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

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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