ALARMING NEUROMUSCULAR REACTIONS DUE TO PROCHLORPERAZINE

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Abstract
Dyskinetic neuromuscular reactions are infrequent side effects of prochlorperazine therapy. Four cases manifesting extrapyramidal symptoms after the administration of prochlorperazine are described. Each of the patients exhibited an alarming sequence of motor abnormalities with uncontrollable eye movements suggestive of oculogyric crises, grotesque facial distortion, protrusion of the tongue, trismus and extensor rigidity. Although the patients were all fully oriented, they were frightened and had great difficulty in swallowing and speaking. In one patient these symptoms were preceded by tightness of the neck muscles and thickening of speech. The differential diagnostic possibilities suggested by the clinical picture included hysteria, catatonic schizophrenia, tetanus, strychnine poisoning and a cerebral vascular accident. The reactions occurred within 1 to 3 days after the institution of prochlorperazine therapy and after a total dose varying from 40 to 90 mg. In 2 cases the reaction did not become manifest until more than 24 hr. after the last dose was given. The pathogenesis of these reactions is unknown. Withdrawal of the drug and simple sedation resulted in prompt disappearance of the symptoms without sequelae.

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