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Neuroleptic Agents
Methotrimeprazine is a phenothiazine that has analgesic properties. Intramuscular doses of 15 mg methotrimeprazine and 10 mg of morphine are equianalgesic.272 This phenothiazine analgesic lacks opioid-inhibitory effects on gut motility and probably produces analgesia through a-adrenergic blockade.39 In patients who are opioid tolerant or who are experiencing dose-limiting opioid side effects, especially intractable constipation, it is an alternative analgesic approach. It also has antiemetic and anxiolytic effects.
Methotrimeprazine can produce sedation and hypotension and should be given cautiously. Although it is approved only for intramuscular administration, clinicians have experience with oraz and slow intravenous infusion to manage delirium, restlessness, and agitation in patients near death. Other phenothiazines have not been demonstrated to have analgesic properties.272
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