Drug Data Generic Name levomepromazin e Trade Name Nazinan Patients Dose N/A Minimum Dose PO 100200mg/day Ma!

imum Dose PO 1g/day Contents levomeprazine Availabilit" and color Tablets: 2mg, 5mg Elixir: 2mg/5ml Routes of administratio n !,"#,"$

Classificatio n Therapeutic Antipsy%&oti% Pharmacolo gic &enot&iazine Pregnanc" Categor" C

Mechanism of Action 'evomepromazine is a p&enot&iazine (it& )N* depressant, +adrenergi%-blo%,ing, antim-s%arini%, anti&istamini% and analgesi% a%tivity. "t a%ts by blo%,ing dopamine re%eptors in t&e mesolimbi% dopaminergi% system. Pharmaco#ine tics A "n%omplete oral bioavailability be%a-se o/ /irstpass metabolism. D 0ist. #ol-me 10 l/,g/. "s lipop&ili% and %rosses bloodbrain barrier, be pla%enta and enters breast mil,. M$% $etablized by liver to s-l/oxide, a gl-%-mide and demet&ylated metabolite. 0r-g elimination is slo(. $etabolism /o-nd in /e%es and -rine. 213-n%&anged4 Onset "$: 1&r !,"#: -n,no(n Pea# !: 1-5&rs "$: 10-60 mins. Duration "$: 2-5&rs. !,"#: -n,no(n Drug &alf 'ife 15-10 &rs.

Indication General Indications Treatment o/ psy%&oses: s%&izop&renia, mani% p&ases o/ bipolar disorder7 Treatment o/ agitated depression. Treatment o/ na-sea and insomnia. Easing distressing symptoms in palliative %are Patients Actual Indication

Contraindications )omatose state, severe )N* depression, p&aeo%&romo%ytoma, blood dys%rasia. Precaution 8ed-%ed 9" motility, -rinary retention, prostati% &yperplasia, xerostomia or vis-al problems, narro(-angle gla-%oma, myast&enia gravis. )ardia% %ond-%tion abnormalities. atients at ris, o/ &ypotension or )# or %erebrovas%-lar disease. :one marro( s-ppression. *evere renal, %ardia% or &epati% disease. 8espiratory disease. redisposition to seiz-res. $ay a//e%t driving, espe%ially at start o/ treatment. Elderly, %&ildren. regnan%y and la%tation. .Drug interaction (drug to drug "n%reased ris, o/ extrapyramidal e//e%ts (it& meto%lopramide, a%etyl%&olinesterase in&ibitors. Additive &ypotensive e//e%ts (it& anti&ypertensive agents, trazodone. Additive sedative e//e%ts (it& )N* depressants. $ay alter levels/e//e%ts o/ ); 20< s-bstrates and prodr-g s-bstrates. 8ed-%ed pressor e//e%ts o/ epinep&rine.

Adverse Reaction CN) extrapyramidal e//e%ts, dizziness, seiz-re, &eada%&e, dro(siness, ne-rolepti% malignant syndrome, inter/eren%e (it& temperat-re reg-lation. C*D =ypotension, ort&ostati% &ypotension, ta%&y%ardia, >T prolongation. Derm p&otosensitivity. %ndo gyne%omastia, (eig&t gain, irreg-lar menstr-ation, %&anges in libido. GI %onstipation, N/# G+ -rinary retention, e?a%-latory dividers, in%ontinen%e poly-ri% priaprism. &emat blood dyserali%s, ?a-ndi%e, &epatotoxi%ity

Nursing Responsibilities ,efore 1. Assess patient@s %ardia, &epati% and renal /-n%tion. 2. Assess patient@s mental stat-s. 1. )on/irm medi%ation /rom do%tor@s orders. 5. Assess ot&er medi%ations ta,en by patient. 5. Assess patient@s '!). During 1. )on/irm patient@s identity. 2. Administer medi%ation at t&e rig&t pres%ribed ro-te. 1. 0o not go over t&e re%ommended dose. 5. ra%ti%e asepti% te%&niA-e. 5. Administer medi%ation be/ore or a/ter meals. After 1. !bserve proper do%-mentation o/ administered medi%ation. 2. Ens-re t&at patient &as /-lly s(allo(ed oral /orm o/ medi%ation. 1. !bserve patient@s be&avior %losely /or atleast 15-10 min-tes a/ter administration. 5. $onitor patient@s #/* t&ro-g&o-t

8ed-%ed e//e%ts o/bromo%riptine, g-ane t&idine, g-anadrel, levodopa. "n%reased ne-rotoxi%ity (it& lit&i-m 2rare4. 8ed-%ed ser-m levels (it& p&enytoin or in%reased p&enytoin toxi%ity. "n%reased ser-m %on%entrations (it& propranolol, s-l/adoxinepyrimet&amine. "n%reased ser-m levels o/ valproi% a%id. 8ed-%ed absorption (it& al-mini-m salts. 8ed-%ed e//e%ts o/ amp&etamines or in%reased ris, o/ psy%&oti% symptoms. 8ed-%ed e//e%ts and ex%essive anti%&olinergi% e//e%ts (it& benztropine, tri&e xyp&enidyl,biperiden, T)As, anti&istamines, disopyramide. )ource $"$*220114.$"$*.B*A:levomepramizine.$"$*. 8etrieved on C-ne 16, 2011 /rom &ttp://(((.mims.%om/-sa/dr-g/in/o/levomepromazine/DtypeE/-llFmtypeEgeneri%GA%tions

t&e t&erapy. 5. "nstr-%t patient to rest a/ter administration.