Nozinan (Levomepromazine)

Levomepromazine is a broad‑spectrum antipsychotic that is used across several psychiatric and palliative‑care pathways.

• Schizophrenia: helps alleviate delusions, hallucinations and thought disorder.
• Severe agitation or psychomotor excitement: calms acute behavioral disturbances.
• Nausea and vomiting in palliative care: reduces refractory nausea when other agents fail.
• Chronic pain adjunct: enhances analgesia as part of multimodal regimens.
• Pre‑operative anesthesia preparation: provides sedation and anti‑emetic cover.
• Delirium in terminal illness: assists in controlling distressing psychomotor symptoms.

• Levomepromazine blocks dopamine D2 receptors and also antagonises histamine H1, muscarinic, and alpha‑adrenergic receptors. This broad receptor profile reduces dopaminergic neurotransmission, producing antipsychotic, sedative, anti‑emetic and analgesic‑modulating effects that are useful in psychiatric and palliative‑care settings.

Levomepromazine may cause a range of adverse reactions that vary in frequency and severity.

Common Side Effects

• Drowsiness or sedation
• Dry mouth
• Constipation
• Orthostatic hypotension
• Blurred vision
• Weight gain

Serious or Rare Side Effects

• Extrapyramidal symptoms (e.g., dystonia, akathisia)
• Neuroleptic malignant syndrome
• Severe hypotension
• Cardiac arrhythmias (QT prolongation)
• Agranulocytosis
• Hepatic dysfunction

When prescribing Levom­epromazine, clinicians should consider several safety measures.

• Cardiac monitoring: patients with known QT‑prolongation risk should have ECG monitoring.
• Metabolic monitoring: watch for weight gain and glucose intolerance.
• Hematologic monitoring: periodic blood counts are advised due to rare risk of agranulocytosis.
• CNS depression: avoid concurrent CNS depressants that may enhance sedation.
• Pregnancy and lactation: use only if benefit outweigh 
• Store at below 25°C: keep in the original packaging 
• Store at below 

• Nozinan (also known as methotrimeprazine or levomepromazine) interacts with many substances, leading to increased drowsiness, low blood pressure, or dangerous heart rhythms.
• Central Nervous System (CNS) Depressants
• • Alcohol: Enhances sedation and severe drops in blood pressure; alcohol should be strictly avoided.
• • Opioids and Painkillers: Can cause extreme drowsiness, breathing difficulties, or severe hypotension.
• • Sleeping Pills and Anxiety Meds: Medications like benzodiazepines (e.g., lorazepam, alprazolam) multiply sedative effects.
• • Antihistamines and Muscle Relaxants: Allergy pills and relaxants add to deep drowsiness and slowed reactions.
• Heart and Blood Pressure Medications
• • Antihypertensives and ACE Inhibitors: Combining them can cause severe, sudden drops in blood pressure (orthostatic hypotension).
• • QT-Prolonging Drugs: Drugs that alter heart rhythm (such as certain antiarrhythmics) combined with Nozinan raise the risk of dangerous irregular heartbeats.
• • Epinephrine: Nozinan can reverse or diminish the blood pressure-raising effects of epinephrine.
• Liver and Enzyme Interactions (CYP2D6)
• • CYP2D6 Substrates: Nozinan inhibits the liver enzyme CYP2D6, which can increase levels and side effects of drugs like antidepressants (amitriptyline, nortriptyline) or codeine in the body.