Related Subjects:
|Cancer of Unknown Primary
|Palliation prescribing
|Levomepromazine
📘 About
- Always check the BNF for latest prescribing advice.
- Levomepromazine is an antipsychotic (neuroleptic) closely related to chlorpromazine.
- Widely used in palliative care for agitation, delirium, and refractory nausea/vomiting, due to its broad receptor-blocking profile.
⚙️ Mode of Action
- Antagonist at multiple receptors:
• Histamine H1 → sedation 🛌
• Muscarinic-cholinergic → anticholinergic effects (dry mouth, constipation) 👄
• Dopamine D2 → antipsychotic & antiemetic 🎭
• Alpha-1 adrenoceptor → hypotension ❤️⬇️
• Serotonin 5-HT2 → antiemetic & anxiolytic 🌙
💊 Indications & Example Doses (palliative care – restless/confused)
🔄 Interactions
- See BNF for full list.
- Additive CNS depression with opioids, benzodiazepines, or alcohol.
- Increased risk of QT prolongation if combined with other QT-prolonging drugs.
⚠️ Cautions
- May lower seizure threshold ⚡ (use caution in epilepsy).
- Increased risk of stroke 🧠 in elderly or those with cerebrovascular disease.
🚫 Contraindications
- Pre-existing QT prolongation (risk of arrhythmia).
- Electrolyte abnormalities: hypokalaemia, hypocalcaemia, hypomagnesaemia.
💥 Side Effects
- Common: postural hypotension, drowsiness 😴, dry mouth 👄, skin irritation, dystonia.
- Serious: neuroleptic malignant syndrome (rare), parkinsonism, seizures.
📖 References
📝 Revisions
- September 2025 – Dosing reformatted, cautions/side effects expanded, emojis added for clarity.
