Neonatal Drug Therapy Manual

Methotrimeprazine

Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Updated December 4, 2019 - 2:46pm

Alternate Name(s): 
Nozinan
Classification: 
First generation (typical) antipsychotic with strong sedative effect
Original Date: 
February 2017
Revised Date: 
November 2019
Indications: 
  • Treatment of refractory agitation
Administration: 
  • IV intermittent infusion: over 20 - 30 minutes
  • SC : administer slowly (irritates skin, burn)
  • PO
Dosage: 
  • IV/SC/PO
    • 0.1 - 0.5 mg/kg/day divided Q6-12h
Side Effects: 
  • CNS: Disruption of body temperature regulation, dizziness, drowsiness, extrapyramidal effects
  • CVS: hypotension, tachycardia, QT interval prolongation
  • Endocrine: hyperglycemia
  • GI: anticholinergic side effects such as constipation, intestinal obstruction, nausea, vomiting, xerostomia
  • Hematologic: eosinophilia, hemolytic anemia, immune thrombocytopenia, leukopenia, pancytopenia
  • Hepatic: cholestatic jaundice, hepatotoxicity
  • Renal: urinary retention
Parameters to Monitor: 
  • BP, HR
  • CBC (baseline and periodically thereafter)
  • Liver function test (baseline and periodically thereafter)
  • Glucose
Reconstitution and Stability: 

IV Intermittent Infusion:

  • Methotrimeprazine 25 mg/mL
    • Add 0.2 mL (5 mg) to 24.8 mL of 0.9% NaCl
    • Final concentration: 0.2 mg/mL

 

SC Bolus Injection:

  • Methotrimeprazine 25 mg/mL
    • Add 1 mL (25 mg) to 9 mL of 0.9% NaCl
    • Final concentration: 2.5 mg/mL

*** Methotrimeprazine 0.5 mg (0.2 mL) of 2.5 mg/mL solution is used for priming of CLEO device.  The CLEO should be changed every 3 to 7 days. ***

Compatibility: 

- Solutions Compatible: D5W, 0.9% NaCl

- Y-site Compatible: fentanyl, hydromorphone, morphine

- Incompatible: heparin, ranitidine

Notes: 

- Oral solution 0.25 mg/mL extemporaneously compounded by CHEO

References: 

- Sanne van der Zwaan, Roos J. Blankespoor, Anton M.H. Wolters and al.  Additional use of methotrimeprazine for treating refractory agitation in pediatric patients. Intensive Care Med. 2012 Jan; 38 (1): 175-176

- Holl, Christopher M, Stenekes S, Harlos Micheal S and al.  Methotrimeprazine for the management of end-of-life symptoms in infants and children. J Palliat Care 2013; 29 (3): 178-85

- Care Beyond Cure: Management of Pain and Other Symptoms, 4th Edition. A.P.E.S. 2009

- American Society of Health-System Pharmacists (ASHP). Handbook on Injectable Drugs. 19th Edition, Bethesda: ASHP 2017

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