Name of the medicine:

Levomepromazine is available as a 6 mg, 6.25 mg or 25 mg tablet, as an oral solution, and as a solution for injection.

The information given in this leaflet should be read along with any patient information leaflet provided by the manufacturer with your medicine. Click Search Results - (emc) (medicines.org.uk)

What is it for?

Levomepromazine can be used to treat vomiting and feelings of being sick (nausea).  

Levomepromazine is also used for the treatment of agitation and acute confusion (delirium) in palliative care patients.

Most medicines available in the UK have a licence. The licence describes the conditions the medicine can be used to treat, and the ways in which the medicine can be given. The manufacturer of the medicine has to show that the medicine is safe and made to a high standard before the medicine is licenced.

Use of levomepromazine for nausea and vomiting, and how you have been told to take it, is outside its licence. There is experience and research to support the use of levomepromazine in this way. The person who prescribed your medicine will have carefully considered the benefits for you.

The information in this leaflet is not included in the information leaflet supplied with the medicine.

We are giving you this extra leaflet to tell you about the reason(s) why you are taking this medicine and to highlight other information. You should read both leaflets. 

What form(s) of this medicine are there and how is it usually taken?

Levomepromazine is available in tablets, oral solution and injection form. 

For nausea and vomiting

The usual starting dose of the tablet form is 3 mg by mouth. The tablet is 6 mg and needs to be split in half to give you the right dose of 3 mg. The unused half should be safely discarded into your general waste bin. You can request a pill cutter from the pharmacy to make this easier.

Alternatively, the oral solution can be used. The usual starting dose for the oral solution is 2.5 mg/2.5 ml of Levorol 5 mg/5 ml oral solution. The solution has an orange smell. A 10 ml oral syringe with black lines marking 0.5 ml and 1 ml amounts and a “Press- In” Bottle Adapter (PIBA) are provided with the product. The solution expires 3 months after the bottle is opened. Any remaining medication should be returned to your pharmacy for safe disposal.

If you are unable to swallow or unable to keep the medication down due to vomiting, 2.5 mg can be administered by a nurse using a subcutaneous (under the skin) injection.

The medicine can be taken every 4 to 6 hours when you have nausea and vomiting.   

For agitation and delirium

The starting dose for agitation or delirium will be higher, usually between 5 mg and 6.25 mg depending on the forms of the medicine available and the severity of the distress you are experiencing. It can be given every 2 to 4 hours as needed. How you take the dose will depend on the form of medicine that you have been given.

Tablet medication

Many tablets that can be split have a line down the middle that makes it easier to split.  This line is called a score. Splitting the tablet means the right dose can be taken.

6 mg tablet (scored)

The usual dose is 3 mg (half a 6 mg tablet) or 6 mg, which is swallowed. The tablet should start to work within 30 minutes. It may take a little longer to get into your body.

25 mg tablet (scored)

The usual dose with this tablet is 6.25 mg (quarter of a tablet) which can either be swallowed or placed under your tongue and allowed to dissolve. The tablet should start to work in 30-60 minutes.

What are the most common side effects I might experience?

You may experience side effects when you take levomepromazine.

The most common side effects are sleepiness and feeling dizzy or faint especially when getting up from a lying or sitting position. This will usually pass on its own but if it does not, tell your doctor.

Other side effects include restlessness or unusual muscle movements. If you notice this let your doctor or nurse know.

You may experience a dry mouth. Keeping your teeth and mouth clean will help, along with having regular small sips of water.

You should contact your doctor or nurse if side effects become troublesome.

What other information should I know about this medicine?

Please remember to order your repeat prescription with a few days spare, to allow it to be processed.

It is important not to order more medication than you need. Even if you return them to the pharmacy in future, they cannot be reused after they have been labelled for your use and must be disposed of.

Your medication needs to be kept in a safe place out of the reach of children.

It is important to store your medication in the original container.

Return ALL unused medication to a pharmacy.

If for any reason a you or your carer are UNABLE to go to the pharmacy, medication can be disposed of at home. However, it is important NOT to flush it down the toilet as this pollutes the water. Medication can be disposed of in a general waste bin, ensuring that cannot be accessed by children or animals, although disposal at a pharmacy is preferable.

Alcohol

It is best to avoid alcohol as it may make you feel very sleepy.

Driving

There is a risk of feeling drowsy when you are taking this medicine. If this happens do not drive.  You should also not operate any machinery if you feel drowsy.

https://www.nhsinform.scot/care-support-and-rights/palliative-care/practical-help-and-advice/driving-when-taking-strong-painkillers

Sunlight

It is useful to wear sunscreen (preferably high protection Factor 50) if you go outside on a sunny day, as levomepromazine can make your skin more sensitive to the effects of the sun. 

Any other important information?

Levomepromazine can be an effective anti-sickness medication, but it may not help with all types of nausea and vomiting. Other treatments may be needed and can be discussed with your doctor or nurse.

Tell your doctor before you are prescribed levomepromazine if you or someone else in your family has a history of blood clots. Medicines like these have been associated with the formation of blood clots.

If you have Parkinson’s disease (a condition in which parts of the brain become progressively damaged over many years), this medicine may worsen your symptoms. Make sure your doctor knows you have this condition before you are prescribed levomepromazine.