levomenthol: clinical use

Prescribing considerations

• Confirm the intended site and formulation: the forehead stick and nasal ointment are not interchangeable.
• Review persistent, worsening or recurrent headache rather than relying on continued symptomatic treatment.
• Consider excipient sensitivity, including peppermint oil in the stick and cineole, geranium oil and paraffins in the ointment.

Contraindications and cautions

• Known hypersensitivity to levomenthol, menthol or another product ingredient.
• The selected nasal ointment is contraindicated in children under 5 years.

Monitoring

• No routine laboratory monitoring is specified.
• Monitor clinically for symptom progression, irritant or allergic skin reactions and eye irritation.

Clinical pharmacology

Levomenthol is the naturally occurring L-isomer of menthol and activates TRPM8 channels on cold-sensitive sensory nerves. Topical exposure produces cooling and counter-irritant effects; systemic absorption is followed by glucuronidation and urinary or biliary excretion.

Formulation and product differences

• The solid cutaneous stick is intended for single-patient application to the forehead for headache relief and can soften if exposed to heat.
• The paraffin-based ointment is intended for application in and around the nasal passages for congestion symptoms and may also be rubbed onto specified external areas.

Ointment

Route: Cutaneous

Strengths: 0.3%