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Compazine vs Reglan
Introduction
For patients dealing with nausea and vomiting, whether due to surgery, chemotherapy, or conditions such as migraines or vertigo, certain drugs that block neurotransmitter receptors associated with emesis can be of great help. Compazine and Reglan are two such drugs prescribed for these symptoms. Both impact different receptors in the brain but have similar effects on managing nausea and vomiting in patients. Compazine is classified as a phenothiazine antiemetic and antipsychotic that works by blocking postsynaptic mesolimbic dopaminergic D1 and D2 receptors in the brain to reduce stimuli leading to nausea or vomiting. Reglan, on the other hand, is a dopamine antagonist which also stimulates gastric motility and accelerates intestinal transit thereby helping manage gastrointestinal disorders.
Compazine vs Reglan Side By Side
| Attribute | Compazine | Reglan |
|---|---|---|
| Brand Name | Compazine | Reglan |
| Contraindications | Should not be taken with dopamine antagonists within a certain timeframe. Black box warnings for tardive dyskinesia and neuroleptic malignant syndrome (NMS). | Should not be taken with dopamine antagonists within a certain timeframe. Black box warnings for tardive dyskinesia and neuroleptic malignant syndrome (NMS). |
| Cost | Brand-name: Around $220 for 60 tablets (5 mg). Generic: As low as around $0.15 per day. | Brand-name: About $245 for 30 tablets (10 mg). Generic: Daily treatment cost falls between about $0.30 and just under a dollar per day. |
| Generic Name | Prochlorperazine | Metoclopramide |
| Most Serious Side Effect | Tardive dyskinesia (TD), severe allergic reactions, vision changes, heart-related issues, low sodium levels. | Neuroleptic malignant syndrome (NMS), uncontrolled muscle movements, depression or thoughts about suicide. |
| Severe Drug Interactions | Dopamine antagonists, may require time to clear from the system to prevent harmful interactions. | Dopamine antagonists, may require time to clear from the system to prevent harmful interactions. |
| Typical Dose | Oral dosages range from 5-10 mg, three to four times daily. Maximum of 40mg/day. | 10–15 mg, taken orally four times daily, half an hour before meals and at bedtime. Not to exceed more than 40-60 mg per day. |
What is Compazine?
Prochlorperazine (the generic name for Compazine) was one of the first drugs in a class known as phenothiazines, a significant advancement from earlier classes of antiemetic medications. Prochlorperazine got its approval from the FDA in 1956. It works by blocking dopamine receptors in certain parts of the brain, resulting in an anti-emetic effect. This drug is often recommended for treating severe nausea and vomiting caused by surgery, cancer treatment or other conditions.
On the other hand, Metoclopramide (the generic name for Reglan), which belongs to a different class called prokinetics, also has an antiemetic effect but operates differently - it works primarily on enhancing stomach contractions to speed up gastric emptying and indirectly prevents stimulation of chemoreceptor trigger zone that induces vomiting. While both drugs are efficient at managing nausea and vomiting, their side effects differ significantly due to their different mechanisms – with Compazine potentially causing more extrapyramidal symptoms like tardive dyskinesia compared to Reglan which can cause restlessness and insomnia due to its indirect dopaminergic action.
What conditions is Compazine approved to treat?
Compazine is approved for the treatment of different conditions:
- Severe nausea and vomiting
- Schizophrenia (for non-psychotic patients or those in whom sedation has not been found to be adequate)
- Anxiety before surgery
Whereas Reglan is used primarily for:
- Short-term treatment of gastroesophageal reflux disease (GERD) in certain patients who do not respond to other therapy.
- Diabetic gastroparesis, a condition that slows the movement of food through the stomach.
How does Compazine help with these illnesses?
Compazine helps to manage nausea and vomiting by blocking dopamine receptors in the brain. It accomplishes this by inhibiting the binding of dopamine, a neurotransmitter that acts as a messenger in both the brain and body, playing crucial roles in behavior, cognition, movement, motivation, sleep patterns and mood among other things. High levels of dopamine are often associated with feelings of pleasure but can also lead to an increase in nausea and vomiting for some individuals. Therefore, by limiting dopamine action via its receptor antagonism effect, Compazine can help patients control their symptoms effectively.
In comparison with Reglan which has similar antiemetic effects through blockade of dopamine receptors but additionally enhances gastric emptying by increasing lower esophageal sphincter pressure and improving coordination between stomach muscles; Compazine focuses more on controlling central nervous system induced nausea-emesis pathway reducing side effects related to enhanced gastrointestinal motility like diarrhea common with use of drugs like Reglan.
What is Reglan?
Reglan, a brand name for metoclopramide, is primarily used as an antiemetic to treat nausea and vomiting. Much like Compazine, it works by blocking dopamine receptors in the brain. However, Reglan also increases muscle contractions in the upper digestive tract which speeds up the passage of food through the stomach. This dual action makes Reglan especially effective when treating gastrointestinal conditions such as acid reflux disease or gastroparesis (delayed gastric emptying) that can cause chronic nausea and vomiting. Approved by FDA in 1980s, Reglan does not inhibit serotonin reuptake because it's not an SSRI class drug.
The side effect profile of Reglan is somewhat different from drugs like Compazine due to its effects on gastrointestinal motility - it may sometimes cause diarrhea instead of constipation common with other antiemetics. Also noteworthy are potential neurological side effects including restlessness or tardive dyskinesia (involuntary movements), particularly with prolonged use. As always though benefits versus risks should be considered carefully under guidance from healthcare professionals.
What conditions is Reglan approved to treat?
Reglan is authorized for the treatment of specific medical conditions, including:
- Gastroparesis (slowed emptying of the stomach) in people with diabetes
- Prevention of nausea and vomiting associated with certain chemotherapy drugs
- Postoperative nausea and vomiting when nasogastric suctioning is undesirable.
How does Reglan help with these illnesses?
Dopamine is a neurotransmitter that has many roles in the body, including regulating mood and muscle movement. Its excess in certain parts of the brain can lead to symptoms such as nausea and vomiting. Reglan works by blocking dopamine receptors in the brain, specifically in an area called the chemoreceptor trigger zone (CTZ), thereby reducing feelings of nausea and promoting gastric emptying. This action makes it particularly useful for treating conditions like gastroesophageal reflux disease (GERD) and delayed gastric emptying. Unlike Compazine, which also blocks dopamine but has more pronounced effects on mood regulation areas of the brain leading to potential side effects like restlessness or dystonia, Reglan's effect is more targeted towards gastrointestinal motility without heavily impacting other regions where dopamine plays critical roles. Therefore, it might be preferred when a patient does not respond well to or cannot tolerate antiemetic drugs such as Compazine.
How effective are both Compazine and Reglan?
Both prochlorperazine (Compazine) and metoclopramide (Reglan) are effective medications with a long history of use for the treatment of nausea and vomiting. They were approved by the FDA in 1956 and 1980 respectively, indicating their established safety profiles. These drugs work on different receptors, hence may be used under varying clinical conditions.
In comparative studies conducted over the years, both Compazine and Reglan have shown similar efficacy in managing symptoms of nausea and vomiting due to various causes such as migraines or chemotherapy. In these studies, there was no significant difference between patients receiving Compazine or Reglan in terms of alleviating these symptoms.
A review published in 2010 indicated that prochlorperazine is particularly effective in treating vertigo-related nausea starting from an early stage of administration. Its side effect profile also appears favorable compared to many other antiemetic drugs but can include drowsiness or mild extrapyramidal symptoms like tremors at higher doses.
On the other hand, metoclopramide has been proven more effective than placebo for postoperative and chemotherapy-induced nausea and vomiting according to several meta-analyses conducted over time. However, it is often considered as a second-line option after serotonin antagonists due to its potential neurological side effects including tardive dyskinesia - involuntary movements mainly around the mouth area which might be irreversible even after discontinuing the drug.
Despite these differences, based on individual patient characteristics such as underlying condition causing nausea/vomiting or presence of contraindications/side-effect tolerance to either drug classes will determine if Compazine or Reglan is preferable.
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At what dose is Compazine typically prescribed?
Oral dosages of Compazine range from 5-10 mg, three to four times daily. However, studies have indicated that a dosage of 5 mg taken three times daily is usually enough for managing nausea and vomiting in most people. Children over two years old may be started on 2.5 mg, two to three times per day or as decided by the doctor based on weight and condition. In either population, dosage can be adjusted after a few days if there's no response but should not exceed a maximum of 40mg/day under any circumstance.
On the other hand, oral dosages for Reglan are typically around 10–15 mg up to four times daily before meals and at bedtime depending upon the medical condition being treated. The initial dose for adolescents aged 14-18 years is usually half the adult dose.
Always remember it's crucial to follow your healthcare provider’s instructions when taking medication.
At what dose is Reglan typically prescribed?
Reglan treatment typically begins at a dosage of 10–15 mg, taken orally four times daily, half an hour before meals and at bedtime. The dose may be adjusted based on individual patient response but should not exceed more than 40-60 mg per day. Treatment duration is usually limited to no more than 12 weeks due to the risk of developing tardive dyskinesia with longer-term use. After initiating Reglan, if there's no noticeable improvement in symptoms after a couple of weeks or so, it would be advisable to consult with your healthcare provider for possible adjustments in dosage or consideration of alternative treatments.
What are the most common side effects for Compazine?
Common side effects of Compazine and Reglan can include:
- Drowsiness or sleepiness
- Restlessness or agitation
- Dizziness, feeling faint
- Dry mouth
- Nausea, vomiting, and diarrhea
- Changes in appetite leading to weight gain or loss
- Tremors (shakes)
- Parkisonian-like symptoms such as slow movements, rigidity and tremors.
In rare cases:
Compazine may cause tardive dyskinesia (TD), a disorder characterized by involuntary movements most often affecting the mouth.
Reglan has been linked with Neuroleptic Malignant Syndrome (NMS) which includes symptoms like fever, muscle stiffness/rigidity and altered mental state.
It is important to monitor for these side effects while taking either medication. Always consult your physician if you experience any adverse reactions.
Are there any potential serious side effects for Compazine?
In rare cases, Compazine can cause serious side effects such as:
- Unusual thoughts or behavior
- Severe allergic reactions including difficulty breathing, swelling in your face or throat, hives, skin pain accompanied by a red or purple rash that spreads and causes blistering and peeling
- Vision changes: blurred vision, tunnel vision, eye pain or swelling
- Heart-related issues: rapid heartbeats, shortness of breath especially when you exert yourself; sudden dizziness
- Low sodium levels - symptoms include headache, confusion, slurred speech, severe weakness,vomiting,and unsteadiness.
On the other hand Reglan also has its potential for severe side effects which includes:
- Symptoms of neuroleptic malignant syndrome (NMS) like high fever,stiff muscles,sweating ,confusion ,fast uneven heartbeats ,and feeling light-headed.
Both medications must be discontinued immediately if any of these symptoms occur. Always consult with your healthcare provider before starting any new medication regimen.
What are the most common side effects for Reglan?
When taking Reglan, you might experience:
- Fatigue or weakness
- Feeling restless, anxious or nervous
- Trouble sleeping (insomnia)
- Headache, dizziness
- Nausea or upset stomach
- Increased urination
- Rash or hives
- Rapid heartbeat -Possible change in weight.
Reglan can also lead to more serious side effects such as tremors and muscle spasms. It's important to consult your healthcare provider if you notice any unusual symptoms while on this medication.
Are there any potential serious side effects for Reglan?
When taking Reglan, it is essential to remain aware of potential serious side effects. These can include:
- Allergic reactions such as hives; difficulty breathing; swelling of your face, lips, tongue or throat
- Uncontrolled muscle movements in your face (chewing, lip smacking, frowning), tongue movement, blinking and moving your eyes;
- Depression or thoughts about suicide or hurting yourself
- Fast or irregular heartbeats
- Neuroleptic malignant syndrome - a very high fever (higher than 102 degrees F), sweating profusely, confusion that comes on quickly and severely, rigid muscles you cannot control.
If any of the above symptoms occur while taking Reglan stop using the medication immediately and seek medical attention. As always with medications like these consult with a healthcare professional for proper guidance.
Contraindications for Compazine and Reglan?
Similar to the antipsychotic medication Compazine and the gastroprokinetic agent Reglan, side effects can occur. If you notice any severe adverse reactions such as muscle stiffness, tremors, or changes in mental state like confusion or agitation, seek immediate medical attention.
Neither Compazine nor Reglan should be taken if you are taking or have been taking dopamine antagonists within a certain timeframe. Always inform your healthcare provider about all the medications you're currently using; this is crucial because dopamine antagonists will require some time to clear from your system in order to prevent harmful interactions with Compazine and Reglan.
Both drugs carry black box warnings due to their links with serious movement disorders known as tardive dyskinesia and neuroleptic malignant syndrome (NMS). These conditions may cause symptoms such as uncontrolled muscle movements or high fever, stiff muscles, confusion which could be irreversible. Hence it's critical that they're used under direct supervision of a healthcare professional.
How much do Compazine and Reglan cost?
For the brand-name versions of these drugs:
- The price of 60 tablets of Compazine (prochlorperazine - 5 mg) averages around $220, which works out to approximately $3.6-$7/day depending on your dose.
- The cost of a similar quantity and strength (30 tablets at 10 mg each) for Reglan (metoclopramide) is about $245, working out to roughly $8/day.
Thus, if you are in the higher dosage range for Compazine (i.e., 20 mg/day or more), then brand-name Reglan may be less expensive on a per-day treatment basis. Please remember that cost should not be the primary factor when determining which medication is right for you.
In terms of generic medications:
- Prochlorperazine can be purchased in quantities ranging from 25 up to hundreds of tablets at once. A pack with an average size will have costs starting as low as around $0.15 per day.
- Metoclopramide also comes in packs varying widely in number, and its daily treatment cost typically falls between about $0.30 and just under a dollar per day.
This makes both generics much less costly than their branded counterparts while offering equivalent efficacy.
Popularity of Compazine and Reglan
Prochlorperazine, in generic form as well as brand names such as Compazine, was estimated to have been prescribed to about 900,000 people in the US in 2020. Prochlorperazine accounted for just over 1% of antiemetic prescriptions in the US. However, it appears to be a commonly used "typical" antipsychotic (classified among first-generation antipsychotics). The prevalence of prochlorperazine has been generally decreasing since the introduction of newer drugs.
Metoclopramide, including brand versions such as Reglan, was prescribed to around 3 million people in the USA in 2020. In the US, metoclopramide accounts for just under 5% of gastroprokinetic agent prescriptions and is a significant player amongst overall antiemetics and motility modifiers. The prevalence of metoclopramide has remained relatively steady over recent years with slight fluctuations due to varying prescribing practices across different medical specialties and patient requirements.
Conclusion
Both Compazine (prochlorperazine) and Reglan (metoclopramide) have long-standing records of usage in patients with gastrointestinal disorders, particularly nausea and vomiting, and are backed by numerous clinical studies indicating that they are more effective than placebo treatments. In some cases, the drugs may be combined, but this is subject to careful consideration by a physician as they can interact negatively with each other. Due to their different mechanisms of action -- with Compazine acting primarily on dopamine receptors in the brain to reduce feelings of sickness, and Reglan primarily speeding up gastric emptying -- they tend to be prescribed under different circumstances.
Compazine is often used for severe nausea and vomiting associated with surgery or cancer treatment like chemotherapy while Reglan is frequently indicated for gastroparesis or reflux disease.
Both drugs are available in generic form which represents significant cost savings especially for patients who must pay out of pocket. Both Compazine and Reglan may require an adjustment period meaning that effects may not be noticeable right away.
The side effect profile is similar between the two drugs: both can cause drowsiness, restlessness, dystonic reactions (sudden abnormal muscle spasms or involuntary movements), among others; however, tardive dyskinesia (a movement disorder characterized by repetitive movements) has been reported more commonly with metoclopramide use than prochlorperazine. For both drugs, patients should closely monitor their symptoms when starting treatment - if any adverse effects appear it's crucial to seek medical attention immediately.
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Refrences
- Rodgers, C. (1992, May). Extrapyramidal side effects of antiemetics presenting as psychiatric illness. General Hospital Psychiatry. Elsevier BV.http://doi.org/10.1016/0163-8343(92)90082-l
- Benrubi, G. I., Norvell, M., Nuss, R. C., & Robinson, H. (1985, July). The use of methylprednisolone and metoclopramide in control of emesis in patients receiving cis-platinum. Gynecologic Oncology. Elsevier BV.http://doi.org/10.1016/0090-8258(85)90268-9
- Olver, I. N., Wolf, M., Laidlaw, C., Bishop, J. F., Cooper, I. A., Matthews, J., … Buchanan, L. (1992, January). A randomised double-blind study of high-dose intravenous prochlorperazine versus high-dose metoclopramide as antiemetics for cancer chemotherapy. European Journal of Cancer. Elsevier BV.http://doi.org/10.1016/0959-8049(92)90006-n
- Aapro, M., & Blower, P. (2005, June 17). 5‐hydroxytryptamine type‐3 receptor antagonists for chemotherapy‐induced and radiotherapy‐induced nausea and emesis. Cancer. Wiley.http://doi.org/10.1002/cncr.21141
- ALBERTS, V. A., CATALANO, G., & POOLE, M. A. (1996, October). Tardive Dyskinesia as a Result of Long-Term Prochlorperazine Use. Southern Medical Journal. Southern Medical Association.http://doi.org/10.1097/00007611-199610000-00010