Methotrimeprazine Hydrochloride, NOZINAN®

• NOZINAN®

• Neuroleptic

• Tablets: 2 mg, 5 mg, 50 mg
• Injection: 25 mg/mL

• Anxiety and tension:
  • Autonomic disturbances
  • Personality disturbances
  • Emotional troubles secondary to such physical conditions as resistant pruritus, etc.
• As an analgesic:
  • Management of terminal pain and accompanying restlessness or distress
  • Trigeminal neuralgia
  • Neurocostal neuralgia
  • Phantom pains and muscular discomforts
  • Cancer pain
  • Zona pain
• As a potentiator of anesthetics:
  • Pre- and post-operative sedative and analgesic.
• As an antiemetic:
  • For the treatment of nausea and vomiting of central origin.
• As a sedative:
  • For the management of insomnia.
• Psychotic disturbances:
  • Acute and chronic schizophrenias
  • Senile psychoses
  • Manic depressive syndromes

• Liver P450 2d6 enzyme

Oral:

• 5 to 50 mg po Q4-8h

Injection:

• Psychosis:
  • 75 to 100 mg given as 3 or 4 deep i.m. injections in a large muscle.
• Pre and post-operative analgesic:
  • 75 to 100 mg given as 3 or 4 deep i.m. injections in a large muscle.
  • When given as a premedication or post-operative analgesic, the average dose varies from 10 to 25 mg every 8 hours, which is equivalent to 20 to 40 mg given orally.
  • The last dose during premedication, given 1 hour before surgery, can be 25 to 50 mg i.m.
• during surgery or labour:
  • 10 to 25 mg in 500 mL of a 5% glucose solution administered at a rate of 20 to 40 drops/minute.

• Nozinan® potentiates the action of other phenothiazines and CNS depressants (barbiturates, analgesics, narcotics and antihistaminics). The usual doses of these agents should be reduced by 50% if they are to be given concomitantly with Nozinan® until the dosage of the latter has been established.
• Nozinan® and its non-hydroxylated metabolites are reported to be inhibitors of cytochrome P450 2D6. Coadministration of Nozinan and drugs primarily metabolized by the cytochrome P450 2D6 enzyme system may result in increased plasma concentrations of these drugs

• CNS:
  • Drowsiness
• Extrapyramidal effects
• Autonomic Nervous System:
  • Dryness of the mouth and, in older patients, occasional urinary retention and tachycardia.
• Cardiovascular:
  • Orthostatic hypotension (at the start of treatment by the parenteral route)
  • Very rare cases of QT interval prolongation have been reported.
  • Tachycardia
  • There have been isolated reports of sudden death, with possible causes of cardiac origin
• Vascular disorder:
  • Cases of venous thromboembolism, including cases of pulmonary embolism
• Blood:
  • Agranulocytosis
  • Neutropenia
• Endocrine:
  • Weight gain
  • Hyperglycaemia or intolerance to glucose
• Gastrointestinal:
  • Rare cases of cholestatic jaundice without liver damage have been observed.
  • Necrotizing enterocolitis, which can be fatal, has been very rarely reported in patients treated with Nozinan®.
• Skin Reactions:
  • Skin reactions due to photosensitivity or allergies are extremely rare.

• Levomepromazine will enhance the activity of any sedative or hypnotic.
• Avoid alcohol.
• Coma or CNS depression due to alcohol, hypnotics, analgesics or narcotics.
• In patients with blood dyscrasia, hepatic troubles or a sensitivity to phenothiazines.

• Neonates exposed to antipsychotic drugs including Nozinan® during the third trimester of pregnancy are at risk for extrapyramidal and/or withdrawal symptoms following delivery.

• Increased death rate in patient with dementia
• Avoid driving or performing jobs that requires high attention because Nozinan® reduce psychomotor activity
• QT interval prolongation
• Tardive Dyskinesia
• Neuroleptic Malignant Syndrome
• Priapism
• Venous thromboembolism
• Simultaneous administration of desferrioxamine and prochlorperazinehas been observed to induce a transient metabolic encephalopathy characterised by loss of consciousness for 48-72 hours. It is possible that this may occur with Nozinan since it shares many of the pharmacological activities of prochlorperazine.
• Avoid giving “Adrenaline” to patients overdosed with neuroleptics.
• Coadministration of levomepromazine and drugs primarily metabolised by the cytochrome P450 2D6 enzyme system may result in increased plasma concentrations of these drugs.

• Nozinan: Retrieved from: http://products.sanofi.ca/en/nozinan.pdf
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This document is prepared by the “Mental Health for All” team. This document is provided for information purposes only and does not necessarily represent endorsement by or an official position of the Essentials of Medicine. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient’s medical history.