Compazine vs. Reglan for Nausea: Important Differences and Potential Risks.

Key takeaways

Prochlorperazine and metoclopramide (Reglan) are both used to treat nausea and vomiting, but they have some key differences. Prochlorperazine is also used to treat schizophrenia and generalized anxiety disorder (GAD), while metoclopramide is also used for gastroesophageal reflux disease (GERD) and diabetic gastroparesis. Even though metoclopramide is used for nausea and vomiting caused by pregnancy or chemotherapy, it’s used off-label for this indication. Prochlorperazine is taken 3 to 4 times daily and comes as an oral tablet or suppository, whereas metoclopramide is taken 4 times daily and comes in various forms, including tablets, liquid, and nasal spray. Both medications can cause serious side effects like tardive dyskinesia, but metoclopramide also has a black box warning for this condition. Additionally, metoclopramide interacts with many medications and is not recommended for people with Parkinson's disease, seizures, or stomach blockages. It also can’t be used in children for more than 12 weeks because of a higher risk of serious side effects. Prochlorperazine, on the other hand, is not recommended for use in children under 2 years old or during pregnancy. Both medications can cause drowsiness and should be used with caution.

Prochlorperazine

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Metoclopramide

(Reglan)

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Summary for Compazine

Prescription only

Prochlorperazine is used to treat severe nausea and vomiting. It's also used to improve mood, thoughts, and behaviors for people with schizophrenia and anxiety. It's not a first-choice medication because it can cause serious side effects, such as extreme sleepiness, falls, and uncontrolled muscle movements. Prochlorperazine comes as a tablet that's taken by mouth, typically 3 to 4 times daily. The brand name version of prochlorperazine (Compazine) is no longer available.

Indications for Compazine

Severe nausea and vomiting
Schizophrenia
Generalized anxiety disorder (GAD)

Pros and Cons for Compazine

Pros

Available as a generic medication
Available as an oral tablet or suppository for treating nausea and vomiting
Typically starts working in 30 minutes and effects last up to 4 hours

Cons

Many serious and sometimes possibly permanent side effects, such as uncontrolled muscle movements
Can't be used in children under 2 years old or under 20 pounds due to higher risk of serious side effects
Not recommended for use in pregnancy or during breastfeeding

Common Side Effects for Compazine

Drowsiness
Dizziness
Absent menstrual periods
Blurry vision
Low blood pressure

Warnings for Compazine

Higher risk of death in older adults with dementia-related psychosis
Difficulty controlling muscle movements (tardive dyskinesia)
Other conditions with uncontrolled muscle movements (dystonia, Parkinsonian symptoms, and restlessness)
Neuroleptic malignant syndrome (NMS)
Cover up more serious health problems
Higher risk of infections
Higher risk of falls
Liver problems
Seizures
High prolactin levels
Difficulty maintaining normal body temperature

Summary for Reglan

Prescription only

Metoclopramide (Reglan) is FDA-approved to treat gastroesophageal reflux disease (GERD), as well as gastroparesis in people with diabetes. Providers might also prescribe it off-label for morning sickness during pregnancy and nausea and vomiting caused by chemotherapy. But metoclopramide (Reglan) isn’t a first-choice medication for these conditions because it has a black box warning for a serious side effect called tardive dyskinesia. Metoclopramide (Reglan) can interact with some commonly prescribed medications, such as risperidone (Risperdal) and quetiapine (Seroquel).

Indications for Reglan

Delayed stomach-emptying caused by diabetes (diabetic gastroparesis)
Severe acid reflux (gastroesophageal reflux disease or GERD) when other medications haven’t worked

Pros and Cons for Reglan

Pros

Available as a lower-cost generic medication
Available in many forms including tablet, fast-melting tablet, liquid, nasal spray, and injection
Typically starts to work in 30 minutes to 1 hour
A possible option during pregnancy

Cons

Shouldn’t be used in children or for more than 12 weeks because of a higher risk of serious side effects
Needs to be taken multiple times a day
Interacts with a lot of medications such as antipsychotics, antidepressants, and opioids
Can't be used if you have Parkinson's disease, seizures, or stomach blockages or bleeds

Common Side Effects for Reglan

Restlessness (10%)
Drowsiness (10%)
Lack of energy (10%)
Tiredness (10%)

Warnings for Reglan

Difficulty controlling muscle movements (tardive dyskinesia)
Other conditions with uncontrolled muscle movements (dystonia, Parkinsonian symptoms, and restlessness)
Neuroleptic malignant syndrome (NMS)
Depression and suicidal thoughts and behavior
High blood pressure
Swelling in arms, legs, or around the belly
High prolactin levels