Use Of Levomepromazine Research Articles

Levomepromazine and Weaning from Sedation in Traumatic Brain Injured Patients

Background: Sedation is a key for the management of patients with traumatic brain injuries. However, in some of the brain injured patients, weaning from sedation is a real challenge. In this work, we aim to evaluate the use of Levomepromazine as a safe strategy for weaning from sedation in mechanically ventilated brain injured patients. Patients and Method: This is a prospective randomized controlled monocentric study carried out on patients admitted to the surgical ICU of the university hospital Ibn Rochd of Casablanca, between January 2022 and April 2022. The study included all mechanically ventilated patients over 18 years old admitted for traumatic brain injury. The patients were divided in two groups. The primary endpoint assessed was the need to resume sedation. Results: In our study, the average age was 30 years ± 10.9. 97% were men. Resumption of sedation was 73.3% in the control group compared to only 37,5% in the group who took levomepromazine. Agitation was significantly lower in the levomepromazine group 18.7% compared to 73,3% in the control group. The reasons of re-sedation in both groups were accidental extubation due to the agitation of the patient and also patient-ventilator asynchrony. The length of stay was reduced in the control group with 18,4 days versus 28,7 days in the levomepromazine group. Concerning the impact on ICU deaths, there was no significant difference. Conclusion: Levomepromazine has been shown through this work to reduce agitation in traumatic brain injured patients. ICU Death may not be influenced by the use of this molecule but it would reduce the need for prolonged or re-sedation.

Use of Levomepromazine for the Treatment of Emergence Agitation in Patients Receiving Mechanical Ventilation for SARS-CoV-2 Related Acute Respiratory Distress Syndrome

Purpose: To report our experience with the use of Levomepromazine (LMZ) for the treatment of delirium in patients treated for Acute Respiratory Distress Syndrome (ARDS) due to COVID-19. Methods: Retrospective series of patients admitted to the Intensive Care Unit (ICU) of a non-academic hospital and who requiring invasive mechanical ventilation for the treatment of ARDS due to SARS-CoV-2. Infection was confirmed by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) testing, and patients presented delirium after withdrawal of neuromuscular blockade or sedation lightening treated with LMZ on top of other treatment. Results: Out of 34 ARDS patients admitted from 22 March 2020 to 23 January 2021, 11 (32.3%) died before neuromuscular blockade withdrawal, and of the remaining 23, 16 were treated with LMZ. The median time to initiation of LMZ was 6 days (interquartile, 5 to 8) from the start of sedation, and median duration of LMZ treatment was 5 (1 to 28) days. Median sedation score (as assessed by the Sedation Agitation Scale (SAS)) was 2 (1-4) at initiation and 3 (2-4) at discontinuation of LMZ, while median analgesia scores (Behavioral Pain Scale (BPS)) were respectively 3 (3-5) and 4 (3-5). Of the 16 patients treated with LMZ, 12 were weaned from mechanical ventilation immediately following discontinuation, without recurrence of delirium. No adverse effects related to LMZ use were observed. The 4 patients who could not be weaned from mechanical ventilation following LMZ required new neuromuscular blockade. Conclusions: Based on this retrospective series, LMZ seems to be useful for the management of delirium occurring after withdrawal of neuromuscular blockade or lightening of sedation in patients with ARDS due to SARS-CoV-2.

The Use of Levomepromazine, a.k.a. Methotrimeprazine, a.k.a. Nozinan, in Child and Adolescent Psychiatry

Levomepromazine is rarely used in child and adolescent psychiatry. Four cases are described where extreme behavioural disturbance responded favourably and promptly to oral prescription. Two additional cases are described where ceasing levomepromazine led to early signs of what was probably tardive dyskinesia, resolving completely.

The effect of levomepromazine on the healthy and injured developing mouse brain – An in vitro and in vivo study

Levomepromazine (LMP) is a phenothiazine neuroleptic drug with strong analgesic and sedative properties that is increasingly used off-label in pediatrics and is being discussed as an adjunct therapy in neonatal intensive care. Basic research points towards neuroprotective potential of phenothiazines, but LMP’s effect on the developing brain is currently unknown. The aim of the present study was to assess LMP as a pharmacologic strategy in established neonatal in vitro and in vivo models of the healthy and injured developing mouse brain. In vitro, HT-22 cells kept exposure-naïve or injured by glutamate were pre-treated with vehicle or increasing doses of LMP and cell viability was determined. In vivo, LMP’s effects were first assessed in 5-day-old healthy, uninjured CD-1 mouse pups receiving a single intraperitoneal injection of vehicle or different dosages of LMP. In a second step, mouse pups were subjected to excitotoxic brain injury and subsequently treated with vehicle or LMP. Endpoints included somatometric data as well as histological and immunohistochemical analyses. In vitro, cell viability in exposure-naïve cells was significantly reduced by high doses of LMP, but remained unaffected in glutamate-injured cells. In vivo, no specific toxic effects of LMP were observed neither in healthy mouse pups nor in experimental animals subjected to excitotoxic injury, but body weight gain was significantly lower following higher-dose LMP treatment. Also, LMP failed to produce a neuroprotective effect in the injured developing brain. Additional studies are required prior to a routine clinical use of LMP in neonatal intensive care units.

Levomepromazine for nausea and vomiting in palliative care.

This is an updated version of the original Cochrane Review published in Issue 4, 2013, on Levomepromazine for nausea and vomiting in palliative care.Nausea and vomiting are common, distressing symptoms for patients receiving palliative care. There are several drugs which can be used to treat these symptoms, known as antiemetics. Levomepromazine is an antipsychotic drug is commonly used as an antiemetic to alleviate nausea and vomiting in palliative care settings. To evaluate the efficacy of, and adverse events associated with, levomepromazine for the treatment of nausea and vomiting in palliative care patients. For this update we searched electronic databases, including those of Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE, up to February 2015. We searched clinical trial registers on 7 October 2015 for ongoing trials. Randomised controlled trials of levomepromazine for the treatment of nausea or vomiting, or both, in adults receiving palliative care. We excluded studies in which symptoms were thought to be due to pregnancy or surgery. We assessed the potential relevance of studies based on titles and abstracts. We obtained copies of any study reports that appeared to meet the inclusion criteria for further assessment. At least two review authors read each paper to determine suitability for inclusion and discussed discrepancies in order to achieve a consensus. In the original review, we identified 421 abstracts using the search strategy. We considered eight studies for inclusion but ultimately excluded them all from the review. We updated the search in February 2015 and identified 35 abstracts, but again none met the inclusion criteria. We identified two trials from clinical trial registers, one of which is ongoing and one of which was closed due to poor recruitment. As in the initial review, we identified no published randomised controlled trials examining the use of levomepromazine for the management of nausea and vomiting in adults receiving palliative care, and our conclusion (that further studies of levomepromazine and other antiemetic agents are needed to provide better evidence for their use in this setting) remains unchanged. We did, however, identify one ongoing study that we hope will contribute to the evidence base for this intervention in future updates of this review.

Evidence for the use of Levomepromazine for symptom control in the palliative care setting: a systematic review.

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.

Use of Levomepromazine in the Management of Aggression in Adults with Intellectual Disability

(2008). Use of Levomepromazine in the Management of Aggression in Adults with Intellectual Disability. The British Journal of Development Disabilities: Vol. 54, No. 106, pp. 11-17.

The use of levomepromazine in Hyperemesis Gravidarum resistant to drug therapy—A case series

Hyperemesis Gravidarum (HG) is a potentially serious complication of early pregnancy, which may rarely be severe enough to warrant termination of pregnancy. HG requires prompt treatment with intravenous fluids, thiamine supplementation and appropriate anti-emetic therapy. Anti-histamines such as promethazine are favoured as first-line agents, with prochlorperazine being used as a second-line drug. However, there is no clear data as to the most appropriate drug if these are ineffective. A case series of six women who presented with HG resistant to drug treatment is described. In these cases, levomepromazine 6.25 mg tds was used to control HG. Five pregnancies progressed leading to live born infants with no evidence of congenital anomaly. One pregnancy resulted in an intra-uterine death with no external or ultrasound evidence of congenital anomaly. The role of phenothiazines in the pharmacological management of HG is discussed.

Emprego da levomepromazina no bloqueio da arritmia induzida pela adrenalina em cães anestesiados pelo Sevoflurano

Este experimento objetivou estudar o possível efeito antiarritmogênico da levomepromazina em cães anestesiados pelo sevoflurano e submetidos a doses crescentes de adrenalina. Para tal, foram empregados 21 animais adultos, machos e fêmeas, sem raça definida e considerados sadios. Os cães foram separados em dois grupos, sendo um de 11 (G1) e outro de 10 (G2) animais. O G1 recebeu, por via intravenosa, solução salina a 0,9%, na dose de 0,2ml/kg (placebo), seguida 15 minutos após, pela aplicação de tiopental, pela mesma via, na dose suficiente para abolir o reflexo laringotraqueal. Procedeu-se à intubação orotraqueal e iniciou-se a administração de sevoflurano a 2,5V%, em circuito anestésico semi-fechado. Decorridos 20 minutos da indução anestésica, iniciou-se a administração contínua, por via intravenosa, com emprego de bomba de infusão, de solução de adrenalina a 2%, em doses crescentes de 1, 2, 3, 4 e 5m g/kg/min (M1 a M5, respectivamente), com incremento da dose a intervalos de 10 minutos. Para o G2, empregou-se a mesma metodologia substituindo-se o placebo por levomepromazina, na dose de 1mg/kg. Foi tomado o traçado eletrocardiográfico, na derivação D2, a partir da indução da anestesia. Para efeito estatístico, foi considerado o número total de batimentos cardíacos de origem não sinusal, coincidentes com cada dose de adrenalina. Os dados numéricos foram submetidos à Análise de Perfil, quando foi possível constatar que as médias do G1 foram crescentes de M1 a M3, diminuindo a partir deste último, até M5. No G2, foi encontrada arritmia ventricular sustentada apenas em M5. Os achados permitiram concluir que a levomepromazina minimiza a arritmia ventricular sustentada, induzida pela adrenalina em cães anestesiados pelo sevoflurano.

Atividade antiarritmogênica da levomepromazina em cães submetidos à anestesia pela quetamina

Este experimento teve por objetivo avaliar a viabilidade do emprego da levomepromazina no bloqueio da atividade arritmogênica da adrenalina, em cães anestesiados pela quetamina. Para tal, foram utilizados 30 cães adultos, machos e fêmeas, considerados sadios, com pesos compreendidos entre 7 e 14kg. Estes foram divididos em 3 grupos de 10 animais (G1, G2 e G3). Aos cães de G1 foi administrada, por via intravenosa, adrenalina em doses de 3, 6, 9, 12 e 15 mg/kg, em intervalos de 10 minutos. Deste grupo, foram colhidos o tempo de duração do efeito da catecolamina (TA), estabelecido pela contagem da freqüência cardíaca e o número total de batimentos cardíacos de origem ectópica, produzidos pela adrenalina (ESV). Aos animais do G2, foi administrada solução salina a 0,9%, na dose de 0,2ml/kg, por via intravenosa, seguida, 10 minutos após, da injeção, pela mesma via, de quetamina, na dose de 2mg/kg. Decorridos 5 minutos, iniciou-se a infusão contínua de quetamina, por via intravenosa, na dose de 0,2mg/kg/min. Aguardou-se 5 minutos e iniciou-se a administração de adrenalina e colheita das variáveis, conforme protocolado para o G1. Aos animais do G3, aplicou-se a mesma metodologia, substituindo-se o placebo pela levomepromazina, administrada por via intravenosa, na dose de 1mg/kg. A análise dos resultados mostrou que a levomepromazina reduz a duração do efeito da catecolamina e minimiza o aparecimento de batimentos cardíacos de origem ectópica. Os achados permitiram concluir que a levomepromazina é útil no bloqueio da arritmia produzida pela adrenalina em cães anestesiados pela quetamina.

Emprego do metaraminol no bloqueio da hipotensão produzida pelo uso da levomepromazina em cães

Avaliou-se a possibilidade do uso do bitartarato de metaraminol, visando o bloqueio da hipotensão produzida pelo cloridrato de levomepromazina em cães. Foram empregados 20 cães, machos e fêmeas, adultos, com pesos compreendidos entre 8 e 12 kg. Os animais foram divididos em dois grupos iguais (GI e GII). Aos cães do GI foi administrada, por via intravenosa, levomepromazina na dose de 2 mg/kg, seguida, 15 minutos após, de 0,5 ml de solução salina 0,9%. A pressão arterial sistólica (PAS), frequências cardíaca (FC) e respiratória (FR), temperatura retal (T) e avaliação eletrocardiográfica na derivação DII foram observadas antes da aplicação da levomepromazina e após a mesma, em intervalos de 15 minutos durante 60 minutos. Aos cães do GII foi aplicada a mesma metodologia, substituindo-se, porém, a solução salina pelo metaraminol na dose de 0,1 mg/kg, pela via intravenosa. Os valores obtidos foram submetidos à avaliação estatística pelo método de Análise de Perfil. Os resultados mostraram que o metaraminol produziu um aumento da PAS e diminuição da FC, além de promover menor queda da T e melhora dos valores de FR. Não foram observadas alterações na eletrocardiografia que pudessem ser atribuídas aos fármacos empregados. Concluiu-se que o metaraminol é seguro e indicado quando se emprega a levomepromazina, em cães.