Levair (Levosulpiride)

Levosulpiride is used in psychiatric and gastrointestinal therapeutic pathways to modulate dopamine activity.

• Schizophrenia: reduces positive symptoms and improves overall psychotic stability.
• Depressive disorders: augments antidepressant effects and alleviates mood symptoms.
• Anxiety disorders: helps control excessive anxiety and related somatic manifestations.
• Functional dyspepsia: enhances gastric motility, relieving upper abdominal discomfort.
• Gastroparesis: promotes gastric emptying, reducing nausea and bloating.

• Levosulpiride selectively blocks dopamine D2 receptors in the central nervous system and gastrointestinal tract. By antagonizing these receptors, it diminishes dopaminergic neurotransmission that contributes to psychotic manifestations, while simultaneously increasing cholinergic activity in the gut, which stimulates smooth‑muscle contraction and accelerates gastric emptying. The selective affinity minimizes effects on other neurotransmitter systems, contributing to a favorable safety profile compared with non‑selective dopamine antagonists.

Levosulpiride may be associated with a range of adverse reactions, varying from mild to serious.

Common Side Effects

• Drowsiness: feeling of sleepiness or reduced alertness.
• Nausea: mild to moderate stomach upset.
• Dry mouth: reduced salivation causing discomfort.
• Weight gain: modest increase in body weight.
• Constipation: reduced bowel movements.
• Headache: mild to moderate head pain.

Serious or Rare Side Effects

• Extrapyramidal symptoms: involuntary muscle movements or rigidity.
• Hyperprolactinemia: elevated prolactin levels leading to menstrual changes or galactorrhea.
• Severe allergic reaction: rash, swelling, or difficulty breathing.

When prescribing levosulpiride, clinicians should consider several precautionary measures to ensure safe use.

• Assess psychiatric history: evaluate prior response to antipsychotics and risk of relapse.
• Monitor metabolic parameters: check weight, glucose and lipid profile periodically.
• Evaluate gastrointestinal function: ensure underlying motility disorder is appropriate for therapy.
• Review concomitant medications: avoid drugs that prolong QT interval or strongly inhibit CYP enzymes.
• Caution in elderly: start with lower doses and monitor for sedation or falls.
• Store at ambient temperature: keep below 25 °C in the original packaging, protected from moisture.

Levosulpiride can interact with other medicines, affecting its efficacy or safety.

Major Interactions (Avoid)

• Antipsychotics with strong D2 antagonism: may increase risk of extrapyramidal symptoms.
• QT‑prolonging agents (e.g., quinidine, erythromycin): can heighten cardiac arrhythmia risk.
• CYP2D6 inhibitors (e.g., fluoxetine, paroxetine): may raise levosulpiride plasma levels.

Moderate Interactions (Monitor Closely)

• Anticholinergic drugs: may reduce pro‑kinetic benefit.
• CNS depressants (e.g., benzodiazepines, alcohol): can enhance sedation.
• Diuretics: monitor electrolytes as levosulpiride may affect potassium balance.