LEVOMEPROMAZINE X EOL CARE TERMINAL AGITATION

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SARAJU NADI 

Levomepromazine (also known as methotrimeprazine) is a commonly used medication in end-of-life (EOL) care, especially in pediatric and adult palliative care settings. It is a multi-purpose phenothiazine derivative with sedative, antiemetic, and antipsychotic properties.

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🟣 Uses of Levomepromazine in EOL Care

1. Terminal Agitation / Delirium

   • Used for severe agitation, restlessness, or confusion in the dying phase.

   • Often given when other agents (e.g., midazolam or haloperidol) are inadequate.

2. Nausea and Vomiting

   • Broad-spectrum antiemetic, especially useful when cause is multifactorial or unclear.

3. Pain Management (Adjuvant)

   • Occasionally used as an adjuvant when pain is difficult to control with opioids alone.

4. Sedation / Palliative Sedation

   • Used in low doses for light sedation, or higher doses for palliative sedation in refractory distress.

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🔶 Common Routes & Dosing (Pediatric)

Indication	Route	Dose (General Pediatric Guidance)
Agitation / Sedation	SC / IV / Oral	Start with 0.1–0.5 mg/kg/dose every 8–12 hrs (max 25–50 mg/day)
Antiemetic	Oral / SC	0.1 mg/kg/dose (1–3 times/day)

💡 Note: Titration should be slow and based on response and tolerability. Always consult local protocols or palliative specialists for pediatric dosing.

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⚠️ Key Safety Points

• Can cause hypotension, sedation, extrapyramidal symptoms, and anticholinergic effects.

• Monitor for QT prolongation and use caution in hepatic impairment.

• May potentiate the effects of other CNS depressants (e.g., opioids, benzodiazepines).

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