Levomepromazine


Concise Prescribing Info
Indications/Uses
Lised in Dosage.
Dosage/Direction for Use
Adult : PO Schizophrenia As maleate: 25-50/day in 3 divided doses, w/ higher dose at night. Non-ambulant: 100-200 mg/day. Max: 1g/day. Adjunct in severe terminal pain; Nausea and vomiting As maleate: 12.5-50 mg 4-8 hrly. Sedation 10-25 mg at bedtime. IV/IM Adjunct in severe terminal pain; Nausea and vomiting As HCl: 12.5-25 mg 6-8 hrly. Severe agitation: Up to 50 mg IM Acute pain As HCl: 75-100 mg in 3-4 deep inj. Post-op pain As HCl: 10-25 mg 8 hrly, 2.5-7.5 mg 4-6 hrly if residual effect of anesth present. Premed in surgical procedures As HCl: 10-25 mg 8 hrly . Final pre-op dose: 25-50 mg approx 1 hr before surgery.
Dosage Details
Intramuscular
Postoperative pain
Adult: As hydrochloride: 10-25 mg every 8 hr; 2.5-7.5 mg every 4-6 hr if residual effect of anaesthetics are present.

Intramuscular
Acute pain
Adult: As hydrochloride: 75-100 mg in 3-4 deep IM inj.

Intramuscular
Premedication in surgery
Adult: As hydrochloride: 10-25 mg every 8 hr. Final preoperative dose: 25-50 mg approx 1 hr before surgery.

Oral
Adjunct in severe terminal pain, Nausea and vomiting
Adult: As maleate: 12.5-50 mg every 4-8 hr.

Oral
Schizophrenia
Adult: As maleate: 25-50 mg daily in 3 divided doses, with the larger dose taken at night. Non-ambulant patients: 100-200 mg daily increased gradually up to 1 g if needed.
Child: ≥10 yr: As maleate: 12.5-25 mg in divided doses. Max dose: 37.5 mg daily.

Oral
Sedation
Adult: 10-25 mg at bedtime.

Parenteral
Adjunct in severe terminal pain, Nausea and vomiting
Adult: As hydrochloride: 12.5-25 mg every 6-8 hr via IM inj. Patient should remain in bed for at least the 1st few doses. Severe agitation: Up to 50 mg. Doses may also be given via IV admin after dilution with an equal volume of normal saline. Total dose range: 25-200 mg daily.
Child: As hydrochloride: ≥1 yr: Limited experience but 0.35-3 mg/kg daily by continuous SC infusion.
Contraindications
Comatose state, severe CNS depression, phaeochromocytoma, blood dyscrasia.
Special Precautions
Reduced GI motility, urinary retention, prostatic hyperplasia, xerostomia or visual problems, narrow-angle glaucoma, myasthenia gravis. Cardiac conduction abnormalities. Patients at risk of hypotension or CV or cerebrovascular disease. Bone marrow suppression. Severe renal, cardiac or hepatic disease. Respiratory disease. Predisposition to seizures. May affect driving, especially at start of treatment. Elderly, children. Pregnancy and lactation.
Adverse Reactions
Hypotension, orthostatic hypotension, tachycardia, QT prolongation; photosensitivity, rash; gynaecomastia, wt gain, irregular menstruation, changes in libido; extrapyramidal effects, dizziness, seizure, headache, drowsiness, neuroleptic malignant syndrome, interference with temperature regulation; constipation, nausea, vomiting, ileus; urinary retention, ejaculatory disorders, incontinence, polyuria, priapism; blood dyscrasias; jaundice, hepatotoxicity.
Potentially Fatal: Arrhythmias. Severe orthostatic hypotension.
Parenteral/PO: C
Overdosage
Symptoms: Deep sleep, respiratory depression, coma, extrapyramidal symptoms, abnormal involuntary muscle movements, hypotension. Management: Symptomatic and supportive.
Drug Interactions
Increased risk of extrapyramidal effects with metoclopramide, acetylcholinesterase inhibitors. Additive hypotensive effects with antihypertensive agents, trazodone. Additive sedative effects with CNS depressants. May alter levels/effects of CYP2D6 substrates and prodrug substrates. Reduced pressor effects of epinephrine. Reduced effects of bromocriptine, guanethidine, guanadrel, levodopa. Increased neurotoxicity with lithium (rare). Reduced serum levels with phenytoin or increased phenytoin toxicity. Increased serum concentrations with propranolol, sulfadoxine-pyrimethamine. Increased serum levels of valproic acid. Reduced absorption with aluminium salts. Reduced effects of amphetamines or increased risk of psychotic symptoms. Reduced effects and excessive anticholinergic effects with benztropine, trihexyphenidyl, biperiden, TCAs, antihistamines, disopyramide.
Potentially Fatal: Increased risk of ventricular arrhythmias with drugs that prolong the QT interval. Increased toxicity with MAOIs.
Action
Description: Levomepromazine is a phenothiazine with CNS depressant, α-adrenergic-blocking, antimuscarinic, antihistaminic and analgesic activity. It acts by blocking dopamine receptors in the mesolimbic dopaminergic system.
Onset: 1 hr (parenteral).
Duration: 2-4 hr (parenteral).
Pharmacokinetics:
Absorption: Peak plasma concentrations reached within 1-4 hr (oral); 30-90 min (IM). Bioavailability: Approx 50% (oral).
Storage
Store at 25°C. Protect from light.
Disclaimer: This information is independently developed by MIMS based on Levomepromazine from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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