Formulary
Levomepromazine: Indications, Dosing, Side Effects and Interactions
Levomepromazine clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 5 min read
Levomepromazine: Indications, Dosing, Side Effects and Interactions
Levomepromazine clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Nausea and vomiting in palliative care [regular dosing]**
- **Adult** (By Mouth, Or By Subcutaneous Injection): 6.25 mg/24 hours, if necessary, dose to be progressively increased every 4-5 days up to max. 25 mg per day in total taking into account regular and as required dosing.
**Nausea and vomiting in palliative care [as required dosing]**
- **Adult** (By Mouth, Or By Subcutaneous Injection): 6-6.25 mg every 2 hours as required, max. 25 mg per day in total taking into account regular and as required dosing.
**Schizophrenia (bed patients)**
- **Adult** (By Mouth): Initially 100-200 mg daily in 3 divided doses, increased if necessary to 1 g daily.
**Schizophrenia**
- **Adult** (By Mouth): Initially 25-50 mg daily in divided doses, dose can be increased as necessary.
**Restlessness and confusion in palliative care for levomepromazine**
- **Child 1-11 years** (By continuous subcutaneous infusion): 0.35-3 mg/kg, to be administered over 24 hours.
- **Child 12-17 years** (By continuous subcutaneous infusion): 12.5-200 mg, to be administered over 24 hours.
**Nausea and vomiting in palliative care for levomepromazine**
- **Child 1 month-11 years** (By continuous intravenous infusion, or by subcutaneous infusion): 100-400 micrograms/kg, to be administered over 24 hours.
- **Child 12-17 years** (By continuous intravenous infusion, or by subcutaneous infusion): 5-25 mg, to be administered over 24 hours.
Cautions
For all antipsychotic drugs Blood dyscrasias; cardiovascular disease; conditions predisposing to seizures; depression; diabetes (may raise blood glucose); epilepsy; history of jaundice; myasthenia gravis; Parkinson's disease (may be exacerbated); photosensitisation (may occur with higher dosages); prostatic hypertrophy; severe respiratory disease; susceptibility to angle-closure glaucoma Cautions, further information Cardiovascular disease An ECG may be required, particularly if physical examination identifies cardiovascular risk factors, personal history of cardiovascular disease, or if the patient is being admitted as an inpatient. Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: for all antipsychotics (other than quetiapine and clozapine) in patients with parkinsonism or Lewy Body Disease (risk of severe extrapyramidal symptoms) in behavioural and psychological symptoms of dementia (BPSD), unless symptoms are severe and other non-pharmacological treatments have failed (increased risk of stroke) for use as a hypnotic, unless sleep disorder is due to psychosis or dementia (risk of confusion, hypotension, extrapyramidal side-effects, and falls) in patients prone to falls (may cause gait dyspraxia, parkinsonism) if prescribed a phenothiazine (other than prochlorperazine for nausea, vomiting, or vertigo; chlorpromazine for relief of persistent hiccups; levomepromazine as an antiemetic in palliative care) as first-line treatment (sedative, significant antimuscarinic (anticholinergic) toxicity in older people, and safer and more efficacious alternatives exist) if prescribed an antipsychotic drug with moderate or marked antimuscarinic effects (e.g. chlorpromazine, clozapine, flupenthixol, fluphenazine, pipothiazine, promazine, and zuclopenthixol) in patients with a history of prostatism or urinary retention (high risk of urinary retention) Cautions For levomepromazine Patients receiving large initial doses should remain supine; susceptibility to QT interval prolongation Cautions, further information Risk of postural hypotension; not recommended for ambulant patients over 50 years unless risk of hypotensive reaction assessed.
Contraindications
CNS depression; comatose states; phaeochromocytoma
Side effects
For all antipsychotic drugs Common or very common Agitation; amenorrhoea; arrhythmias; constipation; dizziness; drowsiness; dry mouth; erectile dysfunction; fatigue; galactorrhoea; gynaecomastia; hyperglycaemia; hyperprolactinaemia; hypersalivation; hypotension (dose-related); insomnia; leucopenia; movement disorders; muscle rigidity; neutropenia; parkinsonism; postural hypotension (dose-related); QT interval prolongation; rash; seizure; tremor; urinary retention; vomiting; weight increased Uncommon Agranulocytosis; confusion; neuroleptic malignant syndrome (discontinue-potentially fatal) Rare or very rare Sudden death; withdrawal syndrome neonatal Side-effects, further information For depot antipsychotics-side-effects may persist until the drug has been cleared from its depot site. Overdose Phenothiazines cause less depression of consciousness and respiration than other sedatives. Hypotension, hypothermia, sinus tachycardia, and arrhythmias may complicate poisoning. For details on the management of poisoning see Antipsychotics under Emergency treatment of poisoning . Side-effects For levomepromazine Common or very common Asthenia; heat stroke Rare or very rare Cardiac arrest; hepatic disorders Frequency not known Allergic dermatitis; delirium; embolism and thrombosis; gastrointestinal disorders; glucose tolerance impaired; hyponatraemia; photosensitivity reaction; priapism; SIADH
Interactions
**Severe interactions:**
- Phenothiazines : Severe orthostatic hypotension has been observed in case of concomitant use of phenothiazines, like e.g.
**Other interactions (4):**
- Medicinal products affected by serum potassium disturbances Periodic monitoring of serum potassium and ECG is recommended when olmesartan/hydrochlorothiazide is administered with medicinal products...
- Combinations requiring precautions for use Torsades de pointes-inducing drugs (such as but not limited to): class Ia antiarrhythmics agents ( e.g.quinidine, hydroquinidine, disopyramide), class...
- Since bradycardia constitutes a risk factor in the occurrence of torsades de pointes, the combination of rivastigmine with torsades de pointes-inducing medicinal products such as antipsychotics i.e.
- Medicinal products affected by serum potassium disturbances Periodic monitoring of serum potassium and ECG is recommended when losartan/hydrochlorothiazide is administered with medicinal products...
Pregnancy
For all antipsychotic drugs Extrapyramidal effects and withdrawal syndrome have been reported occasionally in the neonate when antipsychotic drugs are taken during the third trimester of pregnancy. Following maternal use of antipsychotic drugs in the third trimester, neonates should be monitored for symptoms including agitation, hypertonia, hypotonia, tremor, drowsiness, feeding problems, and respiratory distress.
Breast feeding
For all antipsychotic drugs There is limited information available on the short- and long-term effects of antipsychotic drugs on the breast-fed infant. Animal studies indicate possible adverse effects of antipsychotic medicines on the developing nervous system. Chronic treatment with antipsychotic drugs whilst breast-feeding should be avoided unless absolutely necessary. Phenothiazine derivatives are sometimes used in breast-feeding women for short-term treatment of nausea and vomiting.
Hepatic impairment
Manufacturer advises consider avoiding.
Medicinal forms
Tablet,Tablet,Solution,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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