Levomepromazine

1
Levomepromazine
Levomepromazine
Systematic (IUPAC) name
(2R)-3-(2-Methoxyphenothiazine-10-yl-)-N,N,2-trimethylpropanamine
Clinical data
AHFS/Drugs.com
Micromedex Detailed Consumer Information
[1]
Pregnancy cat. Only if clearly needed
Legal status Prescription Only (S4) (AU) POM (UK)
Routes Oral, seldom intramuscular
Pharmacokinetic data
Bioavailability approx. 50 to 60%
Metabolism Hepatic
Half-life ~ 20 hours
Excretion In feces and urine (metabolites), unchanged drug only 1%
Identifiers
CAS number
60-99-1
[2]

7104-38-3
[3]
(maleate),
1236-99-3
[4]
HCl)
ATC code
N05AA02
[5]
PubChem
CID 72287
[6]
DrugBank
DB01403
[7]
ChemSpider
65239
[8]

UNII
9G0LAW7ATQ
[9]

KEGG
D00403
[10]

Levomepromazine
2
ChEBI
CHEBI:6838
[11]

ChEMBL
CHEMBL1764
[12]

Chemical data
Formula C
19
H
24
N
2
OS
Mol. mass 328.47 g/mol
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[13]
Levomepromazine (INN, BAN, USAN), also known as methotrimeprazine (common use in America; sold as
Nosinan, Nozinan, Levoprome) is an phenothiazine neuroleptic drug. It is a low-potency antipsychotic
(approximately half as potent as chlorpromazine) with strong analgesic, hypnotic and antiemetic properties that's
primarily used in palliative care.
Serious side effects include tardive dyskinesia, akathisia, abnormalities in the electrical cycle of the heart,low blood
pressure and the potentially fatal neuroleptic malignant syndrome.
As is typical of phenothiazine antipsychotics, levomepromazine is a "dirty drug", that is, it exerts its effects by
blocking a variety of receptors, including adrenergic receptors, dopamine receptors, histamine receptors, muscarinic
acetylcholine receptors and serotonin receptors.
Medical uses
Levomepromazine is used for the treatment of psychosis, particular those of schizophrenia, and manic phases of
bipolar disorder. It should be used only with caution in the treatment of agitated depressions, as it can cause akathisia
as a side effect, which could worsen the agitation.
Levomepromazine is also used at lower doses for the treatment of nausea and insomnia.
Levomepromazine is frequently prescribed and valued worldwide in palliative care medicine for its multimodal
action, to treat intractable nausea or vomiting, and for severe delirium/ agitation in the last days of life. Palliative
care physicians will commonly prescribe it orally or via subcutaneous syringe drivers in combination with more
potent opiate analgesics such as Hydromorphone.
Adverse effects
The most common side effect is akathisia. Levomepromazine has prominent sedative and
anticholinergic/sympatholytic effects (dry mouth, hypotension, sinus tachycardia, night sweats) and may cause
weight gain. These side effects normally preclude prescribing the drug in doses needed for full remission of
schizophrenia, so it has to be combined with a more potent antipsychotic. In any case, blood pressure and EKG
should be monitored regularly.
A rare but life-threatening side effect is neuroleptic malignant syndrome (NMS). The symptoms of NMS include
muscle stiffness, convulsions and fever.
Levomepromazine
3
References
[1] http:/ / www. drugs. com/ cons/ methotrimeprazine.html
[2] http:/ / www. nlm. nih.gov/ cgi/ mesh/ 2009/ MB_cgi?term=60-99-1& rn=1
[3] http:/ / tools.wmflabs. org/ magnustools/ cas.php?language=en& cas=7104-38-3& title=
[4] http:/ / tools.wmflabs. org/ magnustools/ cas.php?language=en& cas=1236-99-3& title=
[5] http:/ / www. whocc.no/ atc_ddd_index/ ?code=N05AA02
[6] http:/ / pubchem. ncbi. nlm.nih. gov/ summary/ summary. cgi?cid=72287
[7] http:/ / www. drugbank. ca/ drugs/ DB01403
[8] http:/ / www. chemspider.com/ Chemical-Structure.65239. html
[9] http:/ / fdasis.nlm. nih. gov/ srs/ srsdirect. jsp?regno=9G0LAW7ATQ
[10] http:/ / www.kegg. jp/ entry/ D00403
[11] https:/ / www.ebi.ac. uk/ chebi/ searchId.do?chebiId=CHEBI:6838
[12] https:/ / www.ebi.ac. uk/ chembldb/ index.php/ compound/ inspect/ CHEMBL1764
[13] http:/ / en. wikipedia. org/ w/ index. php?title=Special:ComparePages& rev1=408577545& page2=Levomepromazine
PubChem Substance Summary: Levomepromazine (http:/ / pubchem. ncbi. nlm. nih. gov/ summary/ summary.
cgi?sid=271549) National Center for Biotechnology Information.
NOZINAN - Lvompromazine (http:/ / www. doctissimo. fr/ medicament-NOZINAN. htm) Doctissimo Guides
des Medicaments
(http:/ / grpct. grampianspalliativecare. com. au/ aspx/ documents/ EPAL May 2010. pdf)Grampians Palliative
Care Team Publication May 2010 (Victoria, Australia)
(http:/ / www. palliativecareguidelines. scot. nhs. uk/ documents/ Levomepromazine. pdf) Palliative Care
Guidelines, Scotland, UK
Article Sources and Contributors
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Article Sources and Contributors
Levomepromazine Source: http://en.wikipedia.org/w/index.php?oldid=608966390 Contributors: Ambix, Andrew Benton, Arcadian, Atrian, Axl, Bahastify, Barsamin, BeatmanSwedish,
Beetstra, Blehfu, Boghog, Casliber, Ccroberts, Ceyockey, Chemgirl131, Chowbok, David Kernow, Davidruben, Dr CareBear, EugeneZelenko, Fuse809, Fvasconcellos, Gaius Cornelius, Grafen,
Hazard-SJ, HichamVanborm, Hydrogen Iodide, IAMGOOMBA, Jetman, Kristenq, Lkinkade, Mackensen, Nephron, Nirmos, Pashihiko, Pday12, Richardcavell, Rmky87, Selket, Spiperon,
SpoticusKC, Squids and Chips, Tokino, Wedson, Woohookitty, Zuiram, , 54 anonymous edits
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