Stemetil Tablet Uses, Dosage and Side Effects in Pakistan

What Is Stemetil?

Stemetil's generic name is prochlorperazine — a member of the phenothiazine drug class. In Pakistan it is available as a 5mg tablet and is prescribed for nausea/vomiting and vertigo (dizziness). It works by blocking dopamine D2 receptors in the brain's chemoreceptor trigger zone (CTZ), suppressing the signals that trigger nausea and vomiting.

Stemetil is not just an antiemetic — it also acts on the vestibular system (the balance centre), making it effective for acute vertigo. However, as a phenothiazine, its safety profile is more complex than simpler antiemetics such as domperidone or metoclopramide, and it demands more careful use.

Stemetil Tablet Uses

1. Nausea and Vomiting

Stemetil is widely used in Pakistan for nausea and vomiting from gastroenteritis, food poisoning, and drug-induced nausea. By suppressing the CTZ, it reliably reduces the urge to vomit. Most patients experience relief within one or two doses.

2. Vertigo (Labyrinthitis / Acute Dizziness)

Acute vertigo — caused by inner ear inflammation (labyrinthitis) or benign paroxysmal positional vertigo (BPPV) — responds well to Stemetil for symptom suppression. It is not a cure for Meniere disease; for that chronic condition, Serc (betahistine) is the preferred long-term option.

3. Migraine-Associated Nausea

Migraine headaches are often accompanied by severe nausea and vomiting. Stemetil controls the nausea component and in some studies has modest analgesic benefit. It is commonly prescribed alongside a painkiller (paracetamol or ibuprofen) in migraine management.

4. Motion Sickness

Stemetil can prevent or relieve the nausea and dizziness of motion sickness when taken before travel. It is more potent than many over-the-counter options but requires a prescription — always take it under medical guidance.

5. Post-Operative Nausea

After surgery, anaesthesia-induced nausea is a common problem. Stemetil is used in hospital settings — typically by injection — for this indication.

Dosage

Important: The above is for general reference only. Always take the dose your doctor has prescribed and do not self-adjust.

Side Effects

Common:

• Drowsiness / Sedation — the most frequent side effect; can be significant with phenothiazines
• Dry mouth — stay well hydrated
• Blurred vision — usually resolves after a short time
• Dizziness on standing (postural hypotension) — rise slowly from a seated or lying position
• Constipation — manageable with adequate fibre and fluids
• Nasal congestion — mild autonomic side effect

Serious:

• Extrapyramidal symptoms (EPS) / Acute dystonia — the most critical risk; see dedicated section below
• Tardive dyskinesia — with prolonged use: involuntary repetitive facial and limb movements that may be irreversible
• Neuroleptic Malignant Syndrome (NMS) — very rare but life-threatening; high fever, muscle rigidity, altered consciousness — go to hospital immediately
• Seizures — may lower the seizure threshold in epileptic patients
• Hypotension — more pronounced with the injectable form
• Cholestatic jaundice — rare but reported with phenothiazine use

EPS and Dystonia — Critical Warning

This is Stemetil's most important risk and one that is widely underappreciated in Pakistan. Extrapyramidal symptoms (EPS) include:

• Acute dystonia: sudden involuntary contraction of the neck, eyes (oculogyric crisis), or tongue — frightening and painful. It can occur after the very first or second dose, particularly in young adults aged 15–30
• Akathisia: an intense inner restlessness — patients cannot sit still or feel comfortable in any position
• Drug-induced Parkinsonism: tremor, slow movement, shuffling gait — more common with prolonged use

Children are at substantially higher risk of EPS than adults — this is why Stemetil is generally contraindicated under age 10 and used with great caution under age 18. If EPS occurs, stop Stemetil immediately and contact a doctor — symptoms are usually reversed with an antihistamine (diphenhydramine or promethazine) given promptly.

Stemetil vs Serc — Which Is Right for Vertigo?

Both are prescribed for dizziness in Pakistan but serve different roles:

In simple terms: Stemetil is a rescue medicine for sudden nausea and vertigo; Serc is the preventive for chronic vestibular conditions like Meniere disease. For nausea without vertigo, Motilium (domperidone) is a safer antiemetic that carries no EPS risk.

Who Should Not Take Stemetil

• Children under 10 years (and caution in those under 18)
• Patients with epilepsy — may lower seizure threshold
• Parkinson disease — dopamine blockade worsens symptoms
• Severe liver or kidney disease
• Patients with low blood pressure (hypotension)
• Previous EPS or tardive dyskinesia on any antipsychotic or phenothiazine
• Comatose or severely sedated patients
• Pregnancy — especially first trimester; only on strict medical advice
• Breastfeeding mothers — prochlorperazine passes into breast milk

Drug Interactions

• Alcohol: Dramatically increases sedation — completely avoid combination
• Other sedatives (benzodiazepines, antihistamines): Additive CNS depression
• Antihypertensives: Risk of excessive blood pressure drop
• Antidepressants (TCAs, SSRIs): Risk of QT prolongation — cardiac arrhythmia
• Lithium: Increased risk of neurotoxicity and NMS
• Levodopa (Parkinson medication): Mutual antagonism — do not use together
• Antacids: May reduce Stemetil absorption — leave a 2-hour gap

Stemetil and Driving — Do Not Mix

Stemetil causes significant drowsiness and slows reaction time. Driving, riding a motorcycle or operating any machinery is unsafe while taking this medicine. This applies for several hours after each dose. In Pakistan, many patients are unaware of this — ignoring it creates a serious road safety risk.

Special Caution in Elderly Patients

Patients over 65 should use Stemetil with extra caution:

• Higher risk of postural hypotension — increases fall and fracture risk
• Greater susceptibility to confusion and delirium
• EPS symptoms are more likely and harder to reverse in the elderly
• Reduced kidney and liver clearance prolongs the drug's effects

Domperidone or metoclopramide (with dose adjustment) may be preferable antiemetics for elderly patients — discuss with the treating doctor.

Conclusion

Stemetil (prochlorperazine 5mg) is an effective medicine for acute nausea, vomiting and vertigo in Pakistan — including migraine-associated nausea and motion sickness. However, its phenothiazine nature means real risks: EPS and dystonia (especially in young adults and children), significant sedation that makes driving dangerous, and serious contraindications in epilepsy and Parkinson disease. Use it only for 2–3 days unless a doctor directs otherwise, never give it to children without specialist instruction, and avoid alcohol completely. For chronic vertigo, Serc is the better long-term choice. Use Ilaaj AI for an accurate assessment of your symptoms.