Levomepromazine, also known as methotrimeprazine, is a medication used for schizophrenia and palliative care.[1] In palliative care it is used for restlessness, pain, and vomiting.[1] It may be used by mouth or by injection.[1] Effects generally begin around 0.5 to 3 hours and last for 8 hours.[2]
Levomepromazine was patented in 1954 and come into medical use in the United State in 1957.[4] It is available as a generic medication.[1] In the United Kingdom 84 tablets of 25 mg costs the NHS about £20 as of 2020.[1] It has been widely used;[2] though is no longer commercially available in the United States.[5]
It can be used for moderate to severe pain in people who do not walk (this being because of its strong sedative effects).[6]
Levomepromazine is also used at lower doses for the treatment of nausea and insomnia.[7]
Levomepromazine is frequently prescribed and valued worldwide in palliative care medicine for its multimodal action, to treat intractable nausea or vomiting, and for agitation in the last days of life. Palliative care physicians will commonly prescribe it orally or via subcutaneous syringe drivers in combination with opioid analgesics such as hydromorphone.[7][8]
Levomepromazine is used for the treatment of psychosis, particularly those of schizophrenia, and manic phases of bipolar disorder. It should only be used with caution in the treatment of agitated depressions, as it can cause akathisia as a side effect, which could worsen the agitation.[7][8] A 2010 systematic review compared the efficacy of levomepromazine with atypical antipsychotic drugs:
Levomepromazine versus atypical antipsychotic drugs for schizophrenia[9]
Summary
Data are few and not high quality making it impossible to be confident about the effects for schizophrenia.[9]
Outcome
Findings in words
Findings in numbers
Quality of evidence
Global state
Not much improved (CGI) Follow-up: short-term
Levomepromazine may increase the risk of not seeing an improvement when compared with atypical antipsychotic drugs, but, at present there are only very limited data supporting this finding.
Any response (<20% decrease PANSS Follow-up: short-term
At present it is not possible to be confident about the difference between people given levomepromazine and those receiving atypical antipsychotic drugs. There is very limited data to support this finding.
Levomepromazine may slightly reduce the risk of constipation but there is no clear difference between people given levomepromazine and those receiving atypical antipsychotics. These findings are based on data of low quality.
Levomepromazine may increase the chance of experiencing dizziness when compared with atypical antipsychotic drugs. Data are based on low quality evidence.
There is no clear difference for the outcome of 'drowsiness' between people given levomepromazine and those receiving atypical antipsychotic drugs. These findings are based on data of low quality.
Dry mouth is no more or less common with levomepromazine compared with those receiving atypical antipsychotic drugs. These findings are based on data of low quality.
Levomepromazine may reduce the risk of movement disorders but, with current data, there is no clear difference between people given levomepromazine and those receiving atypical antipsychotic drugs. These findings are based on data of very limited quality.
In schizophrenia the typical dose is 25 to 50 mg per day, though up to 1,000 mg per day may be used.[1]
It can be given once per day to three times per day.[2][1]
Side effects
The most common side effect is akathisia.[8] Levomepromazine has prominent sedative and anticholinergic/sympatholytic effects (dry mouth, hypotension, sinus tachycardia, night sweats) and may cause weight gain.[8] These side effects normally preclude prescribing the drug in doses needed for full remission of schizophrenia, so it has to be combined with a more potent antipsychotic.[8] In any case, blood pressure and EKG should be monitored regularly.[8]
A rare but life-threatening side effect is neuroleptic malignant syndrome (NMS).[8] The symptoms of NMS include muscle stiffness, convulsions and fever.[8]
↑ 2.02.12.22.32.42.52.62.72.82.9Dietz, I; Schmitz, A; Lampey, I; Schulz, C (19 January 2013). "Evidence for the use of Levomepromazine for symptom control in the palliative care setting: a systematic review". BMC palliative care. 12: 2. doi:10.1186/1472-684X-12-2. PMID23331515.
↑"Levomepromazine". Farmacotherapeutisch Kompas (in Nederlands). Archived from the original on 10 October 2016. Retrieved 5 October 2016.
↑ 7.07.17.27.3Brayfield A, ed. (13 December 2013). "Levomepromazine". Martindale: The Complete Drug Reference. London, UK: Pharmaceutical Press. Archived from the original on 28 August 2021. Retrieved 12 May 2014.
