|Systematic (IUPAC) name|
|Pregnancy cat.||Only if clearly needed|
|Legal status||Prescription Only (S4) (AU) POM (UK)|
|Routes||Oral, seldom intramuscular|
|Bioavailability||approx. 50 to 60%|
|Half-life||~ 20 hours|
|Excretion||In feces and urine (metabolites), unchanged drug only 1%|
|Mol. mass||328.47 g/mol|
|(what is this?)|
Levomepromazine (INN, BAN, USAN), also known as methotrimeprazine (common use in America; sold as Nosinan, Nozinan, Levoprome) is an phenothiazine neuroleptic drug. It is a low-potency antipsychotic (approximately half as potent as chlorpromazine) with strong analgesic, hypnotic and antiemetic properties that's primarily used in palliative care.
As is typical of phenothiazine antipsychotics, levomepromazine is a "dirty drug", that is, it exerts its effects by blocking a variety of receptors, including adrenergic receptors, dopamine receptors, histamine receptors, muscarinic acetylcholine receptors and serotonin receptors.
Levomepromazine is used for the treatment of psychosis, particular those of schizophrenia, and manic phases of bipolar disorder. It should be used only with caution in the treatment of agitated depressions, as it can cause akathisia as a side effect, which could worsen the agitation.
Levomepromazine is frequently prescribed and valued worldwide in palliative care medicine for its multimodal action, to treat intractable nausea or vomiting, and for severe delirium/ agitation in the last days of life. Palliative care physicians will commonly prescribe it orally or via subcutaneous syringe drivers in combination with more potent opiate analgesics such as Hydromorphone.
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.
- PubChem Substance Summary: Levomepromazine National Center for Biotechnology Information.
- NOZINAN - Lévomépromazine Doctissimo Guides des Medicaments
- Grampians Palliative Care Team Publication May 2010 (Victoria, Australia)
-  Palliative Care Guidelines, Scotland, UK