An antipsychotic also used in palliative care

Levomepromazine

A sedating antipsychotic used in psychosis but, in UK practice, most often in palliative care for nausea, agitation and distress.

What is Levomepromazine?

Levomepromazine is a first-generation antipsychotic that, in UK practice, is most widely used in palliative care to relieve nausea and vomiting, agitation and restlessness, and to settle distress near the end of life. It is very sedating and can lower blood pressure on standing. It can be given by mouth or by injection, including via a syringe driver.

Education and reference only. This is a plain-language guide to Levomepromazine — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.

Written by Meds Global Health Clinical Team · Clinically reviewed by Dr Muhammad Suffyan, MB BS, Founder & Clinical Director · Last reviewed · How we review
Class: Antipsychotics → Brands: Nozinan
Levomepromazine (Antipsychotics) — Meds Global Health reference card with 2D molecular structure
Levomepromazine — Antipsychotics. The image shows the active ingredient's 2D molecular structure.

What it is

Levomepromazine is a first-generation ('typical') antipsychotic from the phenothiazine group. Although it can be used in psychosis, in UK practice it is best known as a palliative care medicine: it is widely used to control nausea and vomiting, to settle agitation, restlessness or terminal distress, and sometimes to help with pain. It is markedly sedating, which is often helpful in this setting, and can be given by mouth or by injection, including continuously through a syringe driver.

How it works

Levomepromazine blocks a broad range of receptors in the brain, including dopamine receptors (which underlies its antipsychotic and anti-sickness effects) and several others involved in alertness, blood pressure and the vomiting reflex. Acting on the brain's vomiting centre helps control nausea from many causes, while its blocking of histamine and other receptors produces strong sedation and calming. This wide action is why it is useful in palliative care but also why it is so sedating and can lower blood pressure.

Company & origin

Originated / developed by: Rhône-Poulenc (now Sanofi).

Levomepromazine (also known as methotrimeprazine) is a first-generation antipsychotic from the phenothiazine group. While it can be used in psychosis, in UK practice it is best known and very widely used in palliative care, where its calming, anti-sickness and pain-modifying effects are valued.

Practical use

How to take Levomepromazine

General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.

  • Follow your prescriber's or palliative care team's instructions closely — it may be given as tablets, an oral liquid, or by injection, including through a syringe driver.
  • Expect drowsiness; this is often a wanted effect in palliative care but means extra care is needed with moving about and with any tasks needing alertness.
  • Stand and move slowly, and accept help when getting up, as it can cause dizziness or fainting from a drop in blood pressure.
  • If used regularly, do not stop it abruptly without medical advice.
  • Carers should report any new high fever, marked muscle stiffness, confusion or sweating straight away.
  • Tell the team about all other medicines, as several add to drowsiness or affect heart rhythm.

Weighing it up

Advantages & disadvantages of Levomepromazine

Advantages

  • Very useful in palliative care, tackling several distressing symptoms at once — nausea, agitation and restlessness.
  • Can be given by injection or syringe driver when someone cannot take tablets, which is valuable near the end of life.
  • Its strong sedating, calming effect is often exactly what is needed for terminal agitation or distress.

Disadvantages

  • Very sedating, which may be unwanted outside palliative care and limits its use as a routine antipsychotic.
  • Commonly causes a drop in blood pressure on standing, with a risk of dizziness and falls.
  • Shares the movement-related and other side effects of first-generation antipsychotics.
  • Needs careful supervision and is generally not a first-choice antipsychotic for long-term psychosis.

Practical use

Good to know

Levomepromazine is very sedating, so drowsiness is expected and is often part of why it is used in palliative care. It can cause a drop in blood pressure on standing, leading to dizziness or falls, so people are encouraged to move slowly and may need help getting up. In palliative care it is frequently given by injection or through a syringe driver, alongside other symptom-control medicines. Like all antipsychotics it can rarely cause neuroleptic malignant syndrome — a high fever with muscle stiffness, confusion and sweating is a medical emergency. It is not stopped abruptly when used regularly without medical advice.

Who should not take it / use with caution

  • People who are markedly drowsy or have a greatly reduced level of consciousness, or who have certain blood disorders.
  • People with very low blood pressure prone to fainting, used only with great caution; care also with significant heart-rhythm problems.
  • Used cautiously in older people, in Parkinson's disease, and in those with epilepsy, liver disease or a history of blood clots; outside palliative care it is especially sedating for non-bedbound people.

Monitoring

  • Symptom control (nausea, agitation, distress) and level of sedation
  • Blood pressure and any dizziness or falls
  • Movement side effects and any signs of the rare serious reaction (high fever with stiffness)

Side effects

  • Marked drowsiness and a drop in blood pressure on standing, causing dizziness or fainting.
  • Dry mouth, blurred vision, constipation, and movement effects such as stiffness, tremor or restlessness.
  • Rarely, an effect on heart rhythm (QT prolongation), and very rarely neuroleptic malignant syndrome — high fever with stiffness and confusion, which is a medical emergency.

Key interactions

  • Other sedating medicines — opioids, benzodiazepines, alcohol and sedating antihistamines — add strongly to drowsiness.
  • Other blood-pressure-lowering medicines increase the risk of dizziness and fainting on standing.
  • Medicines that affect heart rhythm (some antibiotics, antiarrhythmics and other antipsychotics) increase the risk of QT problems; anticholinergic medicines worsen dry mouth and constipation.

Available as: Tablets and an oral liquid taken by mouth, and a solution for injection, including continuous use through a syringe driver in palliative care.

Answers

Levomepromazine: frequently asked questions

Why is levomepromazine used so much in palliative care?

It tackles several distressing symptoms at once — nausea and vomiting, agitation and restlessness — and its calming, sedating effect is often helpful near the end of life. It can also be given by injection or syringe driver when someone can no longer swallow, which makes it very practical in this setting.

Will it make me very drowsy?

Yes, drowsiness is expected and is one of the main effects of levomepromazine. In palliative care this calming effect is often wanted. If it is used in other situations, the sedation can be limiting, and extra care is needed with moving about and with tasks needing alertness.

Why do I feel dizzy when I stand up on it?

Levomepromazine can lower blood pressure, particularly when you stand, which causes dizziness and can lead to falls. Move slowly, sit on the edge of the bed before standing, and accept help getting up. Report frequent dizziness or any faints to your care team.

What serious reaction should carers watch for?

A rare but serious reaction to antipsychotics is neuroleptic malignant syndrome. Warning signs include a high fever, marked muscle stiffness, confusion, sweating and a fast heartbeat. This is a medical emergency — seek urgent help straight away if these develop.

Can it be given as an injection?

Yes. As well as tablets and liquid, levomepromazine can be given by injection and is often delivered continuously through a syringe driver in palliative care, alongside other symptom-control medicines, when taking tablets is no longer possible.

The wider class

About Antipsychotics

Levomepromazine belongs to the antipsychotics class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.

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Authoritative sources

  • BNF: Levomepromazine.
  • NICE CKS: Antipsychotics.

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