The drug should be discontinued in case of allergic reactions. Simultaneous use with agents oppressing the central nervous system, MAO inhibitors and m-holinoblokatorami requires special care (see the section "Interaction with other drugs").
It is necessary with special care to prescribe the drug to patients with impaired liver and / or kidney function.
Elderly patients have a predisposition to orthostatic hypotension, as well as m-cholinoblocking and sedative effects of phenothiazines. In addition, they often have extrapyramidal side effects. Therefore, the treatment of these patients should start with low doses with a gradual increase.
In elderly people with dementia, who were treated with antipsychotics, there was a slight increase in the risk of death. The data are not sufficient to determine the exact magnitude of the risk, as is unknown and the cause of this increased risk. Tizerzin® is not approved for the treatment of behavioral disorders associated with dementia.
To avoid the development of orthostatic hypotension, the patient should lie for half an hour after the administration of the first dose. If after the introduction of the drug there is dizziness, you should observe bed rest after each dose until the dizziness disappears.
In cases of parenteral administration of the preparation, Tizercin® should, where necessary, alternate injection sites, since the drug may cause local irritation and tissue damage.
It should also be cautious when administering the drug to patients (especially the elderly) having a history of cardiovascular disease, patients with congestive heart failure, conduction disorders, arrhythmia, congenital syndrome elongate slot QT. Before beginning treatment with Tizertsin® necessary to carry out an electrocardiogram to rule out any cardiovascular disorder that can serve as a contraindication to the use of the drug.
There are reports of lengthening the interval QT, occurrence of arrhythmias and, rarely, arrhythmia type "pirouette" in the treatment of phenothiazines (see. section "Side effects").
In the event of hyperthermia during antipsychotic therapy should eliminate the possibility of neuroleptic malignant syndrome (NMS). This syndrome, which is a potential threat to life, characterized by the following symptoms: muscle rigidity, hyperthermia, confusion, impaired autonomic function (unstable blood pressure, tachycardia, arrhythmia, sweating), catatonia, the activity increase of creatine phosphokinase (CPK), myoglobinuria (rhabdomyolysis ) and acute renal failure.If they occur, and if during the treatment there is a hyperthermia of unclear etiology without the remaining clinical symptoms of the NSH, the use of Tizerincin® should be stopped immediately.
After a sudden discontinuation of the drug, used in high doses or for a long time, there may be the appearance of: nausea, vomiting, pain, tremor, increased sweating, tachycardia, insomnia and anxiety, as well as the development of tolerance to sedative effects of phenothiazine derivatives and cross tolerance to various antipsychotics. For this reason, the drug should be discontinued gradually.
Many antipsychotics, including levomepromazine, can reduce the threshold of convulsive readiness and cause epileptiform changes in the ECG. For this reason, when titrating the dose of Tizerincin® to all patients with epilepsy, careful clinical observation and monitoring of the ECG should be ensured.
The development of cholestatic jaundice depends on the individual sensitivity of the patient and completely disappears after discontinuation of the drug. Therefore, long-term treatment requires regular monitoring of liver function.
In some patients receiving phenothiazines, agranulocytosis and leukopenia were noted. Despite the rarity of such cases, long-term therapy with levomepromazine requires regular monitoring of the leukocyte blood count.
During the treatment and until the drug ceases (within 4-5 days after drug withdrawal), alcohol consumption is prohibited.
Prior to and during treatment, it is recommended to regularly monitor the following indicators: blood pressure, liver function (especially in patients with diseases liver), the leukocyte formula of blood, ECG (for cardiovascular diseases and in elderly patients), the concentration of potassium in the blood serum. Periodic monitoring of the electrolyte level in the blood and its correction are necessary (especially when planning long-term therapy).