Abstract
BackgroundLevomepromazine is an antipsychotic drug that is used clinically for a variety of distressing symptoms in palliative and end-of-life care. We undertook a systematic review based on the question “What is the published evidence for the use of levomepromazine in palliative symptom control?”.MethodsTo determine the level of evidence for the use of levomepromazine in palliative symptom control, and to discover gaps in evidence, relevant studies were identified using a detailed, multi-step search strategy. Emerging data was then scrutinized using appropriate assessment tools, and the strength of evidence systematically graded in accordance with the Oxford Centre for Evidence-Based Medicine’s ‘levels of evidence’ tool. The electronic databases Medline, Embase, Cochrane, PsychInfo and Ovid Nursing, together with hand-searching and cross-referencing provided the full research platform on which the review is based.Results33 articles including 9 systematic reviews met the inclusion criteria: 15 on palliative sedation, 8 regarding nausea and three on delirium and restlessness, one on pain and six with other foci. The studies varied greatly in both design and sample size. Levels of evidence ranged from level 2b to level 5, with the majority being level 3 (non-randomized, non-consecutive or cohort studies n = 22), with the quality of reporting for the included studies being only low to medium.ConclusionLevomepromazine is widely used in palliative care as antipsychotic, anxiolytic, antiemetic and sedative drug. However, the supporting evidence is limited to open series and case reports. Thus prospective randomized trials are needed to support evidence-based guidelines.
Highlights
Levomepromazine is an antipsychotic drug that is used clinically for a variety of distressing symptoms in palliative and end-of-life care
This review aimed to summarise and update the available evidence for the use of the “all-rounder” levomepromazine/methotrimeprazine for patients in the palliative care setting with a special focus on symptom control at the end of life
As a consequence of this review we can summarize that there exists some low-grade evidence for the use of levomepromazine for several indications in the palliative care setting
Summary
Levomepromazine is an antipsychotic drug that is used clinically for a variety of distressing symptoms in palliative and end-of-life care. Patients with advanced disease approaching the end of life often suffer from symptoms that impair their own and their families quality of life [1,2] Alleviation of these symptoms, through a multi-dimensional and inter-professional palliative care approach, includes pharmacotherapy as an essential component. One drug widely used in the palliative care setting is levomepromazine in Europe and methotrimeprazine in the United States (trade names Neurocil, Nozinan, Nosinan or Levoprome). This aliphatic phenothiazine is a neuroleptic with low antipsychotic potency first used in psychiatry for the treatment of schizophrenia [8]. For most of the above indications the clinical use of levomepromazine is off-label by application in many countries [20] and published evidence is scarce
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