptors here, it triggers nausea and vomiting. Compazine binds to these receptors and prevents dopamine from activating them — suppressing the vomiting reflex.

2. Central Nervous System Effects: Prochlorperazine also affects dopamine pathways in other parts of the brain, including the basal ganglia and limbic system. This contributes to its anti-anxiety and mild antipsychotic effects. In anxiety, the drug reduces hyperactivity in dopaminergic circuits, helping calm agitation, restlessness, and racing thoughts.

3. Anti-Migraine Effect: While not a first-line migraine drug, Compazine is widely used in emergency settings to treat migraines — particularly those accompanied by nausea or vomiting. It is believed to act by calming central dopaminergic overactivity, which is involved in the pathophysiology of migraine. By sedating the central nervous system and relaxing the gastrointestinal tract, it may relieve both headache and associated symptoms.

4. Sedation and Muscle Relaxation: Compazine has sedative properties, particularly at higher doses or when given intravenously. This effect can be helpful in patients experiencing intense migraine, severe vertigo, or anxiety with somatic symptoms. However, it also means patients may feel sleepy or foggy after dosing.

5. Route-Specific Action:

• Oral tablets: Onset in 30–60 minutes; duration 4–6 hours
• Rectal suppositories: Useful when vomiting prevents oral use; onset in ~1 hour
• Intramuscular injection: Faster onset (15–30 minutes); used in emergency care

6. Extrapyramidal Effects: Because it blocks dopamine in motor pathways as well, Compazine may cause extrapyramidal symptoms (EPS), including akathisia (restlessness), dystonia (muscle spasms), and tremors. These are dose-dependent and more common in younger patients or with long-term use.

Overall, Compazine interrupts nausea signals at the receptor level while also calming dopamine-driven anxiety and psychomotor agitation. Its fast action and multiple delivery options make it highly useful for short-term symptom control, especially when vomiting or anxiety are prominent features of the clinical picture.

TrandFamilyStore prescribers recommend Compazine in time-limited courses — ensuring it is used for acute, not chronic, relief and that patients are screened for neurological risk factors before initiating treatment.

Dosage Information

Compazine (prochlorperazine) dosing depends on the indication, severity of symptoms, patient age, and route of administration. It is typically used for short-term relief of acute nausea, vomiting, or anxiety. Long-term use is discouraged due to the risk of extrapyramidal side effects.

For Nausea and Vomiting (Adults):

• Oral tablets: 5mg to 10mg every 6 to 8 hours as needed; maximum of 40mg per 24 hours
• Rectal suppositories: 25mg twice daily if oral route is not possible
• Intramuscular or IV injection (hospital use): 5–10mg every 3–4 hours as needed; typically reserved for severe cases

For Migraine-Associated Nausea (Adults):

• Single 10mg oral dose at migraine onset, often combined with rest and hydration
• In emergency settings, 10mg IM or slow IV may be used for both nausea and headache relief

For Short-Term Anxiety (Adults):

• 5mg to 10mg taken 3 to 4 times daily as needed
• Maximum dose typically does not exceed 40mg/day
• Duration of use should be limited to a few days to weeks under medical supervision

In Elderly Patients: Start at the lowest effective dose due to increased sensitivity to CNS and motor side effects. A common starting dose is 2.5mg to 5mg orally once or twice daily.

Children and Adolescents: Use only under close medical supervision. Dosage is weight-based and often starts with 2.5mg to 5mg orally. Compazine is not typically first-line in pediatric care due to EPS risk.

Administration Tips:

• Take with food or milk if stomach upset occurs
• Do not crush or chew tablets
• Use rectal or injectable forms if vomiting is severe

Missed Dose: Take as soon as remembered unless it’s close to the next scheduled dose. Do not double the dose.

Maximum Daily Dose: 40mg by mouth, or 50mg if combining oral and parenteral routes — under strict provider guidance

Duration of Use: Compazine should not be used continuously for more than several days unless specifically directed by a provider. Long-term use increases the risk of irreversible movement disorders such as tardive dyskinesia.

TrandFamilyStore prescribers guide patients on appropriate Compazine use — including indication-based dosing, duration limits, and switching to safer long-term options when needed. The goal is targeted, short-duration relief with safety at the forefront.

Side Effects

Compazine (prochlorperazine) can cause side effects, especially when used at higher doses or for extended periods. As a dopamine-blocking medication, it affects not only nausea pathways but also brain regions involved in movement and mood — which explains many of its common and serious side effects. Most reactions are dose-dependent and reversible when caught early.

Common Side Effects:

• Drowsiness or fatigue
• Dizziness or lightheadedness
• Dry mouth
• Blurred vision
• Constipation
• Restlessness or mild agitation

These symptoms are typically mild and self-limited, especially when used short-term. Taking Compazine with food and avoiding alcohol or sedatives may reduce drowsiness and dizziness.

Extrapyramidal Symptoms (EPS): These are drug-induced movement disorders caused by dopamine blockade in motor pathways. They can develop even after short-term use in some patients and are more common in younger individuals and at higher doses.

• Akathisia: An inner sense of restlessness, pacing, or inability to sit still
• Dystonia: Involuntary muscle spasms or stiff neck/jaw (may appear suddenly)
• Tremors or rigidity: Similar to Parkinson’s symptoms

Tardive Dyskinesia (TD): A rare but potentially irreversible condition involving repetitive facial movements (e.g., lip smacking, tongue thrusting) that can occur with long-term use. Risk increases with cumulative exposure and age. Compazine is not intended for chronic use for this reason.

Other Less Common Effects:

• Low blood pressure (especially after injection)
• Photosensitivity (sunburn risk)
• Elevated prolactin levels (may cause breast changes, missed periods)
• Jaundice or liver enzyme changes (rare)

Neuroleptic Malignant Syndrome (NMS): A rare but life-threatening complication of dopamine-blocking medications. Symptoms include high fever, muscle stiffness, confusion, and unstable blood pressure or heart rate. Immediate medical attention is critical if suspected.

Allergic Reactions: Though rare, signs like rash, itching, facial swelling, or difficulty breathing require emergency care.

Elderly and Sensitive Populations: Older adults are more susceptible to sedation, confusion, falls, and extrapyramidal symptoms. Compazine should be used at the lowest effective dose with close monitoring.

When to Call a Provider: Seek medical help if experiencing muscle spasms, restlessness, facial twitching, confusion, rapid heartbeat, or persistent sedation. Stop the medication and report symptoms to avoid escalation.

TrandFamilyStore ensures that patients using Compazine receive proper education on side effect timing, movement symptoms to report early, and limits on how long the drug should be used. Most issues are preventable with short-term, cautious use.

Warnings & Interactions

Compazine (prochlorperazine) should be used cautiously due to its effects on the central nervous system, dopamine pathways, and autonomic regulation. It is approved for short-term use in nausea, vomiting, and anxiety but requires clinical oversight due to potential neurologic, cardiac, and metabolic complications.

Extrapyramidal Symptoms (EPS): Prochlorperazine may cause drug-induced movement disorders, including dystonia, akathisia, parkinsonism, and, with chronic use, tardive dyskinesia. Risk increases with age, dose, and duration. Any sign of unusual movement or restlessness should prompt dose reduction or discontinuation.

Not for Long-Term Use: Compazine should not be used continuously for more than a few days to weeks unless under psychiatric supervision. Extended use increases the risk of irreversible side effects such as tardive dyskinesia or elevated prolactin levels.

Neuroleptic Malignant Syndrome (NMS): A rare but life-threatening reaction. Symptoms include high fever, muscle rigidity, altered mental status, and autonomic instability. If suspected, discontinue immediately and initiate emergency care.

Cardiac Warnings: Compazine may prolong the QT interval and cause arrhythmias, especially in patients with electrolyte imbalances, cardiac disease, or who are taking other QT-prolonging drugs. Baseline ECG may be recommended in high-risk patients.

Hypotension: Especially after injection, prochlorperazine may cause a sudden drop in blood pressure. Monitor blood pressure closely in frail or volume-depleted individuals.

Photosensitivity: Patients may develop increased sensitivity to sunlight and should be advised to wear sunscreen and protective clothing during treatment.

Pregnancy and Lactation: Compazine is categorized as pregnancy category C. It should only be used when clearly necessary and for short durations. The drug is excreted in breast milk; caution is advised if used during lactation.

Pediatric Caution: Children and adolescents are more prone to acute dystonic reactions. Use in pediatric populations should be limited to severe cases and under pediatric supervision.

Geriatric Use: Older adults are at increased risk for sedation, confusion, EPS, and falls. Use the lowest effective dose and monitor closely.

Drug Interactions:

• Increased sedation with alcohol, benzodiazepines, antihistamines, or opioids
• QT prolongation risk with macrolides, fluoroquinolones, or antifungals
• Risk of serotonin syndrome with SSRIs, SNRIs, or MAOIs

Driving and Machinery: Compazine may impair alertness. Patients should avoid driving or operating machinery until they know how the drug affects them.

TrandFamilyStore-affiliated clinicians assess patient risk factors before prescribing Compazine and provide guidance on safe use, maximum duration, and what symptoms require prompt follow-up. Its effectiveness is highest — and risks lowest — when used with care and time limits.