Nozinan (Levomepromazine Maleate)

Levomepromazine, the active ingredient in Nozinan, is a phenothiazine presented as a 25 mg tablet for oral use. It is employed in the management of severe agitation, psychotic disorders, and palliative care symptom control in adult patients.

GNH USA supplies Nozinan as a licensed, GDP‑compliant international pharmaceutical supplier serving hospitals, oncology centres and pharmacies worldwide.

Levomepromazine is a broad‑spectrum antipsychotic that acts on multiple neurotransmitter pathways, particularly dopamine and serotonin receptors.

- Severe agitation and psychosis: helps calm acute episodes in adult psychiatric patients. - Nausea and vomiting in palliative care: reduces refractory symptoms when other anti‑emetics fail. - Painful muscle spasm and terminal delirium: provides sedation and comfort in end‑of‑life settings.

Levomepromazine may cause a range of adverse reactions, from mild to potentially life‑threatening.

Common Side Effects: - Drowsiness: increased sleepiness or fatigue. - Dry mouth: reduced salivation causing discomfort. - Orthostatic hypotension: light‑headedness on standing. - Constipation: slowed gastrointestinal motility. - Blurred vision: temporary visual disturbances. - Weight gain: increased appetite and body weight.

Serious or Rare Side Effects: - Extrapyramidal symptoms: muscle rigidity, tremor or akathisia. - Neuroleptic malignant syndrome: high fever, rigidity and autonomic instability. - Severe hypotension: sudden drop in blood pressure. - Cardiac arrhythmias: irregular heart rhythm, especially QT prolongation. - Agranulocytosis: markedly reduced white‑blood‑cell count. - Hepatotoxicity: liver enzyme elevation or injury.

Before initiating Levomepromazine therapy, clinicians should assess patient‑specific risk factors and monitor for adverse events.

- Cardiovascular assessment: evaluate for pre‑existing hypotension or cardiac disease. - Metabolic screening: check liver and renal function prior to treatment. - CNS monitoring: observe for excessive sedation or extrapyramidal signs. - Drug‑interaction review: avoid concurrent use with other strong dopamine antagonists. - Pregnancy and lactation: weigh benefits against potential fetal or neonatal risks. - Store at below 25°C: keep in the original container, protect from moisture and light.

Levomepromazine interacts with several drug classes; careful review is essential to minimise adverse outcomes.

Major Interactions (Avoid): - Other antipsychotics: additive dopamine blockade increasing extrapyramidal risk. - QT‑prolonging agents: combined effect may precipitate serious arrhythmias. - CNS depressants (e.g., benzodiazepines, opioids): heightened sedation and respiratory depression.

Moderate Interactions (Monitor Closely): - Antihypertensives: may amplify orthostatic hypotension. - Anticholinergic drugs: increase risk of severe dry mouth and constipation. - CYP2D6 inhibitors: can raise levomepromazine plasma levels, requiring dose adjustment.