Levomepromazine

Green-G

Brand Name(s):Nozinan

Indication:Palliative care

Rationale:

Considered:Nov-11

Review Date:Nov-21

Comments:
Ref: Palliativedrugs.com – November 2011

Dose and use
Anti-emetic
Generally used as a second- or third-line anti-emetic:

start with 6 to 12.5mg PO/SC stat, o.n. & p.r.n.
if necessary, increase to 25 to 50mg/24h.
If used as a first-line anti-emetic:

start with 3mg o.d. b.d. & p.r.n.
if necessary, increase to 6mg o.d. b.d. & p.r.n.
Terminal agitation plus or minus delirium
Generally given only if it is intended to reduce a patient’s level of consciousness:

stat dose 25mg SC and 50 to 75mg/24h CSCI
titrate dose according to response; maximum 300mg/24h, occasionally more.15,16
Although high-dose levomepromazine (100mg/24h or greater) is generally best given by CSCI, smaller doses can be conveniently given as a SC bolus o.n. b.d., and p.r.n.

Analgesic
May be of benefit in a very distressed patient with severe pain unresponsive to other measures:

stat dose 25mg PO/SC and o.n.
titrate dose according to response; usual maximum daily dose 100mg SC/200mg PO.
To reduce the likelihood of inflammatory reactions at the skin injection site with CSCI, dilute to the largest volume possible (e.g. for a Graseby syringe driver, 18ml in a 30ml luerlock syringe given over 12 to 24h) and consider the use of 0.9% saline (see Diluent section in Chapter 18).

There are 2-drug compatibility data for levomepromazine in 0.9% saline with diamorphine and oxycodone.

Incompatibility may occur with dexamethasone, ketorolac, or octreotide.

More details and 3-drug compatibility data can be found on the Syringe Driver Survey Database. For compatibility data in WFI, see Charts A4.1 to A4.6.