Levomepromazine (Nozinan, Methotrimeprazine): Why This Phenothiazine Left U.S. Pharmacies and What Telehealth Can Still Do

Last updated: August 24, 2026

Levomepromazine (also called methotrimeprazine) is a phenothiazine used for psychosis and, in many countries, for nausea, pain, and sleep in palliative care. U.S. patients still search for it under both names and the brand Nozinan. It is not a typical U.S. retail antipsychotic today. A licensed clinician can still review your symptoms by video and discuss medicines that are available here.

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What is levomepromazine?

DrugBank DB01403 lists methotrimeprazine as a phenothiazine for psychosis, especially schizophrenia, and manic phases of bipolar disorder. The brand name on that card is Nozinan. The same molecule is levomepromazine (INN/BAN) and methotrimeprazine (common U.S. name).

NCATS Inxight (UNII 5KN5Y9V01K, levomepromazine maleate) marks it US Previously Marketed, first approved in 1966. NCATS describes a phenothiazine with activity similar to both chlorpromazine and promethazine: dopamine D2-like antagonism plus 5-HT2 blockade, plus antihistamine effects. Historic U.S. brand context includes Levoprome for pain. Nozinan remains the common name outside the United States for nausea, vomiting, and insomnia in palliative use.

PubChem lists levomepromazine as CID 72287 (C19H24N2OS).

Is Nozinan or methotrimeprazine still sold in the United States?

Treat current U.S. retail availability as gone unless your own clinician and pharmacy confirm a special-access product. NCATS status is previously marketed, not an active everyday brand. Canadian labels still list methotrimeprazine maleate tablets (often 2 mg, 5 mg, 25 mg, and 50 mg) and injectable hydrochloride. That split is why U.S. searchers find Canadian or U.K. pages and assume a local refill exists.

Do not import leftover Nozinan or buy from unverified sites. A telehealth visit can map what you hoped this drug would do (sleep, nausea, agitation, psychosis) onto medicines your state pharmacy can actually fill.

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What did clinicians use it for?

• Psychosis and mania: DrugBank frames schizophrenia and manic bipolar phases.
• Palliative nausea and vomiting: NCATS lists vomiting and nausea under Nozinan. A 2015 Cochrane update (Cox et al., CD009420) found no published RCTs of levomepromazine for nausea and vomiting in adults in palliative care and could not draw definitive conclusions. Unpublished Twycross 1997 data cited in that review suggested vomiting control in 83% of 23 patients; 3 of 23 (13%) stopped for urticaria, akathisia, or sedation. See PubMed 26524693 and PMC6481825.
• Pain and insomnia: NCATS lists pain under Levoprome and insomnia under Nozinan, both as palliative uses.

Alberta Health patient information (MyHealth Alberta) says oral methotrimeprazine may treat schizophrenia or bipolar illness; clinicians often start low, may split doses 2-3 times daily, then sometimes move a stable dose to bedtime if drowsiness is the issue. That is counseling language, not a U.S. label you should self-dose from. Source: MyHealth Alberta fdb8239.

How does the dose differ for nausea versus psychosis?

Cochrane reviewers note that higher antipsychotic-range doses are more likely than low palliative doses to cause heavy sedation or postural hypotension (citing Skinner 1999 in the same review). An ongoing-study table in that update described oral methotrimeprazine 6.25 mg once daily versus haloperidol 1.5 mg, with a possible increase to twice daily. NCATS lists a pharmacokinetic snapshot at 350 mg oral once daily steady state: Cmax 125 ng/mL, AUC 676 ng·h/mL, half-life 24 hours. Those numbers describe research conditions, not a home start dose.

If an overseas label listed 2-50 mg tablets, that range still does not authorize a U.S. mail-order script. Your clinician chooses a medicine that is legal and stocked where you live.

What side effects matter?

Expect a phenothiazine profile: drowsiness, dizziness, lightheadedness, constipation, low blood pressure on standing, dry mouth, and movement effects (stiffness, restlessness, tardive symptoms with longer use). Alberta’s sheet also flags rare serious heart-rhythm and heart-failure type events and extra caution in older adults. Phenothiazines as a class carry liver-injury caution in LiverTox NBK548793.

Cochrane’s narrative: at the lower doses used in palliative care, side effects other than mild sedation are uncommon; subcutaneous injection can irritate the site. Antipsychotic-range doses raise sedation and postural hypotension risk.

Never stop a psychiatric medicine suddenly without a plan. Alberta notes symptoms can worsen if you quit abruptly.

Can telehealth prescribe levomepromazine?

Usually no, because U.S. pharmacies do not stock it as a routine product. Telehealth still helps. HHS notes Medicare patients can permanently receive telehealth for behavioral health; policy pages were last updated February 5, 2026 (HHS telehealth policy updates).

A Klarity visit can cover diagnosis review, anxiety or mood follow-up, and alternatives that may be appropriate (other antipsychotics, sleep support, nausea workup). Insurance may help pay for the visit. It varies by plan. We do not promise coverage.

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Frequently asked questions

Are levomepromazine and methotrimeprazine the same drug?

Yes. Same molecule, two naming systems. Nozinan is the brand most searchers see. Levoprome is the historic U.S. pain brand on NCATS.

Why do people still search “levomepromazine” in the U.S.?

Family members read Canadian or U.K. hospice notes. Others see both chemical names in papers. Average monthly U.S. search volume for each generic name sits around 720 in Google Ads Keyword Planner, so both spellings belong on one page.

Is it a good sleep medicine?

Sedation is common, and NCATS lists insomnia as a palliative use abroad. Using an old phenothiazine only for sleep is not a first-line U.S. telehealth plan. Ask about insomnia evaluation instead.

What if I still have leftover Nozinan from another country?

Do not restart it on your own. Bring the bottle to a licensed clinician or pharmacist and say how much you take. They can check interactions and a safer local option.

When to get urgent help

Call 911 for chest pain, fainting, severe rigidity with fever, or inability to breathe. For suicidal thoughts, call or text 988. Telehealth is for scheduled evaluation, not emergency sedation or injectable antiemetics.

Next step

If you wanted Nozinan for mood, sleep, or nausea tied to psychiatric illness, start with a visit that can actually prescribe in your state.

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This article is education, not medical advice. Coverage and formularies vary. Verify benefits before you book. Klarity Health is not an insurer or a pharmacy.