Levosulpiride Ferrer (Levosulpiride)

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

• Schizophrenia: helps reduce positive symptoms such as hallucinations and delusions.
• Depressive disorders: may augment antidepressant therapy by improving mood and motivation.
• Functional dyspepsia: alleviates upper‑gastrointestinal discomfort through its prokinetic activity.

• Levosulpiride selectively antagonizes dopamine D2 receptors in the central nervous system, which diminishes dopaminergic overactivity linked to psychotic symptoms. Its peripheral D2 blockade enhances gastrointestinal motility, providing prokinetic effects that aid in functional dyspepsia. The drug’s action does not involve significant serotonin receptor modulation.

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

Common Side Effects

• Nausea: mild to moderate stomach upset.
• Dizziness: transient light‑headedness, especially on standing.
• Headache: occasional tension‑type headache.
• Insomnia: difficulty initiating or maintaining sleep.
• Extrapyramidal symptoms: mild tremor or rigidity.
• Hyperprolactinemia: increased prolactin levels causing breast tenderness.

Serious or Rare Side Effects

• Tardive dyskinesia: persistent involuntary movements.
• Neuroleptic malignant syndrome: life‑threatening reaction with fever and muscle rigidity.
• QT interval prolongation: risk of cardiac arrhythmia.
• Severe allergic reaction: rash, swelling, or anaphylaxis.
• Hepatotoxicity: abnormal liver enzymes indicating liver injury.
• Agranulocytosis: dangerously low white‑blood‑cell count.

Before initiating therapy, clinicians should evaluate patient‑specific risk factors and monitor for adverse events.

• Extrapyramidal monitoring: assess for tremor, rigidity or abnormal movements.
• Cardiac assessment: obtain baseline ECG if patient has cardiac risk factors.
• Liver function: check hepatic enzymes in patients with hepatic impairment.
• Elderly caution: start with lower doses and monitor for confusion or falls.
• Discontinuation: taper gradually to avoid withdrawal or rebound symptoms.
• Store at room temperature: keep in the original packaging, protect from moisture and direct sunlight.

Levosulpiride can interact with other medicines, altering efficacy or safety.

Major Interactions (Avoid)

• MAO inhibitors: may precipitate hypertensive crisis.
• Other dopamine antagonists: increase risk of extrapyramidal symptoms.
• QT‑prolonging agents: additive risk of cardiac arrhythmia.

Moderate Interactions (Monitor Closely)

• CYP2D6 inhibitors: may raise levosulpiride plasma concentrations.
• Anticholinergic drugs: can mask anticholinergic side effects.
• Alcohol: may enhance sedation and dizziness.