Maximum Dosing of Nozinan (Levomepromazine) for a 72-Year-Old Patient
For a 72-year-old patient, the maximum dose of Nozinan (Levomepromazine) on a PRN basis should be 6.25-12.5 mg per dose with a maximum of 100 mg per 24 hours, with doses exceeding 100 mg requiring specialist supervision.
Dosing Guidelines for Elderly Patients
- For elderly patients (72 years old), the recommended starting dose of levomepromazine for delirium management is 6.25-12.5 mg subcutaneously as needed 1
- Doses can be administered hourly as required, but should be reduced in elderly or frail patients compared to standard adult dosing 1
- For maintenance therapy, a subcutaneous infusion of 50-200 mg over 24 hours can be used, with the dose increased according to response 1
- Doses exceeding 100 mg over 24 hours should only be given under specialist supervision 1
Administration Routes and Considerations
- Levomepromazine can be administered orally or subcutaneously, with subcutaneous being preferred when patients are unable to swallow 1
- When administered subcutaneously, levomepromazine is stable for at least 14 days when diluted with 0.9% sodium chloride at concentrations ranging from 0.13 to 6.25 mg/ml 2
- The medication can be safely administered in a continuous subcutaneous infusion with most other commonly used drugs in palliative care 3
Special Considerations for Geriatric Patients
- Elderly patients are more sensitive to the sedative and hypotensive effects of levomepromazine, necessitating lower starting doses 1
- Monitor for orthostatic hypotension, which is a common side effect, especially in elderly patients 1
- Be aware of potential extrapyramidal side effects (EPSEs), which may be more pronounced in elderly patients 1
- Anticholinergic effects may be particularly problematic in the elderly population and should be monitored 4
Monitoring Recommendations
- Monitor for sedation, which is a common side effect that may be more pronounced in elderly patients 1, 4
- Assess for signs of paradoxical agitation, which can occur with levomepromazine 1
- Be vigilant for subcutaneous injection site irritation, which can occur with levomepromazine administration 1
- Consider concomitant use of midazolam if the patient also has anxiety, but be cautious about potential respiratory depression 1
Clinical Applications
- Levomepromazine has shown efficacy in managing delirium in patients who are unable to swallow 1
- It has also demonstrated effectiveness as a rescue medication for high-grade delayed chemotherapy-induced emesis at doses of 25 mg/24 hours subcutaneously 5
- The medication has combined antipsychotic, anxiolytic, and sedative actions that can be beneficial in the terminal phase of many illnesses 3
Cautions and Contraindications
- Avoid rapid dose escalation in elderly patients due to increased risk of adverse effects 1
- Be cautious when using in patients with renal impairment, though specific dose adjustments for renal function are not well established 1
- Monitor for drug interactions, particularly with other CNS depressants which may enhance sedative effects 1
- Consider alternative agents if the patient has severe cardiovascular disease due to potential hypotensive effects 1