Prochlorperazine Shortage: A Provider's Clinical Update for 2026

Prochlorperazine, a cornerstone antiemetic and antipsychotic in the phenothiazine class, continues to experience supply disruptions across multiple formulations in 2026. This article provides prescribers and healthcare providers with actionable clinical guidance for managing patients during the ongoing shortage.

Current Shortage Status

As of early 2026, the following Prochlorperazine formulations have been affected:

• Prochlorperazine edisylate injection (5 mg/mL): Listed on the ASHP Drug Shortage Database with recurring availability gaps dating back to 2015. Multiple manufacturers have experienced production disruptions.
• Prochlorperazine maleate tablets (5 mg, 10 mg): Added to the ASHP shortage list circa late 2022. Supply from manufacturers including Jubilant Cadista, Teva, and Amneal has been intermittent.
• Prochlorperazine maleate suppositories (25 mg): Limited manufacturers (primarily Perrigo) have led to periodic supply constraints.

Providers should consult the ASHP Drug Shortage Database and the FDA Drug Shortage page for real-time updates.

Root Cause Analysis

The Prochlorperazine shortage reflects broader systemic issues in the U.S. generic drug market:

• Manufacturer consolidation: With the brand product Compazine long discontinued, the U.S. relies on a small number of generic manufacturers. Single-source or dual-source products are disproportionately vulnerable to disruption.
• Sterile manufacturing constraints: The injectable formulation requires specialized sterile manufacturing capabilities. FDA compliance requirements and facility remediation efforts have constrained production capacity across the sterile injectables sector.
• Economic disincentives: Prochlorperazine's low acquisition cost (generic tablets typically $0.30–$1.00 per unit at wholesale) provides minimal margin incentive for manufacturers to invest in expanded production or new market entry.
• Supply chain fragility: API sourcing from international suppliers introduces vulnerability to regulatory actions, shipping disruptions, and geopolitical factors.

Clinical Impact Assessment

The shortage has particular impact across several clinical settings:

Emergency Medicine

Prochlorperazine is a first-line agent in many ED antiemetic protocols and is extensively used for acute migraine management (IV/IM administration). The injectable shortage has necessitated protocol revisions at many institutions.

Oncology

While newer antiemetics (5-HT3 antagonists, NK1 receptor antagonists) are primary agents for chemotherapy-induced nausea and vomiting (CINV), Prochlorperazine remains widely used as a breakthrough antiemetic and in cost-sensitive settings.

Primary Care and Gastroenterology

Oral Prochlorperazine is commonly prescribed for nausea and vomiting of various etiologies in the outpatient setting. The tablet shortage directly affects these patients, many of whom report difficulty filling prescriptions.

Therapeutic Alternatives

When Prochlorperazine is unavailable, the following substitutions should be considered based on indication and clinical context:

For Nausea and Vomiting

• Ondansetron (Zofran): 4–8 mg PO/IV/IM q6–8h. 5-HT3 antagonist. Generally well-tolerated; less sedating. Consider QTc prolongation at higher doses. May be less effective for migraine-associated nausea.
• Promethazine (Phenergan): 12.5–25 mg PO/PR/IM q4–6h. Same phenothiazine class. More sedating. Carries boxed warning regarding IV administration (severe tissue injury). Avoid in children under 2.
• Metoclopramide (Reglan): 10 mg PO/IV q6h. Dopamine antagonist with prokinetic properties. Boxed warning for tardive dyskinesia with prolonged use (>12 weeks). Useful when gastroparesis is a contributing factor.
• Haloperidol: 0.5–2 mg IV/IM. Butyrophenone with potent D2 antagonism. Emerging evidence supports use as an antiemetic in the ED setting. Monitor QTc.
• Olanzapine: 5–10 mg PO. Increasingly used for CINV prophylaxis and breakthrough nausea. Evidence supports efficacy comparable to or exceeding standard antiemetics in oncology settings.

For Acute Migraine (ED Setting)

• Metoclopramide 10–20 mg IV + diphenhydramine 25 mg IV (to prevent akathisia)
• Haloperidol 2.5–5 mg IV + diphenhydramine
• Chlorpromazine 12.5–25 mg IV (requires pre-hydration with 500 mL–1 L NS to mitigate hypotension)
• Ketorolac 15–30 mg IV — non-dopaminergic alternative

For Psychotic Disorders

Prochlorperazine's role in psychosis management has largely been supplanted by newer antipsychotics. Alternative agents should be selected based on the patient's clinical profile, prior medication response, and formulary availability.

Formulary and Protocol Recommendations

1. Review institutional antiemetic protocols to ensure alternative agents are included as contingencies.
2. Implement therapeutic interchange policies for Prochlorperazine to permit pharmacist-driven substitution with pre-approved alternatives.
3. Monitor local availability: MedFinder for Providers can help identify retail pharmacies with current Prochlorperazine stock for outpatient prescriptions.
4. Educate patients proactively about the shortage and provide them with alternative options at the time of prescribing, rather than after a failed fill attempt.
5. Consider formulation switching: If tablets are unavailable, suppositories (or vice versa) may be obtainable from different manufacturers.

Patient Communication Guidance

When informing patients about the shortage, consider the following approach:

• Acknowledge the difficulty and validate their frustration
• Explain that the shortage is a national supply issue, not specific to their pharmacy
• Provide a written alternative prescription (with your preferred substitute and dosing)
• Direct them to MedFinder.com to search for pharmacies with Prochlorperazine in stock
• Schedule appropriate follow-up to assess response to any alternative medication

For a patient-facing resource you can share, see: Prochlorperazine shortage update: What patients need to know.

Looking Ahead

Structural reform in the generic drug market — including incentivizing multi-source manufacturing, building strategic reserves, and improving supply chain transparency — is needed to prevent recurring shortages of essential medications like Prochlorperazine. In the interim, proactive formulary management and patient education remain the most effective clinical strategies.

For additional provider resources and real-time pharmacy stock data, visit MedFinder for Providers.