Safety and Efficacy of Rectal Prochlorperazine for the Treatment of Migraine in the Emergency Department

Migraine is a common reason for visits to the emergency room. Attacks that lead patients to come to the emergency room are often more severe, refractory to home rescue medication, and have been going on for longer. All of these features make these attacks more challenging to treat. The purpose of this article is to review available evidence pertinent to the treatment of acute migraine in adults in the emergency department setting in order to provide neurologists with a rational approach to management. Drug classes and agents reviewed include opioids, dopamine receptor antagonists, triptans, nonsteroidal anti-inflammatory drugs, corticosteroids, and sodium valproate.

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“…37,40,41 It has also been used in children with migraine. 42 Typical adult dosing is 10 mg given IV or IM.…”

Section: Phenothiazines (Chlorpromazine Prochlorperazine and Prometmentioning

confidence: 99%

A Neurologist’s Guide to Acute Migraine Therapy in the Emergency Room

Gelfand

Goadsby

2012

The Neurohospitalist

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“…Published consensus statements about acute headache treatment support the use of these agents as first‐line treatment in an ED setting 4 . Antiemetics have demonstrated efficacy in placebo‐controlled clinical trials of ED headache management 5‐9 . Prochlorperazine fared better than metoclopramide in direct comparisons 10,11 .…”

Section: Commentsmentioning

confidence: 99%

Headache in the Emergency Department

et al. 2001

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“…Prochlorperazine has been given rectally in randomized trials associated with the treatment of migraine [78,165]. Although not as effective in relieving migraines as prochlorperazine given i.v., rectal prochlorperazine significantly reduces headache within 2 h. Prochlorperazine is superior to promethazine for the uncomplicated nausea and vomiting found in emergency department patients [47].…”

Section: Prochlorperazinementioning

confidence: 99%

Symptom control in cancer patients: the clinical pharmacology and therapeutic role of suppositories and rectal suspensions

Davis¹,

Walsh²,

LeGrand

et al. 2002

Support Care Cancer

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Rectally administered medications are essential in palliative medicine, particularly in the last days of life. They are underutilized. The pharmacology of rectally administered medications relates not only to the medication but also to the suppository base, additives, drug ionization, p K(a), absorptive surface of the rectum, and rectal health. The pharmacokinetics may differ from those of orally administered medications owing to reduced hepatic first-pass clearance. In this review the pharmacology of rectally administered palliative medications is reviewed and the use of individual drugs is outlined.

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Safety and Efficacy of Rectal Prochlorperazine for the Treatment of Migraine in the Emergency Department

Cited by 53 publications

References 18 publications

A Neurologist’s Guide to Acute Migraine Therapy in the Emergency Room

A Neurologist’s Guide to Acute Migraine Therapy in the Emergency Room

Headache in the Emergency Department

Symptom control in cancer patients: the clinical pharmacology and therapeutic role of suppositories and rectal suspensions

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