HEALTHY LIFESTYLE




Levomepromazine
Levomepromazine.JPG

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
  • other drugs