Wondering about folks’ experience with prochlorperazine, also known as Stemetil?
I’ve just been prescribed prochlorperazine (Stemetil)—5mg, 3x/day, to take alongside nortriptyline (50mg/day). Nort has helped esp with the headache side, but spacey vertigo/dizziness has remained, though lessened. The Stemetil was prescribed by my GP and her pharmacist—I’ve been seeing them between neurologist appointments (1st neuro left the country on a fellowship, new neuro won’t see me until mid-Nov).
I’m unsure about this. From what I read Stemetil is for acute vertigo episodes, not for continual use. Has anyone used this as a daily preventative for vestibular migraine? Any thoughts appreciated. (Also knowing that drugs affect all brains differently.)
Yes, it’s meant for days or weeks but not months of use.
Not only are their risks wrt to blocking compensation, but it also puts you more at risk of some pretty nasty brain disorders if used chronically, I understand, including Parkinsonism.
You could have considered Amitriptyline instead of both of these which itself has pretty effective vestibular suppressive effects but can be taken chronically.
Perhaps you could go easy on the Stemetil and see how you go with Nori.
The biggest issue is that you will probably find it hard to judge how much the Nori is helping you whilst under the influence of the other drug.
Hmm, thanks James. The pharmacist previously recommended Gravol to help with the vertigo/dizziness symptoms—this after I explained that the Nori had lessened the headaches quite a bit, but the vestibular symptoms were persisting. The nori/Gravol combo worked rather well for a little over a week and I was quite encouraged. But a week ago all my symptoms flared up, including the headaches (an unwelcome return), a real drag because the nori had produced slow steady results up to that point. I’ve also had two acute attacks in the last two weeks, hideous. Maybe increasing the nori dose would be a better next step. The pharmacist talked to me about a drug called lamotrigine if the nori does not seem like it’s the right drug—that one sounds a little scary to me.
Hi. Don’t know how long you’ve been on theNori. Preventatives generally takes anything up to 4 months to be fully effective. I found Propranolol took even longer, it was 8 months before it started to control the 24/7 dizzies with me. In the interim, the symptoms aren’t controlled and you will experience relapse/breakthrough symptoms. That’s how it goes, and very depressing it is too. Been there myself so sympathise. Doesn’t mean drug will fail long-term. I know it’s difficult, and messes up daily function but I found it best without adding in other drugs. As @turnitaround so rightly says it queers the pitch in sorting if the preventative is working which long-term is more important.
Stemil is brilliant to stop nausea and actual vomiting. It literally saved me being admitted to hospital more than once when room spinning vertigo made me vomit to the point of near dehydration and worse, it got me to a distant hospital for an MRI scan when I used one for motion sickness. I never found it did anything towards reducing dizziness/imbalance at all. It slows the gut considerably. It’s designed for short term, acute Attacks. I never took more than 3-4 days worth during an attack.The very last time I phoned GP for repeat prescription of Stemil I spoke to a locum who told me taken regularly long-term, it has been proven to cause dizziness and hinder compensation. He said although treating dizziness from inner ear complaints is listed in Stemil literature, this was being removed and in future it would be listed purely to relieve nausea. That was several years ago, Helen
Thanks so much, Helen. I’ve been on Nortriptyline nearly 5 months now. Thought I was on a v. slow but positive upward arc but the dreadful last week or so, plus two recent acute attacks two weeks apart, are breaking my spirit. I had thought the main purpose of the preventative was to precent the acute attacks; if so that’s not working. I’ve decided I’m not comfortable w/taking Stemetil every day, so I’m not going to. And I don’t feel like I want to stop Nori and start on an anti-convulsant w/o a neurologist’s advice. I am wondering if upping the Nori dose would be a better next step. I have all these leftover 10mg pills from my initial prescription so maybe I should just start taking 60mg.
I am so discouraged—in the last few months I’ve I cut out caffeine, aspartame, chocolate, anything containing citrus, red wine, am trying to avoid MSG, upped my morning protein as per neuro’s orders, and am taking all these expensive supplements, plus a pretty high dose of a preventative, and I don’t feel consistently much better at all. Last few visits to restaurants have been disasters—light and noise sensitivities are at all-time highs. My life is just not much of a life at all. It is so hard to remain optimistic that things will get better and I may be able to resume some kind of normal life. This condition is my entire identity now: I used to be a book editor, a yoga teacher, a thin/active person, a fun and attractive wife, but now I’m just an invalid patient.
Do I just need to wait longer for the Nori to work more fully and consistently? People’s experiences coming on and off drugs makes me hesitant to chuck it and start some other terrifying drug that might not work. My GP is kind but I feel like I know more about treatment for this condition b/c of research and this site. 7 weeks until I see a new neurologist but in the meantime I feel like I’m the one in charge of my treatment, which is not at all encouraging.
I had to wait about this long to see a Neurologist and it was worth it for me. I still feel like I’m the one in charge of my treatment though! Everything takes months of waiting on diet/drugs/lifestyle. Its painfully slow, but eventually most of us get to a happy spot. Nort seems like a good one to stick with for a while, upping the dose while waiting for the Neurologist seems reasonable, I think you are still probably on the low end at 50mg. If it doesn’t work then at least you can cross that one off when you get in to see him/her. Switching to an anticonvulsant seems a bit premature to me if you are tolerating Nort okay and have had some improvement.
Hi. I can empathise with everything you say. I really know how you are feeling. I’ve been there, really I have. I could have written most of it myself. It takes over your life. What life is that? I’ve been my own doctor so long now, it seems normal and with this condition I wouldn’t have any other way. You start to ferl a bit like you’ve doubled or trebled (depending on …) your span on earth overnight. Suddenly, you’re an invalid. I think your decision with the Stemitil wise. In fact, the whole post sounds wise to me.
The idea of migraine preventatives is to improve quality of life but it’s not expected to stop all attacks. In fact the bar for what medics consider ‘success’ is for the drugs to reduce number, frequency and severity of attacks by as little as 50%. That being said many do achieve something much much closer to total control. Lots on here have achieved total control. Takes meds, time and patience, allot of fortitude, and probably a bit of luck!
MAV is notoriously ‘ up and down’. It’s depressing but you have to try and steal yourself against that. Even on drugs that are working you will still experience breakthrough attacks for a long time. Really good percentage control only comes after sufficiently long time on a sufficiently high enough to control most symptoms much of the time, ‘effective’ dose. Most probably you aren’t on a sufficiently high enough dose yet. I’d suggest you phoned the consultant but understand that’s not currently possible as you are waiting for a new one to start. I’d probably be tempted to try upping the dose if you’ve spare pills to hand but it’s your decision. I’m no medic. Daniel on this forum did really well at 70mg. See under Success Stories. The next neuro will either up the dose or add in another drug. I think as you cope with Nori, why risk the unknown. Certainly not yet. Anticonvulsants are pretty effective but very high drop out cos people cannot tolerate rate too. They are pretty scary and you need to be comfortable with what you take. Propranolol, a betablocker is often combined with Nori or Ami, and many doctors will prescribe that for you if it’s too long to wait to see new neuro, you could enquire. However if the neuro appointment is a planned ‘next appointment’ slot where the outgoing neuro next wanted to see you perhaps the time between is what they deemed you need to ‘see how it goes with the Nori’.
Just one more thing (it’s way past my bedtime). You are doing meds, diet and lifestyle changes mostly. To really help things on a bit, might be a good idea to look at triggers, and -just like me - restaurants are triggers, avoid them, The migraine specialist neuro I saw told me to:- up meds dosage, walk outside every day and avoid all triggers. For me that meant: No restaurants, no supermarkets. There’s no point taking meds to calm the hypersensitivity then exposing yourself to triggers that excite them! Helen
Thx so much Helen, having a tough week and feeling sorry for myself I think. Good to hear some constructive advice. Just relaxing tonight and tomorrow will set my mind to figuring out my next steps. Very grateful for the support from you and others: much respect and gratitude.
You are so very welcome. It proves my 15 year battle with MAV hasn’t been entirely pointless. I just wish I’d had access to some guidance myself at the beginning however, as screens were a main trigger, I couldn’t have accessed a forum anyway, not for many months, and theonly way to obtain practical advice is from another sufferer. Medics just don’t get it, unless they have personal experience if vertigo themselves or close family member. Nobody does. It’s indescribable so you can lt expect they could.
Just as example of the ups and downs. I was feeling great last eve when I penned yr reply, went to bed, had a not particularly good night and woke up feeling totally rubbish balance-wise. After three virtually perfectly normal, ‘how I used to be’ days. Only good thing is, once you improve a bit, triggers more obvious and you can sometimes exert more control.
Oh, don’t worry about yours lasting 15 years. Highly unlikely. I went 12 years misdiagnosed and unmedicated, ‘lost in the wilderness’. (Extremely long story) . That hasn’t happened to you. Helen
Hi there. I have been taking stemitil on and off for 15 years and although it does help a little when spinning I do agree with you that it makes balance much worse. I always feel a little jittery next day too. Angela
I’ve been using this tablet, 5mg 3 times a day and it does help relieve the symptoms. It goes give me some stomach discomfort and bloating as I have IBS. But it’s better than Sertraline which was horrible. I only seem to be prescribed 28 days worth at a time. Which is 9 days of tablets. Can you stay on Stemetil long term?
That’s a shame as it works for me, the only thing so far. My issue is I’m extremely wary of any antidepressants as I’ve tried a list as long as your arm for my fibromyalgia. Including Amytriptyline and Noratriptyline.I’ve tried anti covulsants like Gabapentin and Pregablin and they caused stomach issues. Couldnt take Propranolol due to worsening asthma.
I want something that helps control the symptoms without causing distressing side effects . I feel like I’m running out of options.