Search

Background: Vertigo is a common presenting symptom in clinical practice, predominantly of vestibular etiology, and often medicated with betahistine, despite the lack of knowledge concerning its mechanism of action. This paper's objective was to review the scientific evidence regarding the efficacy of betahistine on peripheral vertigo. Methods: A systematic search of articles written in English, published within the past 10 years, was conducted in April 2024, on online evidence-based medicine databases, using the MeSH terms "betahistine," "ménière disease," "acute vestibular neuritis," "paroxysmal vertigo," "acute peripheral vestibulopathy," and "labyrinthitis." The Strength of Recommendation Taxonomy of the American Academy of Family Physicians was used to evaluate the level of evidence and strength of recommendation. Results: This review included 12 articles for evidence analysis. Concerning Menière's disease, despite contradictory results, three of the articles analyzed showed a positive effect of betahistine, which is in line with the recommendations of the European Academy of Otology and Neurotology and NICE guidelines, while the American Academy of Otorhinolaryngology guidelines suggest offering betahistine as maintenance therapy. For benign paroxysmal positional vertigo, the established treatment is repositioning maneuvers, and three of the five studies analyzed proved the addition of betahistine to be beneficial. In regard to peripheral vertigo from other causes, two out of three articles revealed a positive recommendation for the use of betahistine. Conclusion: There is a potential benefit to the utilization of betahistine for various etiologies of peripheral vertigo. However, additional studies are required to establish more robust evidence. [ABSTRACT FROM AUTHOR]

Phenothiazine derivatives are well-known anti-psychotic drugs that possess several biological activities including anticancer activity. Much research provides data about its anticancer activity against human glioblastoma cell lines. Unfortunately, to date in vitro studies analyzing the impact of phenothiazines on the viability of human astrocytes have not been performed. However, it is possible to find one study about the viability of neurons and neurons with glia after incubation with perphenazine. Thus, in this study we measured the viability of human astrocytes after 24-, 48-, and 72-hour incubation with perphenazine and prochlorperazine dimaleate using the WST-1 assay. The obtained results suggest that perphenazine is safer for human astrocytes than prochlorperazine dimaleate. Moreover, 24-hour incubation with perphenazine or prochlorperazine did not significantly reduce cellular viability. It is a very important finding since previously we proved that in similar concentrations both drugs reduce the viability of the human glioblastoma U-87 MG cell line by approximately 50%. Therefore, the results suggest that phenothiazines can be used in glioblastoma treatment in concentrations that do not impact human astrocyte viability.

The electromyographic activity of the soleus muscle is a reliable indicator of its functional status. Support unloading causes an immediate cessation of electrical activity of the soleus muscle, which resumes upon restoration of the support load. Prolonged support unloading, however, results in the emergence of spontaneous electrical activity of the soleus muscle. Previous research has established a correlation between this activity and the presence of the potassium-chloride cotransporter (KCC2) on the membranes of spinal cord motor neurons. It has also been demonstrated that the administration of the KCC2 activator prochlorperazine can eliminate spontaneous soleus muscle activity. Here, we aimed to investigate the effect of CLP290, an alternative KCC2 activator, on the spontaneous tonic activity of the rat soleus muscle. The results indicated that daily administration of CLP290 to rats during a 14-day period of hindlimb suspension prevented the reduction in KCC2 levels in lumbar spinal cord motor neurons and the increase in soleus muscle spontaneous tonic activity. Notably, there were no significant differences in the cross-sectional area of slow-type fibers between the antiorthostatic suspension groups with and without CLP290 administration. [ABSTRACT FROM AUTHOR]

Symptoms of nausea and vomiting are common in palliative care and hospice patients. One of the many classes of medications used for the treatment of nausea and vomiting is dopamine receptor antagonists which are particularly helpful for treating nausea mediated by the chemoreceptor trigger zone (CTZ) and impaired gastrointestinal function. While dopamine antagonists can be very effective treatments for nausea they should be used with caution as they carry the risk of QTc prolongation, have a FDA black box warning for tardive dyskinesia (TD), and increased risk of precipitating psychosis and death in patients with dementia. This review will cover haloperidol, olanzapine, prochlorperazine, and metoclopramide for treatment of nausea and vomiting including evidence of efficacy, pharmacokinetics, and pharmacodynamics to improve safe and effective utilization in clinical practice. This includes medication receptor site affinities at histaminic, muscarinic, serotonergic, and alpha-adrenergic receptors which can help providers anticipate potential adverse effects and risk of extrapyramidal symptoms (EPS), TD, and QTc prolongation. This review also includes considerations for dose adjustments based on renal function, hepatic function, and age. Understanding the pharmacology of dopamine antagonists can help providers choose the best treatment for control of nausea and vomiting and subsequently improve patients' quality of life. [ABSTRACT FROM AUTHOR]

Hyperemesis gravidarum complicates 0.5–2% of pregnancies. HG is associated with insomnia, significantly increased risks of anxiety and depression, and may be associated with feelings of guilt, social isolation and thoughts of suicidal ideation or termination of pregnancy. Anti-emetic therapy may be complicated by akathisia and dystonic reactions, which may affect the ongoing management of nausea and vomiting. A case of akathisia and oculogyric crisis following the addition of parenteral prochlorperazine to ondansetron and metoclopramide is presented. The treatment options for extrapyramidal side effects with anti-emetics in pregnancy and for ongoing treatment of nausea and vomiting are discussed. [ABSTRACT FROM AUTHOR]

Aim: To assess the efficacy and safety of prochlorperazine in Indian patients with acute vertigo. Methods: In this prospective, multicenter, open-label, post-marketing observational study, patients with acute peripheral vertigo of different etiologies received 5 mg prochlorperazine thrice a day for 5 days. The primary endpoints were percentage of patients with improvement in (1) vertigo symptoms and (2) clinical response as per scale for vestibular vertigo severity level and clinical response evaluation (SVVSLCRE) from baseline to end of treatment (Day 6). The key secondary endpoints were (1) improvement in nystagmus grading, and (2) safety and tolerability Efficacy of prochlorperazine by route of administration of first prochlorperazine dose (oral or intramuscular) was also assessed. Results: Of 1716 enrolled patients (mean [standard deviation, SD]) age (42.0 [12.95] years; 53.6% men), 57.4% were diagnosed with Meniere's disease, followed by vestibular neuritis (17.4%), labyrinthitis (16.7%), or ear surgery (8.5%). In the overall population, 91.1% of patients showed improvement in clinical response per SVVSLCRE grading at Day 6 (p < 0.0001 vs. non-responders). Nystagmus grading was improved in 99.7% (of patients. No adverse drug reactions events were reported. Tolerability of prochlorperazine was rated as good, very good, and excellent by 43.6%, 32.9% and 20.7% of patients, respectively. Among patients with postoperative vertigo, 80.1% showed improvement in clinical response. In the intramuscular and oral subsets, 85.5% and 92.1% of patients showed improved clinical response, respectively. Conclusion: Prochlorperazine showed improvement in severity of symptoms and clinical response in all subsets of vertigo patients, with a good safety and tolerability profile. Trial Registration Number: CTRI/2022/01/039287. Date of Registration: 10 January 2022. [ABSTRACT FROM AUTHOR]

Objective: Vestibular dysfunction among children and adolescents has recently gained attention. Myriad novel studies and research pertaining to various causes of vestibular dysfunction have emerged. Yet, there is still a lack of awareness among most physicians, notably otorh inola ryngo logis ts, which has led to the condition being overlooked and its prevalence being underestimated. Methods: A cross-sectional Google-form survey involving all otorhinolaryngologists in Malaysia was conducted to determine the awareness of vestibular dysfunction among otorhinolaryngologists in Malaysia. Results: A total of 137 from 156 otorhinolaryngologists answered the survey (87.8%). The majority of the participants were aged between 31 and 40 years old (59.1%), hailing from government hospitals (67.9%), with a working experience of fewer than 5 years (55.5%). A total of 79.6% of them work with children almost daily or frequently. The vestibular assessment was not routine in 91.2% of the participants, and no parental or patient complaint was the top reason behind this (81.0%). Only 16% were comfortable performing vestibular assessment in children. Oculomotor examination is the most favored assessment (71.5%). Otorhinolaryngologists practising longer tends to prescribe medications to children with vestibular dysfunction (P = .025). There is no statistical significance between years of experience, comfort level, or routine vestibular assessment. Conclusion: Vestibular assessment is not routine in children among otorh inola ryngo logis ts, albeit with longer working experience. Lack of assessment is attributed to the parents or patients who do not complain of vestibular dysfunction. The majority of otorhinolaryngologists are not comfortable with vestibular assessment in children. Medication is prescribed comfortably by senior otorh inola ryngo logis ts. These findings suggest that education on vestibular assessment and management is imperative among otorhinolaryngologists to improve the overall care and quality of life in children. [ABSTRACT FROM AUTHOR]

185 Background: Despite advances in antiemetics given during chemotherapy, nausea remains a clinically significant issue and greatly impairs quality of life (QOL). Current ASCO guidelines recommend olanzapine or prochlorperazine for refractory chemotherapy-induced nausea. However, there is a lack of direct empirical comparisons to establish their relative efficacy. Methods: The URCC NCORP Research Base and 21 NCORP practices enrolled 1,363 chemotherapy-naïve patients with breast cancer starting a high/moderate emetogenic chemotherapy regimen to this Phase III RCT (NCT03367572). Antiemetics were prescribed per ASCO guidelines. Screening occurred during Cycle 1, followed by randomization for Cycle 2. Those with ≥ moderate nausea (≥3 on a 1-7 scale) in Cycle 1 and willing to continue were randomized (1:1:1 ratio) into 3 arms (n=310): 1) ASCO regimen plus olanzapine (OLZ), 2) ASCO regimen plus prochlorperazine (PC), or 3) ASCO regimen plus placebo. Nausea was evaluated using a four-day home diary (4x daily), with the primary outcomes being changes in average (avg) and maximum (max) nausea. FACT-G measured QOL. Intent-to-treat primary analyses (ANOVA and Cohen's Δ effect size) evaluated whether OLZ or PC improved nausea, testing between-arm differences in nausea change from Cycle 1 to 2 compared to placebo at a p=0.025 significance level corrected for 3 arms. Results: The median age was 50.7y, with 80.7% White/12.3% Black/5.8% Asian/4.2% Latino, and evenly distributed across groups. The change in avg nausea score was statistically significant for the OLZ (avg change = −1.07: Cohen's Δ = 0.49) and PC arms (avg change = −0.94: Cohen's Δ = 0.38) compared to the placebo (avg change = −0.50; p <0.001 vs OLZ, p = 0.01 vs PC). Similar but larger changes were noted for change in max nausea score in the OLZ (max change = −2.57: Cohen's Δ = 0.86) and PC arms (max change = −2.01: Cohen's Δ = 0.47) against the placebo (max change = −1.30; p <0.001 vs OLZ, p <0.01 vs PC). The OLZ arm had a clinically significant change in overall QOL from pre-chemo to Cycle 2 vs placebo (FACT-G mean difference = +4.91; p = 0.006) but the PC arm vs placebo did not (FACT-G mean difference = −0.87; p = 0.61). OLZ exhibited superiority over PC in terms of changes in max nausea (mean difference = −0.56; p = 0.023) and QOL (FACT-G mean difference = +5.80; p = 0.006), but not for avg nausea (mean difference = −0.13; p = 0.418). Conclusions: OLZ and PC, when added to ASCO guidelines, each significantly reduces refractory nausea. OLZ demonstrates superior max nausea control with clinically and statistically significant improvements in QOL. This study fills the gap in empirical comparisons and solidifies OLZ's position as a promising intervention for refractory nausea. Clinical trial information: NCT03367572. [ABSTRACT FROM AUTHOR]

Background: Women suffering from severe nausea and vomiting during pregnancy, hyperemesis gravidarum, have poor quality of life and increased risk of potentially fatal maternal and fetal complications. There is increasing and reassuring knowledge about safety of antiemetics in pregnancy. In 2013, the European Medical Agency (EMA) issued a warning on metoclopramide limiting treatment to maximum five days. Metoclopramide was the most used antiemetic in pregnancy at the time the warning was implemented in the Norwegian hyperemesis guidelines (2014). We aimed at describing changes in the treatment of hyperemesis over time, including changes associated with the EMA warning.Methods: Retrospective chart review of all women hospitalized for hyperemesis gravidarum with metabolic disturbances between 01/Jan/2002 and 31/Dec/2019 at a university hospital serving nearly 10% of the pregnant population in Norway. Time-series analysis described changes over time and interrupted time series analysis quantified changes in treatment and clinical outcomes related to the EMA warning.Results: In total, 1,064 women (1.2% of the birthing population) were included. The use of meclizine, prochlorperazine, and ondansetron increased during 2002-2019. This led to a yearly increase in the percentage of women using any antiemetic of 1.5% (95%CI 0.6; 2.4) pre-hospital, 0.6% (95%CI 0.2; 1.1) during hospitalization, and 2.6% (95%CI 1.3; 3.8) at discharge. Overall, only 50% of the women received antiemetics pre-hospital. Following the EMA warning, prehospital use of metoclopramide dropped by 30% (95%CI 25; 36), while use of any antiemetic pre-hospital dropped by 20% (95%CI 5.7; 34). In timely association, we observed a decrease in gestational age (-3.8 days, 98.75%CI 0.6; 7.1) at first admission, as well as indication of increased rate of termination of pregnancy with an absolute increase of 4.8% (98.75%CI 0.9; 8.7) in 2014.Conclusion: During 2002-2019, the overall use of antiemetics in treatment of hyperemesis increased. The EMA-warning on metoclopramide in 2013 temporarily limited pre-hospital antiemetic provision associated with hospitalization at lower gestational length and indication of an increase in termination of pregnancy. [ABSTRACT FROM AUTHOR]

ObjectiveTo determine outcomes among patients with migraine in the emergency department (ED) who receive IV hydromorphone vs IV prochlorperazine + diphenhydramine.MethodsThis study was conducted in 2 EDs in New York City. Patients who met international criteria for migraine were eligible for participation if they had not used an opioid within the previous month. Clinicians, participants, investigators, and research personnel were blinded to treatment. Patients were randomized in blocks of 4. Participants received hydromorphone 1 mg or prochlorperazine 10 mg + diphenhydramine 25 mg. Diphenhydramine was administered to prevent akathisia, a common side effect of IV prochlorperazine. The primary outcome was sustained headache relief, defined as achieving a headache level of mild or none within 2 hours of medication administration and maintaining that level for 48 hours without the requirement of rescue medication. A planned interim analysis was conducted once 48-hour data were available for 120 patients.ResultsThe trial was halted by the data monitoring committee after 127 patients had been enrolled. The primary outcome was achieved in the prochlorperazine arm by 37 of 62 (60%) participants and in the hydromorphone arm by 20 of 64 (31%) participants (difference 28%, 95% confidence interval 12-45, number needed to treat 4, 95% confidence interval 2-9).ConclusionsIV hydromorphone is substantially less effective than IV prochlorperazine for the treatment of acute migraine in the ED and should not be used as first-line therapy.Clinicaltrialsgov identifierNCT02389829.Classification of evidenceThis study provides Class I evidence that for patients in the ED with migraine, IV prochlorperazine + diphenhydramine is superior to IV hydromorphone.

Neuroleptic malignant syndrome (NMS) is a rare yet severe condition typically associated with antipsychotic medications. Here, we present a case of NMS induced by prochlorperazine in a 76-year-old male with multiple comorbidities, aiming to delineate its clinical manifestation, diagnostic complexities, and treatment approaches. Our methodology involved a thorough documentation of the patient's medical history, initial symptoms, physical examination findings, laboratory results, diagnostic processes, and subsequent therapeutic interventions. The patient exhibited classic NMS symptoms, including fever, altered mental status, autonomic dysregulation, and generalized rigidity, consistent with diagnostic criteria. Notably, laboratory investigations failed to reveal the typical abnormalities often seen in NMS cases, highlighting the diverse presentation of this syndrome. Management strategies primarily focused on benzodiazepines and amantadine, leading to a gradual improvement in symptoms and eventual resolution of NMS. This underscores the critical role of early recognition and appropriate pharmacotherapy in managing prochlorperazine-induced NMS, even at standard dosage levels. The absence of characteristic laboratory findings in NMS poses challenges in diagnosis, necessitating a comprehensive clinical assessment for accurate identification. Moreover, this case emphasizes the need for further research to better understand the pathophysiology of prochlorperazine-induced NMS and optimize treatment protocols. In conclusion, our case report sheds light on the complexities surrounding NMS induced by prochlorperazine, emphasizing the importance of vigilant monitoring and tailored therapeutic strategies in mitigating its potentially life-threatening consequences. • Rare occurrence of prochlorperazine-induced neuroleptic malignant syndrome (NMS) in an otherwise healthy individual • Absence of typical laboratory abnormalities, emphasizing the variability in NMS diagnostic findings • Successful resolution of NMS symptoms with a personalized pharmacotherapy approach using benzodiazepines and amantadine • Importance of early recognition and prompt initiation of appropriate pharmacotherapy for NMS management [ABSTRACT FROM AUTHOR]

Lupus nephritis (LN) is the most common and significant complication of systemic lupus erythematosus (SLE) due to its poor prognosis and mortality rates in SLE patients. There is a critical need for new drugs as the pathogenesis of LN remains to be elucidated and immunosuppressive therapy comes with many deficiencies. In this study, 23 hub genes (IFI6, PLSCR1, XAF1, IFI16, IFI44, MX1, IFI44L, IFIT3, IFIT2, IFI27, DDX58, EIF2AK2, IFITM1, RTP4, IFITM3, TRIM22, PARP12, IFIH1, OAS1, HERC6, RSAD2, DDX60, and MX2) were identified through bioinformatics and network analysis and are closely related to interferon production and function. Interestingly, immune cell infiltration analysis and correlation analysis demonstrate a positive correlation between the expression of 23 hub genes and monocyte infiltration in glomeruli and M2 macrophage infiltration in the tubulointerstitium of LN patients. Additionally, the CTD database, DsigDB database, and DREIMT database were used to explore the bridging role of genes in chemicals and LN as well as the potential influence of these chemicals on immune cells. After comparison and discussion, six small molecules (Acetohexamide, Suloctidil, Terfenadine, Prochlorperazine, Mefloquine, and Triprolidine) were selected for their potential ability in treating lupus nephritis. [ABSTRACT FROM AUTHOR]

Abstract Background Dystonia is a known neurological complication of certain medications; however, the mechanism behind such effects is often undetermined. Similarly, the clinical pharmacogenomic effects associated with various alleles of the cytochrome P450 family of proteins, and their role in acute dystonic reactions, are also presently unknown. Case presentation We describe a woman presenting with acute dystonic reactions to ondansetron, prochlorperazine, and metoclopramide followed by persistent focal dystonia. A similar family history was reported in her siblings and her father to prochlorperazine, drugs all metabolized by the cytochrome P450 2D6 (CYP2D6) enzyme. Pharmacogenomic testing indicated the patient was heterozygous for the intermediate metabolizer *41 allele (CYP2D6 2988G>A, NM_000106.6:c.985+39G>A, rs28371725). Her father was homozygous for this CYP2D6 *41 allele, and consequently, her siblings were obligate carriers. Conclusions The metabolism of ondansetron, metoclopramide, or prochlorperazine in patients with the *41 CYP2D6 allele has not been studied. In this family, clinical evidence implicates the *41 CYP2D6 allele as causing extrapyramidal adverse pharmacologic reactions. Patients with a family history of medication-induced dystonia involving these medications should be considered for pharmacogenomic testing, and patients carrying the *41 CYP2D6 allele should consider reduction or avoidance of CYP2D6-mediated medications to minimize the potential risk of adverse extrapyramidal effects.

Lung cancer is considered as leading cancer with the highest mortality. The KRAS -oncogenic mutations are dominant in lung carcinoma leading to poor prognosis and radioresistance, which is a major impediment to radiotherapy. Thus, KRAS mutant inhibitors that synergistically sensitize tumours to radiation are urgently needed. In pursuance of the search for a novel radiosensitizer, high-throughput screening of FDA-approved drugs was performed at active site of K-Ras. Prochlorperazine (PCZ), an antipsychotic drug, showed good binding affinity with KRAS-mutant proteins. PCZ binds to the GTP-binding pocket of KRAS -mutant protein and inhibits its constitutive activation by stabilizing the GDP-bound conformation of K-Ras mutants by 9 kcal/mol compared to WT. PCZ alongwith radiation decreased the clonogenic survival of KRAS -mutant NSCLC but not KRAS -WT cells. The combination treatment activates p-ATM, p53, and p21 proteins, leading to cell cycle arrest. PCZ with increasing radiation caused a linear increase in γH2AX foci, suggesting enhanced DSBs-associated apoptosis in radioresistant A549 cells. Pharmacokinetics study showed C max = 526 ng/ml at 30min, 4.6h half-life in plasma, and highest accumulation in tumours. PCZ and 10Gy irradiation synergistically radiosensitize mice xenografts via downregulation of Ras/Raf/MEK/ERK pathway. Our efforts have led to the discovery of PCZ as a lead compound. In preclinical analyses, treatment with PCZ alone and in combination with radiation led to regression of KRAS −G12S tumours. [Display omitted] • Oncogenic KRAS mutation in NSCLC associate with radioresistance and poor prognosis. • PCZ repurposing can shorten drug development time frame and possess clinical translation. • PCZ stabilized GDP-bound mutant K-Ras conformation and supress its activity. • PCZ selectively radiosensitizes KRAS mutant A549 over WT H1299 lung cancer cell. • PCZ renders radiosensitization in vivo in xenograft model via inhibiting Ras pathway. [ABSTRACT FROM AUTHOR]

The uncontrolled simultaneous application of prochlorperazine with typical phenothiazine derivatives antipsychotics and other drugs leads to fatal poisonings. Aim. To optimize TLC procedures for the screening examinations in combined poisonings with prochlorperazine and other drugs. Results and discussion. The chromatographic mobility of prochlorperazine, clorpromazine, ibuprofen, trifluoperazine and quetiapine has been studied on two types of plates (HPTLC and TLC). It has been shown that the TLC-systems used (special – for prochlorperazine, general – for screening of phenothiazine derivatives, as well as drug and narcotic substances of the basic nature recommended by the International Association of Forensic Toxicologists) rather effectively separate the substances analyzed in a thin layer of a sorbent, except for trifluoperazine. To detect the adsorption zones of substances, the Lieberman reagent giving different staining, the Dragendorff reagent and irradiation of chromatograms by UV-light (λ = 254 nm) have been proposed. The detection sensitivity is 0.5 – 1.0 μg in the sample. The validation assessment of the methods developed has been carried out by the chromatographic analysis of prochlorperazine model mixtures with each of the substances studied. Experimental part. The studies were carried out on HPTLC plates (silica gel 60G, particle size – 5 – 7 μm, substrate type – glass, Estonia) with 10 × 10 cm in size and Merck plates (silica gel 60G F254, particle size – 10 – 15 μm, substrate type – aluminum foil, Germany) with 10 × 10 cm in size. Conclusions. The TLC-conditions for screening of prochlorperazine, chlorpromazine, ibuprofen, trifluoperazin and quetiapine have been determined; they can be recommended for drugs detection in real samples of biological objects in the case of combined poisoning.

The clinical presentation of repetitive choreiform involuntary movements of the anterior abdominal wall was first introduced as “belly dancer’s dyskinesia.” Etiologies of this rare condition include idiopathic causes, medication inducement, or post-abdominal surgery. We report a case of orobuccal stereotypic movements and abdominal wall dyskinesia secondary to prochlorperazine intake. The movements began 2 weeks after cessation of prochlorperazine. The patient took this dopamine receptor-blocking medication for 6 months to treat nausea due to chemotherapy. To our knowledge, abdominal wall dyskinesia as a tardive syndrome of prochlorperazine has not been previously reported.

Introduction: Dopamine (D) 2,3 -receptor antagonists (RAs) were the first antiemetics used in the prophylaxis of chemotherapy-induced nausea and vomiting (CINV)., Areas Covered: Eight D 2,3 -RAs, amisulpride, domperidone, droperidol, haloperidol, metoclopramide, metopimazine, olanzapine and prochlorperazine are reviewed focusing on pharmacokinetics, pharmacodynamics, antiemetic effect and side effects., Expert Opinion: Since the introduction of D 2,3 -RAs, antiemetics such as corticosteroids, 5-hydroxytryptamine (5-HT) 3 -RAs and neurokinin (NK) 1 -RAs have been developed. The classical D 2,3 -RAs are recommended in the prophylaxis of CINV from low emetic risk chemotherapy, but not as a fixed component of an antiemetic regimen for moderately or highly (HEC) emetic risk chemotherapy. D 2,3 -RAs are also used in patients with breakthrough nausea and vomiting. It should be emphasized, that most of these drugs are not selective for dopamine receptors.The multi-receptor targeting agent, olanzapine, is recommended in the prophylaxis of HEC-induced CINV as part of a four-drug antiemetic regimen, including a 5-HT 3 -RA, dexamethasone and a NK 1 -RA. Olanzapine is the most effective agent to prevent chemotherapy-induced nausea.Side effects differ among various D 2,3 -RAs. Metopimazine and domperidone possess a low risk of extrapyramidal side effects. Domperidone and metoclopramide are prokinetics, whereas metopimazine delays gastric emptying and haloperidol does not influence gastric motility. Many D 2,3 -RAs increase the risk of prolonged QTc interval; other side effects include sedation and orthostatic hypotension.

Objective: We conducted a randomized trial among emergency department patients with migraine to determine the relative impact on migraine‐associated symptoms of hydromorphone, an opioid, versus prochlorperazine, an antidopaminergic antiemetic. Methods: This was a post hoc analysis of data from a double‐blind study registered at http://clinicaltrials.gov (NCT02389829). Patients who met International Classification of Headache Disorders, 3rd edition criteria for migraine without aura or for probable migraine without aura were eligible for participation. Participants received either hydromorphone 1 mg IV or prochlorperazine 10 mg IV plus diphenhydramine 25 mg IV and could receive a second dose of the same medication 1 h later if needed. The outcomes were sustained relief of nausea, photophobia, and phonophobia. Results: A total of 127 patients were enrolled, of whom 63 received prochlorperazine and 64 received hydromorphone. Of 49 patients in the prochlorperazine arm who reported nausea at baseline, 34 (69.4%) reported complete resolution without relapse versus 15/49 (30.6%) in the hydromorphone arm (absolute risk reduction [ARR] = 38.8%, 95% CI: 20.5%–57.0%, p < 0.001). Of 55 patients in the prochlorperazine arm who reported photophobia at baseline, 23 (41.8%) reported complete resolution without relapse versus 13/62 (20.9%) patients treated with hydromorphone (ARR = 20.8%, 95% CI: 4.3%–37.3%, p = 0.014). Of 56 patients in the prochlorperazine arm who reported phonophobia at baseline, 25 (44.6%) reported complete resolution without relapse versus 16/59 (27.1%) in the hydromorphone arm (ARR = 17.5%, 95% CI: 0.3%–34.8%, p = 0.049). For adverse events, three patients in the prochlorperazine arm reported anxiety or restlessness, and nine patients in the hydromorphone arm reported dizziness or weakness. Conclusions: Prochlorperazine plus diphenhydramine is more efficacious than hydromorphone for the treatment of migraine‐associated symptoms. [ABSTRACT FROM AUTHOR]

Prochlorperazine is frequently used in the treatment of refractory nausea and migraines. Known side effects include extrapyramidal symptoms such as akathisia and dystonia. We report a pregnant patient taking prochlorperazine for hyperemesis gravidarum who developed hemidystonia, which triggered an acute code stroke response from prehospital, emergency medicine and neurology providers. We suspect this report to be the first case of prochlorperazine-induced hemidystonia as a stroke mimic.