Understanding Compazine (Prochlorperazine)
Compazine, the brand name for the drug prochlorperazine, is a medication primarily used to control severe nausea and vomiting [1.8.5]. It belongs to a class of drugs known as phenothiazines, which work by blocking dopamine receptors in the brain [1.8.2]. This action helps to control the brain's vomiting center [1.2.6]. In addition to its antiemetic (anti-nausea) effects, prochlorperazine is also used to treat schizophrenia and, on a short-term basis, anxiety that hasn't responded to other treatments [1.8.5].
Transfer to Breast Milk and Infant Risk
A primary concern for any nursing mother is whether a medication will pass into her breast milk and affect her baby. For prochlorperazine, there are no definitive studies measuring the exact amount that transfers into human milk [1.2.2]. However, based on data from similar medications in the same class (other phenothiazines), experts believe it is likely that only small amounts of Compazine get into breast milk [1.4.7, 1.3.2].
The U.S. National Institute of Health's Drugs and Lactation Database (LactMed®) states that based on the minimal excretion of other phenothiazines, occasional, short-term use of prochlorperazine for nausea and vomiting likely poses little risk to the breastfed infant [1.2.1]. The UK's National Health Service (NHS) concurs, suggesting that if a baby is healthy, a mother can usually take prochlorperazine for short periods. They note that the baby is unlikely to absorb much of the drug from the milk or experience side effects [1.4.7].
Potential Side Effects and Monitoring
Although the risk is considered low, it is not zero. Due to the lack of direct studies, caution is advised, especially with repeated or long-term use [1.4.5]. If a breastfeeding mother takes Compazine, she should monitor her infant for potential side effects. These can include [1.4.7, 1.5.1]:
- Unusual sleepiness or sedation
- Irritability or other behavioral changes
- Poor feeding or not waking to feed
- Dry mouth
- Tremors or sudden, jerky movements (extrapyramidal symptoms)
If any of these symptoms are observed, it is important to contact a healthcare provider immediately [1.4.7]. Repeated use may increase the risk of infant sedation [1.4.5].
Effects on Lactation
Another consideration is the medication's effect on milk supply. Prochlorperazine works by blocking dopamine, which can lead to an increase in the hormone prolactin (hyperprolactinemia) [1.2.1, 1.4.1]. Prolactin is essential for milk production. While this has led to reports of galactorrhea (breast milk production) in non-breastfeeding individuals, its effect on an already established milk supply in a lactating mother is not thought to be significant [1.4.4, 1.2.1]. However, some sources suggest repeated use may affect lactation, though evidence is limited [1.4.5]. Conversely, some related medications like promethazine have been shown to potentially lower prolactin secretion, which could interfere with the establishment of lactation [1.3.1].
Comparison of Anti-Nausea Medications for Breastfeeding
When considering treatment for nausea, it's helpful to compare Compazine with other available options. Always consult with a healthcare provider to determine the best choice for your specific situation.
| Medication | Breast Milk Transfer & Risk | Key Considerations | Infant Monitoring |
|---|---|---|---|
| Prochlorperazine (Compazine) | Believed to be low/minimal for short-term use [1.4.7]. | Best for occasional, short-term use. Repeated use may increase risk of infant sedation [1.4.5]. | Drowsiness, irritability, poor feeding, tremors [1.5.1]. |
| Ondansetron (Zofran) | Unlikely to pass into milk in high amounts; considered a safe choice [1.2.7, 1.6.2]. | Frequently used postpartum; no adverse infant effects reported in this setting [1.6.2]. Can cause constipation in the mother [1.2.6]. | Drowsiness, irritability, constipation, or diarrhea [1.2.6]. |
| Metoclopramide (Reglan) | Passes into milk in small to moderate amounts; no serious side effects reported in infants [1.4.5, 1.2.6]. | Use is restricted to 5 days. May increase milk supply. Avoid in mothers with a history of depression [1.2.6]. | Drowsiness, upset tummy, tremors [1.2.6]. |
| Promethazine (Phenergan) | Unlikely to pass into milk in significant amounts [1.4.5]. | Can cause drowsiness in both mother and infant [1.2.7]. May interfere with establishing lactation if used in the early postpartum period [1.3.1]. | Drowsiness, irritability, poor feeding [1.4.5]. |
| Doxylamine/Pyridoxine (Diclegis) | Considered safe for use during lactation [1.2.7]. | This combination is a first-line treatment for nausea and vomiting in pregnancy and is also considered safe for breastfeeding [1.2.7, 1.6.6]. | Monitor for drowsiness [1.6.6]. |
Conclusion
So, is Compazine safe while breastfeeding? The consensus among experts is that for occasional, short-term use, Compazine (prochlorperazine) is considered a low-risk option for managing severe nausea and vomiting in breastfeeding mothers [1.2.1, 1.3.2]. The amount transferred into breast milk is thought to be minimal. However, due to a lack of comprehensive studies, long-term or repeated use is discouraged [1.4.5].
It is essential for the mother to be vigilant and monitor her infant for any signs of drowsiness, irritability, or poor feeding. Before starting Compazine or any new medication, a thorough discussion with a healthcare provider is non-negotiable. They can weigh the potential benefits against the potential risks and may recommend safer, better-studied alternatives like ondansetron or the combination of doxylamine and pyridoxine [1.2.7].
Authoritative Link: For detailed information on medications and their safety during lactation, consult the Drugs and Lactation Database (LactMed®).
