Levomepromazine: uses and side effects of this drug.

A neuroleptic drug used primarily to combat positive psychotic symptoms.

Throughout history many drugs have been developed to combat the symptoms and disturbances caused by many disorders and disturbances of the psyche. Antidepressants and anxiolytics are unfortunately not uncommon, given the high prevalence of the problems they treat.

Another problem, which is well known and generates a high level of suffering, is schizophrenia. Fortunately for schizophrenia there are also drugs that contribute to the treatment of its symptoms. Among them is levomepromazineof which we are going to speak next.

What is levomepromazine?

Levomepromazine is a high potency psychopharmaceutical classified as an antipsychotic or neuroleptic drug. as an antipsychotic or neuroleptic drug.which is part of the phenothiazine chemical family.

As such, levomepromazine is effective in the treatment of the symptoms of schizophrenia and other psychotic disorders and other psychotic disorders, especially in the productive clinical symptoms such as delusions, hallucinations and agitation.

Among the antipsychotics, this substance is part of the so-called typical, classical or first generation antipsychotics.

This subtype of antipsychotic was the first to be synthesized, and is characterized because it is highly effective in treating psychotic symptomatology. treating positive psychotic symptomatology (lease that which introduces elements in the psychic functioning of the subject, such as the aforementioned hallucinations or delusions) even though they unfortunately produce bothersome and even in some cases dangerous secondary symptoms.

Moreover, they have no effect on and may even worsen negative symptomatologyor that which is characterized by the deterioration or loss of previously present functionalities: impoverishment of language, abulia and affective flattening and impoverishment of thought or alogia.

Levomepromazine has sedative and tranquilizing action, as well as analgesic, and is one of the oldest antipsychotics. Also has antihistaminic and antispasmodic properties.. It is absorbed in the intestine, metabolized mainly in the liver and excreted in the urine.

It can be found in different presentations including tablets and drops for oral administration or in the form of injectables for intravenous administration. One of the main brand names is Sinogan.

Mechanism of action

Levomepromazine acts in our brain by altering the chemistry of the organism, causing an effect on the levels of neurotransmitters that our neurons emit.

Specifically, the action of this drug is due to the fact that we are dealing with a dopaminergic antagonistwhich blocks the D2 receptors of the neurons of the brain in such a way that the neurons stop capturing it to a great extent and its levels are reduced.

This is of great utility in the treatment of agitation and positive symptoms, since it has been seen that in schizophrenia there is an excess of dopamine in the mesolimbic pathway of the brain and that such excess is linked to the appearance of agitation, hallucinations and delusions..

However, the action of this drug and that of the other classic neuroleptics is non-specific, in such a way that they also decrease dopamine levels in brain areas that do not have any excess of dopamine or that may even have a deficit (something that occurs precisely in the mesolimbic pathway when there are negative symptoms), so that secondary symptoms such as the motor or sexual symptoms mentioned above may appear.

In addition to this, it also alters the levels of histamine, adrenaline and acetylcholine, which can also cause secondary symptoms.which can also cause harmful secondary symptoms.

Main medical uses

As one of the typical antipsychotics, levomepromazine has as its main indication the treatment of all those conditions in which psychotic symptoms occur. Its most relevant indications are schizophrenia, acute psychoses and paranoid states.. But schizophrenia and psychotic disorders are not the only indications for this drug.

It also has an important effect on algesia or pain sensitivity, being a potent analgesic that allows to treat pain of moderate to severe intensities of different conditions.

In this sense, another of its most relevant indications is found in palliative care, specifically in those patientsspecifically in those patients who are in the terminal phase. Levomepromazine helps to treat agitation, delirium and states of confusion and nervousness in these patients, especially when associated with pain.

It has even been used in some states of anxiety, depression, bipolar episode or obsessive-compulsive disorder, although today there are many safer and much more useful drugs for these conditions.

Side effects

Although it is effective in treating various conditions, the truth is that levomepromazine can generate really annoying side effects or even be dangerous for the physical integrity of the person (although these are less frequent).

Among the most common side effects are drowsiness or weight gain.. Other less frequent side effects can be hyperglycemia and the modification of glucose tolerance, the provocation of tardive dyskinesia or involuntary performance of repetitive movements, generally of the chewing type. It can generate sexual dysfunctions such as erectile dysfunction or loss of libido, as well as hyperprolactinemia.

In some cases it also favors breast growth in men or lack of menstruation. Hyperglycemia or hyponatremia (low blood sodium levels), as well as antidiuretic hormone alterations, may be possible. Also seizures and Parkinsonian symptoms.

Some more dangerous reactions may include possible pulmonary embolism, thrombosis, jaundice, agranulocytosis or leukopenia (these two conditions involving decreased levels of essential blood elements, respectively granulocytes and leukocytes).

It can generate hepatic damages, alterations of the cardiac rhythm as arrhythmias, bradycardias or tachycardias, enterocolitis (life-threatening) or the (life-threatening) or the potentially fatal neuroleptic malignant syndrome.

Contraindications

The adverse effects and the alteration that levomepromazine generates in the organism can become dangerous for some sectors of the population, which will have this drug contraindicated.

First of all, it should be noted that this drug is contraindicated for those who are or have been allergic to it or to any of its components.

Pregnant and lactating women should also avoid this drug.or at least consult a doctor about the suitability of taking it or change the drug if necessary.

It is contraindicated in patients with glaucoma, Parkinson's disease or porphyria. Its administration with other drugs should be avoided or consulted (especially if levodopa is consumed), and its consumption with alcohol is contraindicated.

It is contraindicated or should be monitored in patients who have had cardiovascular, renal or hepatic alterations (especially if renal or hepatic failure has occurred).

It is also not recommended in diabetic patients (since it affects blood glucose levels) or subjects with problems such as thrombi or embolisms. Epileptic patients should be monitored and controlled due to the risk of generating new seizures or reducing the activation threshold that generates seizures.

It should be avoided in the elderly, especially if they suffer from any type of dementia, since it may increase the probability of premature death.