lCONTRA-INDICATIONSAvoid oral route in child under 10 kg
.children (in psychotic disorders).CNS depression.
comatose states.phaeochromocytoma
lCAUTIONSHypotension (more likely after intramuscular
injection)
lINTERACTIONS→Appendix 1 : phenothiazines
lSIDE-EFFECTS
GENERAL SIDE-EFFECTS
▶Rare or very rareGlucose tolerance impaired.
hyponatraemia.SIADH
▶Frequency not knownPhotosensitivity reaction
SPECIFIC SIDE-EFFECTS
▶Rare or very rare
▶With buccal useBlood disorder.hepatic disorders
▶Frequency not known
▶With buccal useEjaculation disorder.extrapyramidal
symptoms.oral disorders.postural hypotension.skin
eruption.thromboembolism
▶With intramuscular useAkinesia.arrhythmias.
atrioventricular block.cardiac arrest.eye disorders.
jaundice.muscle rigidity.nasal congestion.postural
hypotension.respiratory depression.skin reactions
▶With oral useArrhythmias.atrioventricular block.
autonomic dysfunction.cardiac arrest.consciousness
impaired.hyperthermia.jaundice.muscle rigidity.nasal
congestion.oculogyric crisis.respiratory depression.skin
reactions
SIDE-EFFECTS, FURTHER INFORMATIONAcute dystonias are
more common with potentfirst-generation antipsychotics.
The risk is increased in men, young adults, children,
antipsychotic-naïve patients, rapid dose escalation, and
abrupt treatment discontinuation.
lHEPATIC IMPAIRMENTCan precipitate coma;
phenothiazines are hepatotoxic.
lRENAL IMPAIRMENT
Dose adjustmentsStart with small doses in severe renal
impairment because of increased cerebral sensitivity.
lDIRECTIONS FOR ADMINISTRATIONBuccal tablets are
placed high between upper lip and gum and left to
dissolve.
lPATIENT AND CARER ADVICEPatients or carers should be
given advice on how to administer prochlorperazine buccal
tablets.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Tablet
CAUTIONARY AND ADVISORY LABELS 2
▶Prochlorperazine (Non-proprietary)
Prochlorperazine maleate 5 mgProchlorperazine 5 mg tablets|
28 tabletP£ 0. 72 DT = £ 0. 50 | 84 tabletP£ 1. 50 – £ 2. 16
▶Stemetil(Sanofi)
Prochlorperazine maleate 5 mgStemetil 5 mg tablets|
28 tabletP£ 1. 98 DT = £ 0. 50 | 84 tabletP£ 5. 94
Solution for injection
▶Stemetil(Sanofi)
Prochlorperazine mesilate 12.5 mg per 1 mlStemetil 12. 5 mg/ 1 ml
solution for injection ampoules| 10 ampouleP£ 5. 23 DT = £ 5. 23
Buccal tablet
CAUTIONARY AND ADVISORY LABELS 2
▶Prochlorperazine (Non-proprietary)
Prochlorperazine maleate 3 mgProchlorperazine 3 mg buccal
tablets| 50 tabletP£ 35. 94 – £ 51. 75 DT = £ 51. 75
▶Buccastem(Alliance Pharmaceuticals Ltd)
Prochlorperazine maleate 3 mgBuccastem M 3 mg tablets|
8 tabletp£ 4. 01
Oral solution
CAUTIONARY AND ADVISORY LABELS 2
▶Stemetil(Sanofi)
Prochlorperazine mesilate 1 mg per 1 mlStemetil 5 mg/ 5 ml syrup
| 100 mlP£ 3. 34 DT = £ 3. 34
5 Pain
Analgesics
Pain relief
The non-opioid drugs, paracetamol p. 271 and ibuprofen
p. 655 (and other NSAIDs), are particularly suitable for pain
in musculoskeletal conditions, whereas the opioid analgesics
are more suitable for moderate to severe pain, particularly of
visceral origin.Pain in sickle-cell disease
The pain of mild sickle-cell crises is managed with
paracetamol, an NSAID, codeine phosphate p. 276 ,or
dihydrocodeine tartrate p. 278. Severe crises may require the
use of morphine p. 282 or diamorphine hydrochloride p. 277 ;
concomitant use of an NSAID may potentiate analgesia and
allow lower doses of the opioid to be used. A mixture of
nitrous oxide and oxygen (Entonox®,Equanox®) may also be
used.
Dental and orofacial pain
Analgesics should be used judiciously in dental care as a
temporarymeasure until the cause of the pain has been
dealt with.
Dental pain of inflammatory origin, such as that associated
with pulpitis, apical infection, localised osteitis or
pericoronitis is usually best managed by treating the
infection, providing drainage, restorative procedures, and
other local measures. Analgesics provide temporary relief of
pain (usually for about 1 to 7 days) until the causative factors
have been brought under control. In the case of pulpitis,
intra-osseous infection or abscess, reliance on analgesics
alone is usually inappropriate.
Similarly the pain and discomfort associated with acute
problems of the oral mucosa (e.g. acute herpetic
gingivostomatitis, erythema multiforme) may be relieved by
benzydamine hydrochloride p. 707 or topical anaesthetics
until the cause of the mucosal disorder has been dealt with.
However, where a child is febrile, the antipyretic action of
paracetamol or ibuprofen is often helpful.
Thechoiceof an analgesic for dental purposes should be
based on its suitability for the child. Most dental pain is
relieved effectively by non-steroidal anti-inflammatory
drugs (NSAIDs) e.g. ibuprofen. Paracetamol has analgesic
and antipyretic effects but no anti-inflammatory effect.
Opioid analgesics such as dihydrocodeine tartrate act on
the central nervous system and are traditionally used for
moderate to severe pain. However, opioid analgesics are
relatively ineffective in dental pain and their side-effects can
be unpleasant.
Combining a non-opioid with an opioid analgesic can
provide greater relief of pain than either analgesic given
alone. However, this applies only when an adequate dose of
each analgesic is used. Most combination analgesic
preparations have not been shown to provide greater relief
of pain than an adequate dose of the non-opioid component
given alone. Moreover, combination preparations have the
disadvantage of an increased number of side-effects.
Any analgesic given before a dental procedure should have
a low risk of increasing postoperative bleeding. In the case of
pain after the dental procedure, taking an analgesic before
the effect of the local anaesthetic has worn off can improve
control. Postoperative analgesia with ibuprofen is usually
continued for about 24 to 72 hours.Dysmenorrhoea
Paracetamol or a NSAID will generally provide adequate
relief of pain from dysmenorrhoea. Alternatively use of a
combined hormonal contraceptive in adolescent girls may
prevent the pain.BNFC 2018 – 2019 Pain 269
Nervous system4