Safety of Prochlorperazine During Pregnancy

Therapeutic Alternatives for Nausea and Vomiting in Pregnancy

The American Gastroenterological Association recommends vitamin B6 (pyridoxine) supplementation as a first-line option for hyperemesis gravidarum (HG) or severe nausea and vomiting in pregnancy 1, 2
The European guidelines consider phenothiazines, such as prochlorperazine, as a first-line option for HG, though with caution, and also recommend doxylamine and pyridoxine combination as a first-line option 1
Metoclopramide is considered a second-line option with similar efficacy to phenothiazines but with fewer adverse events, and no increased risk of congenital defects has been reported with its use 1, 2
Ondansetron may be used as a third-line option for severe cases requiring hospitalization, on a case-by-case basis, especially before 10 weeks of pregnancy 1, 2

The American College of Gastroenterology suggests reserving prochlorperazine for severe, intractable nausea and vomiting not responsive to first-line therapies, and considering safer alternatives before resorting to prochlorperazine 1, 2

Cyclizine, Promethazine, and Domperidone are considered first or second-line options for nausea and vomiting in pregnancy, according to the Journal of Hepatology 3
Corticosteroids may be used as a third-line option for severe cases of nausea and vomiting in pregnancy, as per the Journal of Hepatology 3

Fetal growth should be monitored closely with additional ultrasounds every 3-4 weeks, and fetal umbilical artery Doppler exams should be considered if growth restriction is suspected, as recommended by the Annals of Oncology 4

At 17 weeks of pregnancy, the patient is in the second trimester, when many medications have lower teratogenic risk compared to the first trimester, according to the British Journal of Dermatology 5
The EASL guidelines list prochlorperazine as compatible with all trimesters of pregnancy, as stated in the Journal of Hepatology 3

The American Gastroenterological Association recommends Vitamin B6 (pyridoxine) 10-25 mg every 8 hours as the initial pharmacologic treatment for nausea and vomiting in pregnancy 6
The American Gastroenterological Association suggests Doxylamine-pyridoxine combination (10 mg/10 mg or 20 mg/20 mg) as a first-line therapy, which is FDA-approved and should be used before prochlorperazine 6
H1-receptor antagonists (doxylamine, promethazine, dimenhydrinate) are considered safer alternatives for nausea and vomiting in pregnancy, according to the American Gastroenterological Association 6
Prochlorperazine 5-10 mg every 6-8 hours or 25 mg suppository every 12 hours can be considered as a second-line therapy for severe cases of nausea and vomiting in pregnancy, as recommended by the American Gastroenterological Association and the American Academy of Family Physicians 7, 8

The American Gastroenterological Association reports that central nervous system depression, anticholinergic effects, and drug-induced leukopenia or neutropenia are documented adverse effects of prochlorperazine 7
The American Gastroenterological Association notes that there is a risk of neuroleptic malignant syndrome, though rare, associated with prochlorperazine use 7
The American Gastroenterological Association advises to avoid prochlorperazine in patients with a history of leukopenia, neutropenia, dementia, glaucoma, or seizure disorders 7