Slow infusion for the prevention of akathisia induced by prochlorperazine:A randomized controlled trial

The utility of intravenous prochlorperazine (PCZ) in the treatment of nause a, vomiting, and headache may be limited by the akathisia that occurs frequ ently with the recommended 2-min infusion rate. We tested the hypothesis th at decreasing the rate of PCZ infusion to 1.5 min reduces the incidence of akathisia at 1 hour, This double-blinded, randomized, controlled trial was conducted in the Emergency Department of an academic tertiary-care medical center with an annual census of 95,000 emergency patient visits. We enrolle d a convenience sample of adult patients who received 10 mg i.v. PCZ for th e treatment of nausea, vomiting, or headache. Subjects were randomized to r eceive either a 2-min infusion of PCZ (10 mg) followed by a 15-min infusion of saline, or a 2-min infusion of saline followed by a 15-min infusion of prochlorperazine. The incidence of akathisia at 1 hour was measured by usin g explicit diagnostic criteria. One hundred sixty patients were randomly en rolled into two groups, which were comparable with respect to age, gender, weight, and complaint. Akathisia developed in 31 of 84 patients (36.9%) who received the 2-min infusion of PCZ and in 18 of 76 patients (23.7%) who re ceived the 15-min infusion of PCZ (p = 0.07), a 36% (95% CI, -5% to 61%) re lative reduction. The delta from pre-infusion to postinfusion scores betwee n the two groups was not significant (p = 0.19), We conclude that slowing t he rate of PCZ infusion does not decrease akathisia, (C) 2001 Elsevier Scie nce Inc.