Greater Glasgow and Clyde Medicines

Oral Levomepromazine Replaced by Prochlorperazine in Adult Palliative Care

Key messages:

  • NHSGGC Palliative Care team is recommending a move to prochlorperazine (displacing oral levomepromazine 6mg tablets) as a second line treatment option for nausea and vomiting in adults in the palliative care setting.*
  • The recommended dose of prochlorperazine is:
    • Oral: 5-10mg two to three times daily
    • Buccal: 3-6mg twice daily, tablets to be placed high between upper lip and gum and left to dissolve
  • Prochlorperazine is available in the following preparations:
    • Oral tablet 5mg
    • Buccal tablet 3mg
    • Oral solution 5mg/5ml
  • Levomepromazine injection remains the anti-emetic of choice for ‘just in case’ medication, unless the patient is already stabilised on another anti-emetic.

 

Background:

Low dose oral levomepromazine was previously recommended within NHSGGC as a second line option for intractable nausea and vomiting in palliative care. Until recently, there has been no licensed oral levomepromazine product available and the use of an unlicensed 6mg tablet was recommended.

A licensed levomepromazine 6mg tablet has now been launched (£2401/28 tablets), meaning that unlicensed 6mg tablets can no longer be sourced. The licensed 6mg tablet has a significantly higher acquisition cost than the previous unlicensed product. This change has prompted the NHSGGC Palliative Care team to review their guidance for the treatment of nausea and vomiting.

Following careful consideration, the NHSGGC Palliative Care team has concluded that using oral prochlorperazine instead of oral levomepromazine is of comparable clinical effectiveness and the most cost effective option. Prochlorperazine has a similar (but not identical) spectrum of activity at receptors as levomepromazine.

*Please note this information relates to levomepromazine in palliative care only and currently not for chemotherapy induced nausea and vomiting.

 

Further information:
The GGC Adult Therapeutics handbook is under review and will be updated in due course

The West of Scotland ‘Chemotherapy Induced Nausea & Vomiting’ guidelines are currently being updated

Dictionary of medicines and device browser1 accessed 31/03/2021

 

Contacts for advice:

 

Published 12/04/2021. Medicines Update blogs are correct at the time of publication.