prochlorperazine and co-beneldopa

ContraindicatedDo not co-prescribe these two.

Mechanism

Pharmacodynamic antagonism: prochlorperazine is a phenothiazine that blocks central dopamine D2 receptors. Co-beneldopa contains levodopa, which is converted to dopamine and acts on these receptors. Prochlorperazine antagonises the effects of levodopa, counteracting its therapeutic action in Parkinson's disease.

What it means clinically

Concurrent use can lead to loss of Parkinson's disease control, with worsening of rigidity, tremor, bradykinesia, and postural instability. Prochlorperazine may also induce extrapyramidal symptoms that mimic or complicate the underlying disease. The combination is contraindicated in Parkinson's disease.

What to do

Avoid co-prescription. If an antiemetic is needed, choose a non-dopamine antagonist such as ondansetron or domperidone. For Parkinson's patients, consider specialist advice. Do not use prochlorperazine in patients receiving levodopa-containing products.

Evidence

Based on pharmacological principles and extensive clinical experience. Phenothiazines are known to exacerbate parkinsonism. Guidelines consistently avoid these agents in Parkinson's disease.

The two drugs

prochlorperazinePhenothiazine antipsychoticRead the monograph co-beneldopaDopaminergic antiparkinsonian agentRead the monograph

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Other interactions involving prochlorperazine or co-beneldopa

metoclopramide and co-beneldopacontraindicated

Educational reference for students and clinicians in training. It does not replace professional judgement, local protocols or current prescribing information.