Nozinan (Levomepromazine)

Levomepromazine is a low‑potency phenothiazine that acts on multiple neurotransmitter pathways, providing relief in several clinical situations.

• Severe agitation and psychosis: helps calm patients with acute or chronic psychiatric disturbances.
• Nausea and vomiting in palliative care: reduces refractory symptoms when other anti‑emetics fail.
• Pre‑operative sedation: used to tranquilize patients before surgery.
• Painful muscle spasm: alleviates muscle rigidity associated with certain neurological conditions.
• Delirium in terminal illness: improves comfort and reduces distress.
• Anxiety disorders : offers short‑term relief of severe anxiety when other agents are unsuitable.

• Levomepromazine blocks dopamine D2 receptors and also antagonises histamine H1, muscarinic, and alpha‑adrenergic receptors. This broad receptor blockade reduces dopaminergic transmission, producing antipsychotic, anti‑emetic, and sedative effects, while also influencing autonomic and histaminergic pathways that contribute to its calming properties.

Levomepromazine may cause a range of adverse reactions, from mild to potentially life‑threatening.

Common Side Effects

• Drowsiness: feeling unusually sleepy or fatigued.
• Dry mouth: reduced salivation leading to a sticky sensation.
• Constipation: slowed gastrointestinal motility.
• Orthostatic hypotension: drop in blood pressure when standing.
• Blurred vision: temporary visual disturbances.
• Weight gain: increase in body weight over time.

Serious or Rare Side Effects

• Extrapyramidal symptoms: muscle rigidity, tremor, or uncontrolled movements.
• Neuroleptic malignant syndrome: high fever, muscle rigidity, and autonomic instability.
• Severe hypotension: dangerous drop in blood pressure.
• Cardiac arrhythmias: irregular heart rhythms that may require monitoring.
• Torsades de pointes: a specific type of ventricular tachycardia.
• Agranulocytosis: dangerously low white‑blood cell count.

When prescribing Levomepromazine, clinicians should consider several safety aspects.

• Assess baseline cardiovascular status: patients with existing heart disease may be at higher risk of hypotension.
• Monitor for extrapyramidal symptoms: early detection can prevent progression to severe movement disorders.
• Evaluate liver and kidney function: impaired metabolism may increase drug exposure.
• Use caution in the elderly: increased sensitivity to sedative and anticholinergic effects.
• Avoid abrupt discontinuation: taper gradually to reduce withdrawal phenomena.
• Store at ambient temperature: keep in the original container, protect from moisture and light.

Levomepromazine can interact with a variety of medicines, altering its efficacy or safety profile.

Major Interactions (Avoid)

• Other central nervous system depressants: may cause excessive sedation or respiratory depression.
• Antihypertensive agents: additive blood‑pressure‑lowering effects can lead to severe hypotension.
• QT‑prolonging drugs: combined use raises the risk of torsades de pointes.

Moderate Interactions (Monitor Closely)

• Anticholinergic drugs: may intensify dry‑mouth and constipation.
• CYP2D6 inhibitors: can increase