Home Drug Guide Thiethylperazine Malate

Drug Guide

Generic Name

Thiethylperazine Malate

Brand Names Torecan

Classification

Therapeutic: Antiemetic, Antipsychotic (Typical phenothiazine)

Pharmacological: Dopamine antagonist, Phenothiazine derivative

FDA Approved Indications

  • Prevention and treatment of nausea and vomiting

Mechanism of Action

Thiethylperazine blocks dopamine receptors in the central nervous system, which helps prevent nausea and vomiting. It may also have sedative and anti-allergic effects.

Dosage and Administration

Adult: 25-50 mg 3-4 times daily, orally or intramuscularly, based on clinical response.

Pediatric: Use is less common; dosage must be cautious and pediatrician-guided.

Geriatric: Start at lower end of dosing range due to increased sensitivity; monitor closely.

Renal Impairment: Adjust dose cautiously; no specific guidelines—monitor patient's response.

Hepatic Impairment: Use with caution, as metabolism may be impaired; no specific dosage adjustment established.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Widely distributed, crosses the blood-brain barrier.

Metabolism: Hepatic, primarily via conjugation.

Excretion: Via urine and feces.

Half Life: Approximately 9-12 hours, variable depending on individual factors.

Contraindications

  • Hypersensitivity to phenothiazines
  • Comorbid Parkinson's disease
  • Bone marrow depression

Precautions

  • Use with caution in patients with cardiovascular disease, CNS depression, epilepsy, or liver impairment.
  • Pregnancy category C; use only if potential benefits justify risks.
  • Lactation: May pass into breast milk; risk vs. benefit should be considered.

Adverse Reactions - Common

  • Drowsiness or sedation (Common)
  • Dizziness (Common)
  • Dry mouth (Common)
  • Blurred vision (Common)

Adverse Reactions - Serious

  • Extrapyramidal symptoms (tremors, dystonia, akathisia) (Uncommon)
  • QT prolongation, arrhythmias (Rare)
  • Neuroleptic malignant syndrome (NMS) (Very rare)
  • Blood dyscrasias (e.g., leukopenia, thrombocytopenia) (Rare)

Drug-Drug Interactions

  • CNS depressants (enhanced sedation)
  • Other dopamine antagonists (risk of additive side effects)
  • CNS stimulants (opposite effects)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for effectiveness in controlling nausea and vomiting. Assess for extrapyramidal symptoms, sedation level, and cardiac status (EKG if indicated).

Diagnoses:

  • Risk for injury related to sedation or extrapyramidal symptoms.
  • Impaired comfort related to nausea.

Implementation: Administer with food to minimize gastric irritation. Use cautiously in elderly. Monitor cardiac status if on other QT-prolonging drugs.

Evaluation: Effectiveness of antiemetic action. Observation for adverse effects, especially extrapyramidal symptoms and cardiac arrhythmias.

Patient/Family Teaching

  • Take the medication exactly as prescribed.
  • Report any signs of unusual movement, muscle stiffness, or restlessness.
  • Be cautious when driving or operating machinery until effects are known.
  • Avoid alcohol and other CNS depressants during therapy.

Special Considerations

Black Box Warnings:

  • Increased risk of death in elderly patients with dementia-related psychosis.

Genetic Factors: Certain individuals may have genetic susceptibility to adverse reactions such as tardive dyskinesia.

Lab Test Interference: May cause false-positive tests for methemoglobinemia.

Overdose Management

Signs/Symptoms: Severe sedation, extrapyramidal symptoms, hypotension, seizures, respiratory depression.

Treatment: Supportive care; manage hypotension with vasopressors; treat seizures with anticonvulsants; gastric lavage or activated charcoal if ingestion recent.

Storage and Handling

Storage: Store at room temperature, 20-25°C (68-77°F), protect from light.

Stability: Stable for the period specified in the package insert unless otherwise disturbed.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.