Compazine

1 What is Compazine?

Brand: Compazine, Compro, Mellaril, Permitil, Phenadoz, Prolixin, Serentil, Sparine, Thorazine, Torecan, Trilafon, Phenergan

Generic: Phenothiazine

Compazine, also known as typical neuroleptics/antipsychotic drugs, are usually used to treat a variety of functional psychotic disorders, including schizophrenia. Bipolar disorder, anxiety, delirium, and hiccups are also treated with this group of medicines.

In addition, these drugs are effective against both drug and disease induced nausea and vomiting. Chlorpromazine, a drug of this group is used in the treatment of certain types of porphyria, and with other medicines for the treatment of tetanus.

Some medicines are used to control agitation in certain patients and some drugs may also be used for other conditions as determined by your doctor. On the contrary, they are also responsible for severe extrapyramidal side effects (e.g., parkinsonism, acute muscular dystonia, akathisia, malignant neuroleptic syndrome, tardive dyskinesia), hyperprolactinemia, and substantial weight gain.

Compazine is classified into three groups according to the side chain:

  • Aliphatic derivatives (e.g., chlorpromazine, promazine, triflupromazine, levomepromazine, methotrimeprazine)
  • Piperidine derivatives (e.g., mesoridazine, thioridazine, pipothiazine)
  • Piperazine derivatives (e.g., prochlorperazine, trifluoperazine, perphenazine, fluphenazine)

Compazine is available only with your doctor's prescription.

These drugs are available in the following dosage forms:

  • Capsule
  • Capsule, Extended Release
  • Elixir
  • Liquid
  • Syrup
  • Solution
  • Suspension
  • Suppository
  • Tablet
  • Tablet, Chewable

2 What to Know Before Using

Before using Compazine, you must know all about the risks and complications associated with it. The suitable drug therapy is usually chosen by a doctor with the active participation of the patient.

There are some important factors such as drug interactions, the presence of any metabolic impairment, history of hypersensitivity reaction, pregnancy, lactation etc. which may alter the desired therapeutic effects of a medicine.

Sometimes the presence of other health disorders affects the beneficial effects of this medicine and even may cause serious toxic effects. If you have had any allergic reactions to any medicine then you must tell your doctor about that. The use of phenothiazines is contraindicated in those who are hypersensitive to these drugs and in comatose states.

Further, make sure you inform your doctor if you have any other medical problems, especially:

  • Blood disease 
  • Breast cancer 
  • Cardiovascular disease 
  • Difficult urination 
  • Glaucoma 
  • Parkinson's disease 
  • Seizure disorders 
  • Stomach ulcers— these drugs may make the condition worse
  • Brain damage or disease of the blood vessels in the brain— serious increase in body temperature may occur
  • Liver disease— increased risk of having unwanted effects
  • Lung disease— difficulty in breathing may become more severe and increased risk of developing complications, such as pneumonia
  • Pheochromocytoma 
  • Kidney disease— severe low blood pressure may occur
  • Reye's syndrome

Because of drug-drug interactions, certain medicines should not be used along with phenothiazines. It is always recommended to consult with your doctor if you are in need of some other medications or even any over-the-counter medicine for another health problem in order to avoid unwanted toxic effects.

Besides, the following drug interactions should be kept in mind:

  • Concurrent use of phenothiazines potentiates all CNS depressants –hypnotics, anxiolytics, alcohol, opioids, and antihistaminics. Overdose symptoms may occur.
  • These drugs block the actions of levodopa and direct DA agonists in Parkinson’s disease.
  • Antihypertensive action of clonidine and methyldopa is reduced due to the central alpha-2 adrenergic blockade.
  • Enzyme inducers (e.g., barbiturates, anticonvulsants) can reduce blood levels of phenothiazines.

Animal reproduction studies have shown an adverse effect, and there are no adequate and well-controlled studies in pregnant women. Thus, phenothiazines should be used during pregnancy only if clearly needed. Besides, caution should be exercised when used in lactating women because there are no adequate studies in women for determining infant risk when using during breastfeeding.

3 Proper Usage

To use Compazine properly, you must follow all instructions given by your doctor. The dosage schedule and the duration of drug therapy should be individualized and determined based on the physician’s advice. The therapeutic dose may also vary with the patient’s condition or requirement and the strength of the medicine as well.

As with all psychoactive drugs including phenothiazines, the lowest effective dose should be used to reduce the risk of side effects. These drugs are generally started at a low dosage and increased as necessary and as tolerated.

Higher doses may be required for the treatment of psychosis in certain individuals. But these drugs should not be taken for long-term because of increased risk of complications. The total daily dosage should be taken in divided doses and must not exceeding the maximum therapeutic dose.

When the symptoms are controlled, the dosage should be reduced gradually as soon as possible. The dosage schedule should be maintained only by a healthcare professional. After stabilization on the short-acting forms of the drug, individuals may elect to switch to the longer-acting forms to make taking the drug easier.

You should use this medicine following the directions were given by your doctor. Never use this drug in larger amounts, more often, or for a longer time than your doctor ordered. If you miss a dose of this medicine, take it as soon as possible.

But, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Further, it is advised to store the medicine in a closed container at room temperature away from heat, moisture, and direct light. All kinds of medicines should be kept out of the reach of children. However, outdated medicines should be disposed of by an appropriate way.

4 Precautions to Take

Before using Compazine, there are some precautions you must take. Firstly, regular visits to your doctor are recommended to check that this medicine is working properly or not.

Additionally, the following guidelines should be followed to prevent unwanted complications as well as for the better prognosis of the patients:

Before using any prescription or over-the-counter (OTC) medicine for any medical condition even colds or allergies, check with your doctor. Concurrent use of other medicines may increase the chance of developing heatstroke or other unwanted effects, such as dizziness, dry mouth, blurred vision, and constipation, while you are taking a phenothiazine.

Phenothiazines potentiate the effects of alcohol and other central nervous system depressants (e.g., antihistamines, sedatives, tranquilizers, narcotics, barbiturates, medicine for seizures, muscle relaxants, anesthetics). Check with your doctor before taking any of the above whiles you are using this medicine.

Before you have any medical tests, tell the medical doctor in charge that you are taking this medicine. The results of some tests (such as electrocardiogram [ECG or EKG] readings, the gonadorelin test, the metyrapone test, tests for phenylketonuria, and urine bilirubin tests) may be affected by this medicine.

Before having any kind of surgery, dental treatment, or emergency treatment, tell the medical doctor or dentist in charge that you are using this medicine. Taking phenothiazines together with medicines that are used during surgery, dental treatments, or emergency treatments may increase CNS depression or cause low blood pressure.

This medicine may cause some people to become drowsy or less alert than they are normal. Even if this medicine is taken only at bedtime, it may cause some people to feel drowsy or less alert on arising. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are not alert.

These drugs may cause blurred vision, difficulty in reading, or other changes in vision, especially during the first few weeks of treatment. Do not drive, use machines, or do anything else that could be dangerous if you are not able to see well. If the problem continues or gets worse, check with your doctor.

Dizziness, lightheadedness, or fainting may occur, especially when you get up from a lying or sitting position. Getting up slowly may help. If the problem continues or gets worse, check with your doctor.

These medicines may make you sweat less, causing your body temperature to increase. Use extra care not to become overheated during exercise or hot weather while you are taking this medicine, since overheating may result in heatstroke. Also, hot baths or saunas may make you feel dizzy or faint while you are taking this medicine.

Phenothiazines may cause dryness of the mouth. For temporary relief, use sugarless candy or gum, melt bits of ice in your mouth, or use a saliva substitute. However, if your mouth continues to feel dry for more than 2 weeks, check with your medical doctor or dentist. Continuing dryness of the mouth may increase the chance of dental disease, including tooth decay, gum disease, and fungus infections.

These drugs may make your eyes more sensitive to sunlight than they are normal. Exposure to sunlight over a period of time (several months to years) may cause blurred vision, change in color vision, or difficulty in seeing at night. When you go out during the daylight hours, even on cloudy days, you should wear sunglasses that block ultraviolet (UV) light. Ordinary sunglasses may not protect your eyes.

These medicines also may make your skin more sensitive to sunlight than it is normal. Exposure to sunlight, even for brief periods of time, may cause a skin rash, itching, redness or other discoloration of the skin, or severe sunburn.

When you begin taking this medicine, you should stay out of direct sunlight and wear protective clothing, including a hat and sunglasses. Also, you may apply a sunblock product that has a skin protection factor (SPF) of at least 15.

5 Potential Side Effects

Make sure you meet with your doctor in using Compazine to avoid unwanted potential side effects. Along with the beneficial effects, phenothiazines may cause some unwanted effects.

These side effects are common and often limit their use. Your healthcare professional may advise you about the ways how to prevent or reduce the unwanted side effects.

Sometimes you may need to consult with the doctor if you notice excessive toxic effects, especially:

Based on pharmacological actions (dose related):

  • CNS –drowsiness, lethargy, mental confusion, tolerance to sedative effect, increased appetite, and decreased seizure threshold (aggravation of seizures in epileptics).
  • CVS –postural hypotension, palpitation, inhibition of ejaculation, cardiac arrhythmias, and cardiovascular mortality have been reported.
  • Anticholinergic –dry mouth, blurring of vision, constipation, and urinary hesitancy in elderly males.
  • Endocrine –hyperprolactinemia is common but amenorrhea, infertility, galactorrhea, and gynecomastia may also occur infrequently after prolonged use.
  • Metabolic effects –elevation of blood sugar and triglyceride levels as a consequence of chronic therapy.
  • Extrapyramidal disturbances:
    • Parkinsonism: typical manifestations (e.g., rigidity, tremor, hypokinesia, mask-like facies, shuffling gait) appears between 1-4 weeks of therapy and persist unless the dose is reduced.
    • Acute muscular dystonias: bizarre muscle spasm, mostly involving linguofacial muscles –grimacing, tongue thrusting, torticollis, locked jaw; occurs within a few hours of a single dose or at the most in the first week of therapy. It is more common in children below 10 years and in girls, particularly after parenteral administration.
    • Akathisia: restlessness, the feeling of discomfort, apparent agitation manifested as a compelling desire to move about, but without anxiety. It is seen in some patients between 1-8 weeks of therapy.
    • Malignant neuroleptic syndrome: occurs rarely with high doses of potent agents and lasts 5-10 days after drug withdrawal. The patient develops marked rigidity, immobility, tremor, hyperthermia, semi-consciousness, fluctuating blood pressure, and heart rate.
    • Tardive dyskinesia: manifests as purposeless involuntary facial and limb movements like constant chewing, pouting, puffing of cheeks, lip licking.
  • Miscellaneous –weight gain often occurs due to long-term therapy. Blue pigmentation of exposed skin, corneal and lenticular opacities, and retinal degeneration occur rarely after long-term use of high doses of phenothiazines.

Hypersensitivity reactions (these are not dose related):

  • Cholestatic jaundice with portal infiltration occurs between 2-4 weeks of starting therapy.
  • Skin rashes, urticaria, contact dermatitis, and photosensitivity have been reported.
  • Agranulocytosis and myocarditis may occur in few cases.

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

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