|Trade names||Nozinan, Levoprome, Detenler, Hirnamin, Levotomin, Neurocil, others|
|Drug class||Typical antipsychotic|
|Main uses||Schizophrenia, palliative care|
|Side effects||Low blood pressure with standing, sleepiness, dry mouth, liver problems, dystonia|
|By mouth, IV, SC, IM|
|Onset of action||0.5 to 3 hr|
|Duration of action||8 hr|
|AHFS/Drugs.com||International Drug Names|
|Elimination half-life||~20 hours|
|Excretion||In feces and urine (metabolites), unchanged drug only 1%|
|Chemical and physical data|
|Molar mass||328.47 g·mol−1|
|3D model (JSmol)|
|(what is this?)|
Levomepromazine, also known as methotrimeprazine, is a medication used for schizophrenia and palliative care. In palliative care it is used for restlessness, pain, and vomiting. It may be used by mouth or by injection. Effects generally begin around 0.5 to 3 hours and last for 8 hours.
Side effects may include low blood pressure with standing, sleepiness, dry mouth, liver problems, and dystonia. Serious side effect may include priapism, QT prolongation, and neuroleptic malignant syndrome. It is an antipsychotic of the phenothiazine type. It works by blocking a variety of receptors, including adrenergic, dopamine, histamine, muscarinic acetylcholine, and serotonin.
Levomepromazine was patented in 1954 and come into medical use in the United State in 1957. It is available as a generic medication. In the United Kingdom 84 tablets of 25 mg costs the NHS about £20 as of 2020. It has been widely used; though is no longer commercially available in the United States.
It can be used for moderate to severe pain in people who do not walk (this being because of its strong sedative effects).
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.
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. A 2010 systematic review compared the efficacy of levomepromazine with atypical antipsychotic drugs:
Data are few and not high quality making it impossible to be confident about the effects for schizophrenia.
In schizophrenia the typical dose is 25 to 50 mg per day, though up to 1,000 mg per day may be used.
The most common side effect is akathisia. Levomepromazine has prominent sedative and anticholinergic/sympatholytic effects (dry mouth, hypotension, sinus tachycardia, night sweats) and may cause weight gain. 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. In any case, blood pressure and EKG should be monitored regularly.
It is a phenothiazine low-potency antipsychotic (approximately half as potent as chlorpromazine) with strong analgesic, hypnotic and antiemetic properties that are primarily used in palliative care.
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