Nozinan (Levomepromazine)

Levomepromazine is a low‑potency phenothiazine that acts on multiple neurotransmitter pathways, providing therapeutic effects in several clinical areas.

• Severe agitation in terminal illness: helps calm patients and reduce distress.
• Nausea and vomiting associated with chemotherapy: controls emesis when other agents are insufficient.
• Moderate to severe pain in palliative care: enhances analgesia as an adjuvant.
• Acute psychotic episodes: reduces psychotic symptoms when higher‑potency agents are not required.
• Pre‑operative sedation: provides calming effect before surgery.

• Levomepromazine blocks dopamine D2 receptors and antagonises histamine H1, muscarinic, and alpha‑adrenergic receptors. This broad receptor blockade reduces dopaminergic neurotransmission, produces sedation, anti‑emetic effects, and potentiates analgesia, while also providing anticholinergic and antihistamine activity that contributes to its therapeutic profile.

• Nozinan (levomepromazine/methotrimeprazine) commonly causes strong drowsiness, dry mouth, low blood pressure when standing up, and constipation.
• Common Side Effects
• • Sleepiness and fatigue: High levels of sedation, especially during the first few days of treatment.
• • Anticholinergic effects: Dry mouth, blurred vision, constipation, and difficulty passing urine.
• • Low blood pressure: Orthostatic hypotension (dizziness or lightheadedness when rising quickly from a sitting or lying position).
• • Weight gain: Increased risk of metabolic changes and weight changes over time.
• Serious Side Effects
• • Extrapyramidal symptoms: Movement issues like tremors, muscle stiffness, restlessness, or shuffling walk.
• • Heart rhythm changes: QT prolongation and potential irregular heartbeats.
• • Blood disorders: Agranulocytosis, a severe and dangerous drop in white blood cells causing vulnerability to infections.
• • Neuroleptic Malignant Syndrome (NMS): A rare, life-threatening condition marked by high fever, severe muscle rigidity, and confusion.
• • Temperature regulation issues: Trouble adapting to extreme heat or cold, increasing the risk of heat stroke or hypothermia.