Assessment

• Monitor blood pressure (sitting, standing, lying down), ECG, pulse, and respiratory rate before and frequently during the period of dosage adjustment. May cause Q-wave and T-wave changes in ECG

» Assess patient for level of sedation after administration

» Monitor patient for onset of akathisia (restlessness or desire to keep moving) and extrapyramidal side effects (parkinsonian—difficulty speaking or swallowing, loss of balance control, pill rolling, mask-like face, shuffling gait, rigidity, tremors; and dystonic—muscle spasms, twisting motions, twitching, inability to move eyes, weakness of arms or legs) every 2 mo during therapy and 8–12 wk after therapy has been discontinued. Report these symptoms; reduction in dosage or discontinuation may be necessary. Trihexyphenidyl or diphenhydramine may be used to control these symptoms

» Monitor for tardive dyskinesia (uncontrolled rhythmic movement of mouth, face, and extremities; lip smacking or puckering; puffing of cheeks; uncontrolled chewing; rapid or worm-like movements of tongue). Report immediately; may be irreversible

» Monitor for development of neuroleptic malignant syndrome (fever, respiratory distress, tachycardia, seizures, diaphoresis, hypertension or hypotension, pallor, tiredness, severe muscle stiffness, loss of bladder control). Notify health care professional immediately if these symptoms occur

• Assess patient for nausea and vomiting before and 30–60 min after administration

• Monitor patient's mental status (orientation to reality and behavior) before and periodically during therapy

» Observe patient carefully when administering oral medication to ensure that medication is actually taken and not hoarded

» Assess fluid intake and bowel function. Increased bulk and fluids in the diet may help minimize constipation

• Assess degree and manifestations of anxiety and mental status before and periodically during therapy

• CBC and liver function tests should be evaluated periodically during therapy. May cause blood dyscrasias, especially between wk 4 and 10 of therapy. Hepatotoxicity is more likely to occur between wk 2 and 4 of therapy. May recur if medication is restarted. Liver function abnormalities may require discontinuation of therapy

» May cause false-positive or false-negative pregnancy test results and false-positive urine bilirubin test results

» May cause ↑ serum prolactin levels

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