What conditions is Cutilor (generic name unknown) 5 mg used for?

Cutilor 5 mg: Uses and Indications

Based on the available evidence, Cutilor 5 mg appears to be levomepromazine (methotrimeprazine), which is primarily used for the management of delirium symptoms in adult cancer patients.

Primary Indication

Levomepromazine (Cutilor) 5 mg is a first-generation antipsychotic medication used for:

• Management of delirium symptoms in adult patients, particularly those with cancer 1
• Control of problematic delusions, hallucinations, severe psychomotor agitation, and combativeness 1

Dosage and Administration

• Starting dose: 5-12.5 mg orally or subcutaneously as needed
• PRN dosing: 5-12.5 mg orally/subcutaneously every 2 hours as needed
• For scheduled dosing: Every 8-12 hours
• Lower doses (e.g., 2.5 mg) should be used in older or frail patients with gradual titration 1
• In some countries, tablets are available in 6 mg dose rather than 5 mg 1

Pharmacological Properties

Levomepromazine (Cutilor) is a first-generation antipsychotic with:

• Sedating properties
• Anticholinergic effects
• Potential for extrapyramidal side effects (EPSEs)
• Risk of orthostatic hypotension
• Potential for paradoxical agitation 1

Important Side Effects and Precautions

• Sedation (significant effect)
• Anticholinergic effects
• Extrapyramidal symptoms
• Orthostatic hypotension
• Paradoxical agitation
• Subcutaneous injection may cause local irritation 1

Clinical Considerations

• Levomepromazine should be used cautiously in elderly patients, starting with lower doses (2.5 mg)
• It should be avoided in patients with Parkinson's disease or dementia with Lewy bodies due to risk of extrapyramidal symptoms
• The medication has significant sedating properties, which may be beneficial or problematic depending on the clinical situation
• Careful monitoring for orthostatic hypotension is necessary, especially when initiating therapy

Alternative Medications

For similar indications (delirium management), alternatives include:

1. Other first-generation antipsychotics:

   • Haloperidol: 0.5-1 mg orally or subcutaneously 1
   • Chlorpromazine: 12.5-25 mg orally or per rectum 1

2. Second-generation antipsychotics:

   • Olanzapine: 2.5-5 mg orally or subcutaneously 1
   • Quetiapine: 25 mg (immediate release) orally 1
   • Risperidone: 0.5 mg orally 1

Common Pitfalls and Caveats

• Avoid using in patients with Parkinson's disease or Lewy body dementia due to risk of severe extrapyramidal symptoms
• Monitor for orthostatic hypotension, especially in elderly patients
• Be aware of the significant sedating effects, which may be problematic in some patients
• Subcutaneous injection may cause local irritation
• Start with lower doses in elderly or frail patients to minimize adverse effects

The evidence strongly suggests that Cutilor 5 mg is levomepromazine (methotrimeprazine), primarily used for managing delirium symptoms in adult patients, particularly those with cancer.