Levomepromazine

CLINICAL USE

Treatment of schizophrenia Adjunctive treatment in palliative care Nausea and vomiting

DOSE IN NORMAL RENAL FUNCTION

Schizophrenia: Oral, initially 25–50 mg daily, increasing to 100–200 mg in 3 divided doses; maximum dose 1 g dailyPalliative care: Oral: 12.5–50 mg every 4–8 hours —IM/IV: 12.5–50 mg every 6–8 hours —SC Infusion: 5–200 mg daily —

PHARMACOKINETICS

Molecular weight :328.5

%Protein binding :No data

%Excreted unchanged in urine : 1

Volume of distribution (L/kg) :23–42

half-life – normal/ESRD (hrs) :30/–

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Dose as in normal renal function

<10 : Start with small dose and increase as necessary

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Unknown dialysability. Dose as in GFR <10 mL/min

HD :Unknown dialysability. Dose as in GFR <10 mL/min

HDF/high flux :Unknown dialysability. Dose as in GFR <10 mL/min

CAV/VVHD :Unknown dialysability. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Anaesthetics: enhanced hypotensive effect

Analgesics: increased risk of convulsions with tramadol; increased hypotension and sedation with opioid analgesics

Anti-arrhythmics: increased risk of ventricular arrhythmias due to prolongation of QT interval; increased risk of ventricular arrhythmias with amiodarone – avoid concomitant administration

Antibacterials: increased risk of ventricular arrhythmias with moxifloxacin – avoid concomitant administration

Antidepressants: possibly increased plasma level of tricyclics, increased antimuscarinic effects and ventricular arrhythmias; avoid concomitant administration with MAOIs (2 fatalities have been reported)Anticonvulsant: lowers anticonvulsant threshold

Antimalarials: avoid concomitant use with artemether/lumefantrine

Antipsychotics: increased risk of ventricular arrhythmias with pimozide – avoid concomitant use

Antivirals: plasma concentration possibly increased by ritonavirAntihypertensives: enhanced hypotensive effect; increased risk of ventricular arrhythmias with sotalolAnxiolytics and hypnotics: increased sedation

Diuretics: enhanced hypotensive effect

Lithium: increased risk of extrapyramidal effects and neurotoxicity

Pentamidine: increased risk of ventricular arrhythmias – avoid concomitant use

Sibutramine: increased risk of CNS toxicity – avoid concomitant useLevomepromazine (methotrimeprazine).LEVoMEProMAZinE (METhoTriMEPrAZinE) 433

ADMINISTRATION

Reconstition

–

Route

Oral, IV, IM, SC

Rate of Administration

–

Comments

For a subcutaneous infusion dilute in sodium chloride 0.9% and give via a syringe driverCompatible with diamorphine For IV injection, dilute with an equal volume of sodium chloride 0.9%

OTHER INFORMATION

In renal disease there is an increased risk of cerebral sensitivity

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