Neurocil Tropfen (Levomepromazine Hydrochloride)

Levomepromazine is a phenothiazine antipsychotic used across several psychiatric and supportive‑care indications.

• Schizophrenia: reduces psychotic symptoms such as delusions and hallucinations.
• Severe agitation: calms acute behavioral disturbances when rapid sedation is needed.
• Nausea and vomiting: controls chemotherapy‑induced or postoperative emesis through central anti‑emetic action.
• Sedation in palliative care: provides comfort and reduces distress in end‑of‑life patients.

• Levomepromazine exerts its therapeutic effects primarily by antagonizing dopamine D2 receptors in the central nervous system, diminishing dopaminergic neurotransmission associated with psychosis. It also blocks histamine H1 receptors, producing sedative and anti‑emetic effects, and inhibits muscarinic cholinergic and alpha‑adrenergic receptors, contributing to its anti‑emetic, antihistaminic, and hypotensive properties. These combined receptor actions account for its broad clinical utility across psychiatric, anti‑emetic, and palliative settings.

Levomepromazine may cause a range of adverse reactions, which are categorized by frequency and severity.

Common Side Effects

• Drowsiness: feeling of sleepiness or reduced alertness.
• Dry mouth: reduced salivation leading to discomfort.
• Constipation: slowed gastrointestinal motility.
• Orthostatic hypotension: drop in blood pressure upon standing causing dizziness.
• Blurred vision: temporary visual disturbances.

Serious or Rare Side Effects

• Neuroleptic malignant syndrome: rare but life‑threatening reaction with fever, rigidity, and autonomic instability.
• Torsades de pointes: rare cardiac arrhythmia associated with QT prolongation.
• Severe extrapyramidal symptoms: such as acute dystonia or parkinsonism.

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

• Assess cardiac risk: monitor ECG for QT prolongation, especially in patients with cardiac disease.
• Evaluate hepatic and renal function: dose may need adjustment in impairment.
• Use caution in elderly: increased sensitivity to sedative and anticholinergic effects.
• Avoid abrupt discontinuation: taper gradually to reduce withdrawal or rebound agitation.
• Pregnancy and lactation: limited data; use only if benefit outweighs potential risk.
• Store at ambient temperature: keep below 25 °C, protect from moisture and light in original container.

Levomepromazine interacts with several medicines; awareness of the interaction level guides clinical management.

Major Interactions (Avoid)

• Other CNS depressants (e.g., benzodiazepines, opioids): may cause profound sedation or respiratory depression.
• Anticholinergic agents (e.g., atropine, antihistamines): increase anticholinergic burden leading to severe constipation, urinary retention, or delirium.
• QT‑prolonging drugs (e.g., quinidine, macrolide antibiotics): heighten risk of torsades de pointes.

Moderate Interactions (Monitor Closely)

• CYP2D6 inhibitors (e.g., fluoxetine, paroxetine): can raise levomepromazine plasma levels.
• Antihypertensives: additive orthostatic hypotension may occur.
• Lithium: may enhance neurotoxic effects.