Levomepromazine 6mg oral
- Drugs List
- Therapeutic Indications
- Dosage
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Oral formulations of levomepromazine containing 6mg.
Drugs List
Therapeutic Indications
Uses
Nausea,vomiting in terminal care when other drugs ineffective/unavailable
Second or third line treatment of adults with refractory nausea unassociated with chemotherapy in palliative care.
Dosage
Adults
Nausea in palliative care
Day 1 to 3: 3mg to 6mg once daily at night for 3 days.
Day 4 to 5: Titrate dose to 6mg twice a day (maximum 12mg daily).
Day 6 to 14: 12mg once daily at night.
Patients dose should be reviewed daily. The maximum treatment duration is 2 weeks.
Other sources suggest an alternative dose for nausea and vomiting in palliative care:
6mg at bedtime, increased if necessary to 12.5mg to 25mg twice a day.
Patients with Renal Impairment
Alternative sources recommend starting with small doses in severe renal impairment due to increased cerebral sensitivity.
Contraindications
Children under 18 years
Breastfeeding
Galactosaemia
Long QT syndrome
Pregnancy
Torsade de pointes
Precautions and Warnings
Debilitation
Elderly
Family history of long QT syndrome
Predisposition to diabetes mellitus
Predisposition to epileptic disorder
Predisposition to prolongation of QT interval
Predisposition to venous thromboembolism
Prolonged starvation
Risk of cerebrovascular accident
Alcoholism
Bradycardia
Cardiovascular disorder
Dementia
Diabetes mellitus
Electrolyte imbalance
Epileptic disorder
Glucose-galactose malabsorption syndrome
Hepatic impairment
History of long QT syndrome
History of torsade de pointes
History of ventricular arrhythmias
Lactose intolerance
Second degree atrioventricular block
Severe renal impairment
Third degree atrioventricular block
Correct electrolyte disorders before treatment
Advise ability to drive/operate machinery may be affected by side effects
May reduce seizure threshold
Contains lactose
Keep patient supine when receiving large initial doses
Perform ECG before and during treatment
Diabetic control may need adjustment
Monitor ECG prior to increasing dosage
Monitor patients at risk for signs & symptoms of venous thromboembolism
Monitor serum electrolytes
May cause postural hypotension especially in elderly
Predisposition QT prolongation: Counsel patient on symptoms of arrhythmias
Discontinue if Torsade de Pointes should occur during treatment
Advise patient to avoid alcohol during treatment
Male & female: May cause infertility
Female: Ensure adequate contraception during treatment
Cases of venous thromboembolism (VTE) have been reported with antipsychotic medication. All possible risk factors for VTE should be identified before and during treatment and preventative measures taken.
Pregnancy and Lactation
Pregnancy
Levomepromazine is contraindicated during pregnancy.
The manufacturer does not recommend using levomepromazine during pregnancy or in women of childbearing potential not using contraception. At the time of writing there is no published information regarding the use of levomepromazine during pregnancy. Safety in pregnancy has not been established.
Levomepromazine may cause dose-dependant withdrawal symptoms or transient extrapyramidal symptoms in neonates. There have been reports of agitation, hypertonia, hypotonia, tremor, somnolence, respiratory distress, or feeding disorder and newborns should be monitored carefully.
Lactation
Levomepromazine is contraindicated during breastfeeding.
The manufacturer advises that the patient either discontinues levomepromazine or discontinues breastfeeding. Available data indicates that levomepromazine is excreted in human breast milk in low amounts. Effects on exposed infants are unknown.
Side Effects
Accelerated erythrocyte sedimentation
Acid/base balance disturbance
Agranulocytosis
Akathisia
Allergic dermatitis
Asthenia
Blurred vision
Cardiac arrest
Cardiac arrhythmias
Cholestatic liver changes
Confusion
Constipation
Convulsions
Corneal opacities
Decreased glucose tolerance
Deep vein thrombosis (DVT)
Delirium
Difficulty in micturition
Dry mouth
ECG changes
Electrolyte disturbances
Extrapyramidal effects
Heat stroke
Hepatocellular damage
Hyperglycaemia
Hyponatraemia
Hypotension
Hypoxia
Inappropriate secretion of antidiuretic hormone
Intestinal colic
Jaundice
Keratopathy
Lens opacities
Melanosis
Necrotising enterocolitis
Neuroleptic malignant syndrome
Paralytic ileus
Parkinson-like symptoms
Photosensitivity
Pigmented retinopathy
Precipitation of diabetes
Priapism
Prolongation of QT interval
Pulmonary embolism
Somnolence
Sudden unexplained death
Tardive dyskinesia
Thrombocytopenia
Torsades de pointes
Venous thrombosis
Ventricular arrhythmias
Ventricular fibrillation
Ventricular tachycardia
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Further Information
Last Full Review Date: January 2021
Reference Sources
Summary of Product Characteristics: Levomepromazine Maleate 6mg Tablets. Morningside Healthcare Ltd. Revised April 2020.
The Renal Drug Handbook. Fifth Edition (2019) ed. Ashley, C. and Dunleavy, A. Radcliffe Publishing Ltd, London.
NICE Evidence Services Available at: www.nice.org.uk Last accessed: 14 January 2021.
Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.