Levomepromazine (Methotrimeprazine)

Levomepromazine, also known as methotrimeprazine, is a phenothiazine neuroleptic drug that belongs to the same class of drugs as chlorpromazine and promethazine. It is used to treat severe mental/mood disorders, such as schizophrenia and manic phases of bipolar disorder. It works by helping to restore certain natural substances in the brain, such as dopamine and serotonin, that are involved in mood regulation and perception of reality.

How is levomepromazine taken?

Levomepromazine can be taken orally as tablets or liquid, or by injection into a muscle or vein. The dosage and frequency of administration depend on the condition being treated, the response to the drug and the occurrence of side effects. The usual starting dose for adults is 25 mg three times a day, which can be increased gradually up to 300 mg per day. The maximum daily dose is 600 mg. For elderly patients, lower doses are recommended. Levomepromazine should be taken with food or milk to prevent stomach upset.

What are the possible side effects of levomepromazine?

Like other phenothiazine drugs, levomepromazine can cause various side effects, some of which can be serious or life-threatening. Some of the common side effects include:

  • Drowsiness, sedation, dizziness, fainting
  • Dry mouth, blurred vision, constipation, urinary retention
  • Weight gain, increased appetite, increased blood sugar
  • Tremor, muscle stiffness, restlessness, involuntary movements
  • Low blood pressure, irregular heartbeat, changes in electrocardiogram (ECG)
  • Increased sensitivity to sunlight, skin rash, jaundice
  • Decreased sexual ability or interest, menstrual irregularities, breast enlargement
  • Blood disorders, such as agranulocytosis (low white blood cell count), thrombocytopenia (low platelet count), anemia (low red blood cell count)

Some of the rare but serious side effects include:

  • Neuroleptic malignant syndrome (NMS), a potentially fatal condition characterized by high fever, muscle rigidity, altered mental status and autonomic instability
  • Tardive dyskinesia (TD), a condition that causes involuntary movements of the face, tongue, mouth, jaw, limbs or trunk that may persist even after stopping the drug
  • Akathisia, a condition that causes an intense urge to move or restlessnessthat may worsen agitation or depression
  • Agranulocytosis (low white blood cell count), which increases the risk of infection and requires regular blood tests to monitor
  • Liver damage or failure, which may cause symptoms such as nausea, vomiting, abdominal pain, jaundice or dark urine
  • Seizures or convulsions
  • Allergic reactions or hypersensitivity reactions that may cause symptoms such as rash, itching, swelling or difficulty breathing

If you experience any of these side effects or any other unusual or bothersome symptoms while taking levomepromazine, you should contact your doctor immediately or seek emergency medical attention.

What are the precautions and contraindications for levomepromazine?

Before taking levomepromazine, you should inform your doctor if you have any allergies to this drug or any other phenothiazine drugs. You should also tell your doctor if you have any medical conditions or history of:

  • Liver disease or dysfunction
  • Kidney disease or dysfunction
  • Heart disease or arrhythmias
  • Blood disorders or bleeding problems
  • Glaucoma or increased eye pressure
  • Prostate enlargement or difficulty urinating
  • Thyroid problems or low thyroid hormone levels
  • Diabetes or high blood sugar
  • Parkinson’s disease or other movement disorders
  • Epilepsy or seizures
  • Brain tumors or head injuries
  • Alcohol or drug abuse or dependence
  • Depression or suicidal thoughts or attempts

You should also inform your doctor if you are pregnant, planning to become pregnant or breastfeeding, as levomepromazine may harm the unborn baby or pass into breast milk. You should also inform your doctor if you are taking any other medications, vitamins, supplements or herbal products, as levomepromazine may interact with them and cause adverse effects. Some of the drugs that may interact with levomepromazine include:

  • Other antipsychotics, such as haloperidol, risperidone, olanzapine, quetiapine, aripiprazole, clozapine
  • Antidepressants, such as fluoxetine, sertraline, citalopram, escitalopram, paroxetine, venlafaxine, duloxetine, bupropion
  • Mood stabilizers, such as lithium, valproate, carbamazepine, lamotrigine
  • Anxiolytics or sedatives, such as diazepam, lorazepam, alprazolam, zolpidem, zopiclone
  • Opioids or narcotics, such as codeine, morphine, oxycodone, hydrocodone, fentanyl
  • Antihistamines, such as diphenhydramine, cetirizine, loratadine
  • Antiemetics or anti-nausea drugs, such as metoclopramide, ondansetron
  • Anticholinergics or antispasmodics, such as atropine, hyoscine, oxybutynin
  • Beta-blockers or blood pressure drugs, such as propranolol, atenolol, metoprolol
  • Anticoagulants or blood thinners, such as warfarin, heparin
  • Antidiabetic drugs or insulin
  • Cytotoxic drugs or chemotherapy agents
  • St. John’s wort or other herbal products that may affect the brain chemicals

You should avoid drinking alcohol or using illegal drugs while taking levomepromazine, as they may increase the risk of side effects or overdose. You should also avoid driving or operating machinery until you know how levomepromazine affects you. You should also avoid exposure to sunlight or artificial UV rays (such as tanning beds), as levomepromazine may make your skin more sensitive and prone to sunburn. You should wear protective clothing and sunscreen when outdoors.

How much does levomepromazine cost in different countries?

The price of levomepromazine may vary depending on the brand name, dosage form and strength. The following table shows the average price of levomepromazine in different countries based on online sources. The prices are in US dollars and are for reference only. They do not include shipping fees or taxes.

CountryBrand nameDosage form and strengthPrice per unitReference URL
AustraliaNozinanTablet 25 mg$0.32https://www.pbs.gov.au/medicine/item/1016F-1017G
CanadaNozinanTablet 25 mg$0.29https://www.drugbank.ca/drugs/DB01403/prices
New ZealandNozinanTablet 25 mg$0.23<a href=”https://www.pharmac.govt.nz/tools-resources/pharmaceutical-schedule/browse-section/?

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