Levosulpirida Aristo (Levosulpiride)

Levosulpiride acts on dopaminergic pathways and is indicated for several psychiatric and gastrointestinal conditions.

• Schizophrenia: alleviates psychotic symptoms by modulating dopamine D2 receptors.
• Depression: augments antidepressant response through serotonergic activity.
• Anxiety: reduces anxiety manifestations via central dopamine regulation.
• Nausea and vomiting: controls emesis associated with chemotherapy or postoperative states.
• Gastroparesis: improves gastric emptying and relieves dyspeptic symptoms.

• Levosulpiride selectively antagonizes dopamine D2 receptors in the central nervous system, thereby reducing dopaminergic hyperactivity linked to psychosis. Its antagonism also enhances serotonergic transmission, which contributes to mood regulation. In the gastrointestinal tract, D2 blockade disinhibits cholinergic pathways, increasing acetylcholine release and promoting coordinated smooth‑muscle contractions, which accelerates gastric emptying and improves motility. The combined central and peripheral actions make levosulpiride useful for both psychiatric and prokinetic therapy.

Levosulpiride may be associated with a range of adverse reactions, which are classified by frequency and severity.

Common Side Effects

• Drowsiness: feeling of sleepiness or reduced alertness.
• Dry mouth: reduced salivary secretion causing oral discomfort.
• Constipation: infrequent bowel movements or hard stools.
• Nausea: mild gastrointestinal upset.

Serious or Rare Side Effects

• Neuroleptic malignant syndrome: life‑threatening reaction with fever and muscle rigidity.
• Tardive dyskinesia: persistent involuntary movements after prolonged use.
• Severe hyperprolactinemia: galactorrhea, menstrual disturbances, or sexual dysfunction.
• Cardiac arrhythmias: abnormal heart rhythm requiring medical attention.

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

• Renal impairment: dose adjustment may be required and renal function should be monitored.
• Hepatic dysfunction: use with caution and monitor liver enzymes.
• Elderly patients: increased sensitivity to extrapyramidal effects; start at lower dose.
• History of cardiac disease: assess risk of arrhythmias before initiating therapy.
• Pregnancy and lactation: safety not established; avoid unless benefits outweigh risks.
• Store at ambient temperature: keep below 25 °C in the original packaging, protected from moisture.

Levosulpiride can interact with other medicines; awareness of major and moderate interactions helps prevent adverse outcomes.

Major Interactions (Avoid)

• MAO inhibitors: concurrent use may precipitate hypertensive crisis.
• Potent CYP3A4 inhibitors: may increase levosulpiride plasma concentrations.
• Anticholinergic agents: additive anticholinergic burden can worsen constipation and dry mouth.

Moderate Interactions (Monitor Closely)

• SSRIs or SNRIs: monitor for serotonin syndrome when combined with serotonergic activity.
• Other antipsychotics: additive extrapyramidal side effects may occur.
• Diuretics: monitor electrolyte balance and blood pressure.