levomepromazine maleate: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
levomepromazine maleate: clinical details
Prescribing considerations
- Assess postural-hypotension and sedation risk, particularly in older, frail or cardiovascularly compromised patients.
- Review personal and family cardiac history, bradycardia, electrolyte disturbance and all QT-prolonging medicines.
- Consider seizure threshold, diabetes, venous thromboembolism, constipation, urinary retention and extrapyramidal effects.
- It is not licensed for dementia-related behavioural disturbance; older people with dementia have increased mortality and possible cerebrovascular risk with antipsychotics.
- Avoid routine use in Parkinson’s disease except in exceptional circumstances.
Contraindications and cautions
- Hypersensitivity to levomepromazine or tablet ingredients.
- Concurrent citalopram, escitalopram, hydroxyzine, piperaquine or domperidone.
- The selected product information states that there are no absolute contraindications in terminal care; specialist benefit–risk judgement is required.
Monitoring
- Baseline ECG and calcium, magnesium and potassium where the clinical situation permits; repeat according to cardiac risk and treatment changes.
- Baseline and periodic liver-function testing during ongoing treatment.
- Monitor glucose in people with diabetes or risk factors for diabetes.
- Obtain a full blood count for persistent fever, sore throat or infection.
- Monitor bowel function, postural blood pressure, sedation, movement disorders and venous-thromboembolism risk.
Clinical pharmacology
Levomepromazine is a phenothiazine antipsychotic with antiemetic, antihistamine, anti-adrenaline and strong sedative properties. Elimination is slow, with an approximately 30-hour half-life, through urine and faeces.
Formulation and product differences
- The selected product is an uncoated, scored oral tablet containing levomepromazine as the maleate salt.
- UK injection products contain levomepromazine hydrochloride and are not interchangeable solely on the basis of salt name or formulation.
- The tablet contains sodium lauryl sulphate and is described as essentially sodium-free.
levomepromazine maleate preparations and strengths
Tablet
Route: Oral
Strengths: 6 mg, 6.25 mg, 25 mg, 50 mg
levomepromazine maleate interactions
Check all prescribed, over-the-counter and herbal products because levomepromazine has important cardiac, sedative and anticholinergic interactions.
Citalopram, escitalopram, hydroxyzine, piperaquine or domperidone
The selected product lists these combinations as contraindicated because they increase the risk of serious ventricular rhythm disturbance.
Other QT-prolonging medicines
Antiarrhythmics, some antidepressants, antipsychotics, antimicrobials and methadone can further increase arrhythmia risk and may require avoidance or ECG monitoring.
Alcohol, sedatives and barbiturates
Sedation, reduced alertness and central nervous system or respiratory depression may increase.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.