Nozinan (Levomepromazine Maleate)

Levomepromazine is a broad‑spectrum phenothiazine that acts on multiple neurotransmitter pathways, providing therapeutic effects in several clinical contexts.

• Severe agitation in terminal illness: helps calm patients who are highly distressed.
• Nausea and vomiting associated with chemotherapy: reduces episodes of emesis.
• Moderate to severe pain in palliative care: enhances analgesia when combined with opioids.
• Schizophrenia resistant to other antipsychotics: offers an alternative when standard agents fail.
• Acute psychotic episodes: can be used to rapidly control severe psychotic symptoms.

• Levomepromazine blocks dopamine D2 receptors and antagonizes histamine H1, muscarinic, and alpha‑adrenergic receptors. This broad receptor blockade reduces dopaminergic transmission, produces sedation, and diminishes nausea signals, while also providing analgesic adjuvant effects through modulation of spinal pain pathways.

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

Common Side Effects

• Drowsiness: feeling ​the ​most ​common ​sedative ​effect.
• Dry mouth: reduced salivation.
• Orthostatic hypotension: drop ​in ​blood ​pressure ​upon ​standing.
• Constipation: slowed gastrointestinal motility.
• Blurred vision: temporary visual disturbances.
• Weight gain: increased appetite.

Serious or Rare Side Effects

• Neuroleptic Malignant Syndrome (NMS): A rare, life-threatening reaction causing high fever, severe muscle stiffness, sweating, fast heartbeat, and confusion.
• Agranulocytosis: A severe, dangerous drop in white blood cells that increases your risk of serious infections, marked by fever, sore throat, or mouth ulcers.
• Heart Rhythm Disorders (QT Prolongation / Torsades de Pointes): Irregular heartbeats, palpitations, dizziness, or fainting linked to changes in the heart's electrical activity.
• Severe Orthostatic Hypotension: A sharp drop in blood pressure when standing up, leading to dizziness, lightheadedness, or fainting.
• Paralytic Ileus: Severe bowel blockage or lack of gut movement causing long-term constipation, abdominal pain, and bloating.
• Severe Allergic Reactions: Anaphylaxis, skin rashes, hives, and swelling of the face, lips, or throat.
• Movement Disorders: Long-term or abnormal involuntary muscle movements, tremors, rigidity, and tardive dyskinesia.

• Levomepromazine ​     
• Nozinan (levomepromazine/methotrimeprazine) requires careful medical oversight due to risks of severe low blood pressure, sedation, and temperature regulation problems