A Cochrane review [Abstract] 1 included 4 RCTs with a total of 192 subjects. Trials compared levomepromazine with placebo or other antipsychotics for schizophrenia and schizophreniform psychoses. The longest study duration was 30 weeks. For the primary outcome, leaving the study early, levomepromazine was not significantly different compared with other antipsychotics. On Clinical Global Impression (CGI) Scale severity the levomepromazine arm was significantly better when compared with chlorpromazine (WMD -0.80, CI -1.51 to -0.09; 1 RCT, n=38), but worse than risperidone (RR 2.33, CI 1.11 to 4.89, NNT 3, CI 2 to 10; 1 RCT, n=42). Patients on levomepromazine had a better Brief Psychiatric Rating Scale (BPRS) endpoint score (WMD -9.00, CI -17.46 to -0.54; 1 RCT, n=38) and Positive and Negative Syndrome Scale (PANSS) total score (WMD -15.90, CI -30.30 to -1.50; 1 RCT, n=38) than chlorpromazine. Risperidone recipients noticed a significant difference for the outcome 'at least 20% reduction' on BPRS endpoint score (RR 3.33, CI 1.07 to 10.42, NNT 3, CI 2 to 14; 1 RCT, n=42) compared with levomepromazine. Levomepromazine caused less tremor (RR 0.12, CI 0.02 to 0.87; 1 RCT, n=41) and less antiparkinsonian medication administration (RR 0.39 CI 0.17 to 0.90; 2 RCTs, n=79) compared with haloperidol. Levomepromazine caused less akathisia compared with chlorpromazine, but more hypotension compared with risperidone (RR 2.50, CI 1.21 to 5.18; 1 RCT, n=42). Dizziness was common with levomepromazine compared with other antipsychotic medications.
Comment: The quality of the evidence is downgraded by study quality (inadequate allocation concealment, lack of blinding, short follow-up time), imprecise results (limited study size for each comparison) and indirectness of evidence (differences in studied outcomes).
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