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Palliative cancer care - nausea & vomiting - Management
What issues do I need to be aware of before prescribing levomepromazine?
- Levomepromazine is usually used as a second- or third-line anti-emetic because of its sedative effect.
- Levomepromazine may be given orally but is generally given by the subcutaneous route. It is usually given once a day but some people may benefit from dividing the daily dose to twice or three times a day, or from continuous subcutaneous infusion.
- When converting from the oral route to the subcutaneous route the dose should be divided by two.
- Levomepromazine 6 mg tablets are an off-licence preparation and are available on a named-patient basis only. They can be ordered direct from the manufacturer (but this can take up to 48 hours) or they may be available through the local palliative care team or hospice.
- If the 6 mg tablets are not available, experts suggest using a quarter of a 25 mg tablet (i.e. 6.25 mg).
- Adverse effects include sedation (particularly at doses of 25 mg or more in 24 hours), dose-dependent postural hypotension, and antimuscarinic adverse effects (dry mouth, sedation, and blurred vision). Doses less than 12.5 mg daily do not usually cause problems.
[Twycross et al, 2002]
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