Levomepromazin Neuraxpharm (Levomepromazine Hydrochloride)

Levomepromazine is a phenothiazine antipsychotic used across several therapeutic areas.

• Schizophrenia: helps control psychotic symptoms such as delusions and hallucinations.
• Severe agitation: reduces extreme restlessness and aggressive behavior.
• Nausea and vomiting: provides antiemetic relief when other treatments are insufficient.
• Palliative care: alleviates refractory symptoms including distressing nausea, pain, and anxiety in end‑of‑life settings.

• Levomepromazine acts primarily as an antagonist at dopamine D2 receptors, reducing dopaminergic neurotransmission that contributes to psychosis and agitation. It also blocks histamine H1, muscarinic, and alpha‑adrenergic receptors, producing antihistaminic, anticholinergic, and vasodilatory effects that contribute to its antiemetic and sedative properties.

Levomepromazine may cause a range of adverse reactions that vary in frequency and severity.

Common Side Effects

• Drowsiness or sedation: excessive sleepiness or reduced alertness.
• Orthostatic hypotension: dizziness or light‑headedness upon standing.
• Dry mouth and throat: reduced salivation leading to discomfort.
• Constipation: slowed gastrointestinal motility.
• Blurred vision: temporary visual disturbances.
• Weight gain: increase in body weight over time.

Serious or Rare Side Effects

• Neuroleptic malignant syndrome: life‑threatening fever, muscle rigidity, and autonomic instability.
• Tardive dyskinesia: involuntary, repetitive movements, often of the face.
• Severe hypotension: marked drop in blood pressure requiring medical attention.
• Cardiac arrhythmias: irregular heart rhythms, especially in patients with pre‑existing conditions.
• Agranulocytosis: dangerously low white‑blood‑cell count.
• Seizures: convulsive episodes, particularly in predisposed individuals.

When prescribing Levomepromazine, clinicians should consider several safety measures.

• Blood pressure monitoring: watch for orthostatic drops, especially after dose initiation.
• Extrapyramidal assessment: evaluate for movement disorders such as tremor or rigidity.
• Elderly caution: start at low doses and monitor for sedation and falls.
• Gradual discontinuation: taper the dose to avoid withdrawal phenomena.
• Hypersensitivity avoidance: do not use in patients with known allergy to phenothiazines.
• Store at room temperature: keep in the original packaging, protect from moisture and direct sunlight.

Levomepromazine can interact with other medicines, altering its efficacy or safety profile.

Major Interactions (Avoid)

• Other dopamine antagonists: may increase risk of severe extrapyramidal symptoms.
• Central nervous system depressants (e.g., benzodiazepines, opioids): can cause profound sedation or respiratory depression.
• Anticholinergic agents: additive anticholinergic burden may lead to severe constipation, urinary retention, or delirium.
• QT‑prolonging drugs: combined effect can raise the risk of cardiac arrhythmias.

Moderate Interactions (Monitor Closely)

• Antihypertensive agents: additive hypotensive effect may require dose adjustment.
• Anticholinesterase inhibitors (e.g., donepezil): may reduce therapeutic benefit of either drug.
• Alcohol: can enhance sedative properties and impair coordination.