Levomepromazine Flunitrazepam

Thomare, R Wang, K. Van Der Meersch-Mougeot, V. Diquet, B. Sensitive micromethod for column liquid chromatographic determination of fluoxetine and norfluoxetine in human plasma. J.Chromatogr., 1992, 583, 217-221 [plasma extracted metabolites LOD 2 ng/mL simultaneous amineptine, amitriptyline, chlordiazepoxide, chlorpromazine, clomipramine, clonazepam, clorazepate, desipramine, diazepam, doxepin, flunitrazepam, fluvoxamine, imipramine, levomepromazine, loraze-pam, loxapine, maprotiline, mefloquine, nortriptyline, oxazepam, thioridazine]... 

Simultaneous alprazolam, chlorpromazine, chlorprothixene, clomipramine, desclomipra-mine, desmethylimipramine, dieizepam, flunitrazepam, fluphenazine, haloperidol, imip-ramine, levomepromazine, perphenazine, protriptyline, thioridazine, thioridazine sulfone, trimipramine, zimeldine, zuclopenthixol... 

Obstruction of airways. A patient with catatonic schizophrenia was given intravenous diazepam 20 mg followed by intramuscular haloperidol 10 mg and levomepromazine 50 mg. Because of combative behaviour about 50 minutes later, he was given intravenous flunitrazepam 2 mg, and about 2 hours later another dose of both intravenous haloperidol 12 mg and flunitrazepam 5 mg. An hour after the last injection he became mildly cyanotic due to collapse of glossopharyngeal structures and excessive oral and nasal secretions, causing airways obstruction. Four other cases of airways obstruction associated with the combination of intramuscular levomepromazine in doses of 0.52 mg/kg or more and intravenous flunitrazepam or diazepam are also described. A subsequent review of all cases found that there were no cases of airways obstruction in patients who received haloperidol with either levomepromazine or a benzodiazepine. The interaction occurred immediately after the last intravenous injection in one patient and about 25 minutes after intramuscular levomepromazine but onset may be delayed up to 2 hours or more. ... 

A depressed man taking clomipramine 175 mg, levomepromazine 25 mg and flunitrazepam 2 mg daily, was started on lithium 600 mg daily. About one week later, after his dosage of lithium was raised to 1 g daily and he developed the serotonin syndrome (myoclonus, shivering, tremors, incoordination). Due to this reaction, and because his serum-lithium levels were 1.6 mmol/L, the lithium was stopped. The serotonin syndrome then abated. The clomipramine dosage was reduced, but some mild symptoms remained until the clomipramine was stopped. He responded well to lithium 600 mg daily alone, without developing the serotonin syndrome. ... 

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