Adverse Effects of Prochlorperazine

Neurological Adverse Effects

The American Academy of Child and Adolescent Psychiatry reports that young patients, particularly males, are at a higher risk for extrapyramidal symptoms, including acute dystonia, which involves sudden spastic contractions of muscle groups, and can be distressing and potentially life-threatening in the case of laryngospasm 1
The American Academy of Child and Adolescent Psychiatry also notes that parkinsonism, characterized by bradykinesia, tremors, and rigidity, may be difficult to differentiate from negative symptoms of psychosis, and akathisia, a sense of severe restlessness, occurs in 44% of patients receiving IV prochlorperazine within one hour of administration 1
According to the American Academy of Pediatrics, tardive dyskinesia, characterized by involuntary facial movements and extremity/truncal movements, occurs in approximately 5% of young patients per year and is more common with typical antipsychotics like prochlorperazine 2
The American Academy of Child and Adolescent Psychiatry reports that tardive dystonia, characterized by slow movements along the body axis culminating in spasms, often associated with tardive dyskinesia, can be quite disabling 3

The American Academy of Pediatrics notes that NMS is a potentially lethal syndrome consisting of mental status changes, fever, muscle rigidity, and autonomic dysfunction, with mortality decreasing from 76% in the 1960s to <10-15% more recently 2
Risk factors for NMS include dehydration, physical exhaustion, preexisting brain disease, and concomitant psychotropic medications, as reported by the American Academy of Pediatrics 2

The American Academy of Pediatrics reports that prochlorperazine can cause QT interval prolongation, leading to potentially dangerous arrhythmias, including torsades de pointes 4

The American Academy of Child and Adolescent Psychiatry notes that prochlorperazine can cause sedation, cognitive blunting, memory deficits, especially with agents having greater anticholinergic activity, and apathy 3

The American Academy of Child and Adolescent Psychiatry recommends clinical monitoring of both efficacy and side effects, with frequency varying according to the stage of treatment, and regular assessment for tardive dyskinesia should occur at least every 3-6 months using standardized measures like the Abnormal Involuntary Movement Scale 1, 3
The American Academy of Pediatrics suggests that patients receiving prochlorperazine should be monitored with close clinical observation, cardiorespiratory monitoring, pulse oximetry, and/or electrocardiogram when tolerated 4