No

Antiemetic

Relief of nausea and vomiting

X

Comatose states, hypersensitivity to thiethylperazine or any component; pregnancy, cross-sensitivity to other phenothiazines may exist

Reduce or discontinue if extrapyramidal effects occur; safety and efficacy in children <12 years of age have not been established; postural hypotension may occur after I.M. injection; the injectable form contains sulfite which may cause allergic reactions in some patients; use caution in patients with narrow-angle glaucoma

>10%:

Central nervous system: Drowsiness, dizziness

Gastrointestinal: Xerostomia

Respiratory: Dry nose

1% to 10%:

Cardiovascular: Tachycardia, orthostatic hypotension

Central nervous system: Confusion, convulsions, extrapyramidal effects, tardive dyskinesia, fever, headache

Hematologic: Agranulocytosis

Hepatic: Cholestatic jaundice

Otic: Tinnitus

Symptoms of overdose include deep sleep, coma, extrapyramidal symptoms, abnormal involuntary muscle movements, hypotension

Following initiation of essential overdose management, toxic symptom treatment and supportive treatment should be initiated. Hypotension usually responds to I.V. fluids or Trendelenburg positioning. If unresponsive to these measures, use of a parenteral inotrope may be required (eg, norepinephrine 0.1-0.2 mcg/kg/minute titrated to response); avoid epinephrine for thiethylperazine-induced hypotension. Seizures commonly respond to diazepam (I.V. 5-10 mg bolus in adults every 15 minutes if needed up to a total of 30 mg; I.V. 0.25-0.4 mg/kg/dose up to a total of 10 mg in children) or to phenytoin or phenobarbital. Critical cardiac arrhythmias often respond to I.V. phenytoin (15 mg/kg up to 1 g), while other antiarrhythmics can be used. Neuroleptics often cause extrapyramidal symptoms (eg, dystonic reactions) requiring management with diphenhydramine 1-2 mg/kg (adults) up to a maximum of 50 mg I.M. or I.V. slow push followed by a maintenance dose for 48-72 hours. When these reactions are unresponsive to diphenhydramine, benztropine mesylate I.V. 1-2 mg (adults) may be effective. These agents are generally effective within 2-5 minutes.

Increased effect/toxicity with CNS depressants (eg, anesthetics, opiates, tranquilizers, alcohol), lithium, atropine, epinephrine, MAO inhibitors, TCAs

Store suppositories below 25°C (77°F) in foil

Blocks postsynaptic mesolimbic dopaminergic receptors in the brain; exhibits a strong alpha-adrenergic blocking effect and depresses the release of hypothalamic and hypophyseal hormones; acts directly on chemoreceptor trigger zone and vomiting center

Onset of antiemetic effect: Within 30 minutes

Duration of action: ~4 hours

Children >12 years and Adults:

I.V. and S.C. routes of administration are not recommended

Hemodialysis: Not dialyzable (0% to 5%)

Dosing comments in hepatic impairment: Use with caution

Drowsiness and dizziness are common; may cause confusion and extrapyramidal symptoms

May rarely cause agranulocytosis, caution with clozapine and carbamazepine. Adverse effects may be increased with concurrent use of CNS depressants (ethanol), lithium, TCAs, and MAO inhibitors

No information available to require special precautions

>10% of patients will experience dry mouth

Take as directed; do not use more than recommended. Do not use alcohol and prescription or OTC depressant without consulting prescriber. May cause drowsiness, dizziness, stupor (use caution when driving or engaging in tasks requiring alertness until response to drug is known); dry mouth (frequent oral care and sucking on lozenges may help); photosensitivity (use sunscreen, wear protective clothing and eyewear, and avoid direct sunlight); postural hypotension (rise slowly from sitting or lying position and use caution when climbing stairs). Report abnormal or involuntary muscle movements or twitching or facial tics, acute drowsiness or restlessness, excessive fatigue or dizziness. Pregnancy/breast-feeding precautions: Inform prescriber if you are pregnant. Do not get pregnant during or for 1 month following therapy. Consult prescriber for instruction on appropriate contraceptive measures. This drug may cause severe fetal defects. Consult prescriber if breast-feeding.

Assist with ambulation, observe for extrapyramidal symptoms

Injection, as maleate: 5 mg/mL (2 mL)

Suppository, rectal, as maleate: 10 mg

Tablet, as maleate: 10 mg

Diaz-Rubio E, Martin M, Rosell R, et al, "The Antiemetic Efficacy of Thiethylperazine and Methylprednisolone Versus Thiethylperazine and Placebo in Breast Cancer Patients Treated With Adjuvant Chemotherapy (Fluorouracil, Doxorubicin, and Cyclophosphamide). A Randomized, Double-Blind, Cross-Over Trial," Acta Oncol, 1991, 30(3):339-42.

Fortner CL, Finley RS, and Grove WR, "Combination Antiemetic Therapy in Control of Chemotherapy-Induced Emesis," Drug Intell Clin Pharm, 1985, 19:21-4.

Khanderia U, "Recurrent Dystonic Reactions Induced by Thiethylperazine," Drug Intell Clin Pharm, 1985, 19(7-8):550-1.

Plezia PM, Alberts DS, Kessler JF, et al, "Randomized Crossover Comparison of High-Dose Intravenous Metoclopramide Versus a Five-Drug Antiemetic Regimen," J Pain Symptom Manage, 19909, 5(2):101-8.

Sulkava R, "Thiethylperazine and Tardive Dyskinesia," Acta Neurol Scand, 1984, 70(5):364-72.