Levopraid Per Uso I.M./E.V. (Levosulpiride)

• Levosulpiride is used in the management of psychotic and gastrointestinal disorders.
• Schizophrenia: alleviates positive and negative symptoms, improving thought organization and reducing hallucinations in adult patients.
• Other psychotic disorders: reduces acute psychotic episodes and stabilizes mood in conditions such as schizoaffective disorder.
• Nausea and vomiting: controls chemotherapy‑induced or postoperative nausea, providing anti‑emetic relief when administered intravenously.
• Gastrointestinal motility disorders: enhances gastric emptying and intestinal transit, helping patients with functional dyspepsia or gastroparesis.

• Levosulpiride selectively antagonizes dopamine D2 receptors in the central nervous system, thereby reducing dopaminergic over‑activity that underlies psychotic symptoms. It also exhibits moderate antagonism at D3 and D4 receptors and enhances cholinergic neurotransmission in the gastrointestinal tract, producing a prokinetic effect that facilitates gastric emptying and intestinal motility.

Levosulpiride may cause a range of adverse reactions, varying from mild to serious.

Common Side Effects

• Drowsiness: increased sleepiness or fatigue, especially after initial doses.
• Extrapyramidal symptoms: muscle stiffness, tremor, or involuntary movements.
• Dry mouth: reduced salivation leading to discomfort.
• Constipation: slowed intestinal transit causing difficulty passing stool.

Serious or Rare Side Effects

• Neuroleptic malignant syndrome: rare but life‑threatening condition with fever, rigidity, autonomic instability.
• Tardive dyskinesia: persistent involuntary facial or limb movements that may be irreversible.
• Severe allergic reactions: anaphylaxis, angioedema, or widespread rash requiring immediate medical attention.

When prescribing levosulpiride, clinicians should observe several safety considerations.

• Monitor extrapyramidal symptoms: assess patients regularly for signs of movement disorders.
• Check prolactin levels: hyperprolactinemia may occur, especially with prolonged therapy.
• Use caution in cardiovascular disease: may cause hypotension or arrhythmias in susceptible individuals.
• Avoid in patients with known hypersensitivity: discontinue immediately if allergic reaction develops.
• Pregnancy and lactation: prescribe only if potential benefit justifies potential risk to fetus or infant.
• Store at ambient temperature: keep in original container, protect from light and moisture.

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

Major Interactions (Avoid)

• Other dopamine antagonists (e.g., haloperidol): additive risk of extrapyramidal symptoms and hyperprolactinemia.
• CNS depressants (benzodiazepines, opioids): may enhance sedation and respiratory depression.
• Anticholinergic agents: can mask early signs of movement disorders.

Moderate Interactions (Monitor Closely)

• CYP2D6 inhibitors (fluoxetine, paroxetine): may increase levosulpiride plasma concentrations.
• CYP3A4 inducers (rifampicin, carbamazepine): may reduce drug levels, diminishing therapeutic effect.
• Diuretics (furosemide): may potentiate hypotensive effects.