skip to main content

Levomepromazine Palliative — SCE Medical Oncology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateSupportive & Palliative OncologyLevomepromazine PalliativeSCE Medical Oncology

A 62-year-old woman with advanced cancer develops intractable nausea and vomiting. Standard anti-emetics have failed. She is not on chemotherapy. What palliative pharmacological approach is appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Levomepromazine 6.25-12.5 mg SC — a broad-spectrum anti-emetic acting on multiple receptor pathways (D2, 5-HT2, H1, muscarinic) making it effective for multifactorial nausea; it is the 'rescue' anti-emetic in palliative care

Levomepromazine (methotrimeprazine) is a phenothiazine with broad receptor antagonism (D2, 5-HT2, H1, muscarinic, alpha-adrenergic), making it the most versatile anti-emetic in palliative care when standard first-line agents fail. At low doses (6.25-12.5 mg/24h) it provides anti-emetic action with acceptable sedation. Higher doses cause significant sedation and are used for refractory nausea or agitation. It can be given via syringe driver. It is widely used in UK palliative care as a 'rescue' anti-emetic.

Reference: NICE palliative care; Palliative Care Formulary; ESMO Supportive Care