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Open Access Research article

Evidence for the use of Levomepromazine for symptom control in the palliative care setting: a systematic review

Isabel Dietz1*, Andrea Schmitz2, Ingrid Lampey23 and Christian Schulz2

Author Affiliations

1 Clinic for Anaesthesiology HELIOS Clinic Wuppertal, University Witten/Herdecke, Witten, Germany

2 Interdisciplinary Center for Palliative Medicine, University Hospital Dusseldorf, Dusseldorf University, Dusseldorf, Germany

3 NELCS Northeast London (NHS) Community Services, London, United Kingdom

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BMC Palliative Care 2013, 12:2  doi:10.1186/1472-684X-12-2

Published: 19 January 2013

Abstract

Background

Levomepromazine is an antipsychotic drug that is used clinically for a variety of distressing symptoms in palliative and end-of-life care. We undertook a systematic review based on the question “What is the published evidence for the use of levomepromazine in palliative symptom control?”.

Methods

To determine the level of evidence for the use of levomepromazine in palliative symptom control, and to discover gaps in evidence, relevant studies were identified using a detailed, multi-step search strategy. Emerging data was then scrutinized using appropriate assessment tools, and the strength of evidence systematically graded in accordance with the Oxford Centre for Evidence-Based Medicine’s ‘levels of evidence’ tool. The electronic databases Medline, Embase, Cochrane, PsychInfo and Ovid Nursing, together with hand-searching and cross-referencing provided the full research platform on which the review is based.

Results

33 articles including 9 systematic reviews met the inclusion criteria: 15 on palliative sedation, 8 regarding nausea and three on delirium and restlessness, one on pain and six with other foci. The studies varied greatly in both design and sample size. Levels of evidence ranged from level 2b to level 5, with the majority being level 3 (non-randomized, non-consecutive or cohort studies n = 22), with the quality of reporting for the included studies being only low to medium.

Conclusion

Levomepromazine is widely used in palliative care as antipsychotic, anxiolytic, antiemetic and sedative drug. However, the supporting evidence is limited to open series and case reports. Thus prospective randomized trials are needed to support evidence-based guidelines.

Keywords:
Levomepromazine; Methotrimeprazine; Palliative care; End of life care; Symptom control; Evidence; Systematic review