GVS review levomepromazine (Nozinan®) for palliative sedation in a home situation
Zorginstituut Nederland has completed its assessment whether the substance levomepromazine (Nozinan®) can be included in the Medication Reimbursement System (GVS). Levomepromazine is registered for the off-label application for palliative sedation in a home situation, as defined in the Palliative Sedation guideline. The Zorginstituut's advice is to include levomepromazine in List 1B and List 2 of the Health Insurance Regulation, and imposing some conditions.
Registered indication
Levomepromazine is registered for the off-label application for palliative sedation in a home situation, as defined in the Palliative Sedation guideline. Levomepromazine (Nozinan®) is available in the following forms of administration:
- 25 mg (film-coated) tablet;
- injection fluid 25 mg/ml.
For years, levomepromazine has been applied off-label as palliative sedation and to treat nausea and vomiting in the palliative phase. These applications are included in the relevant national treatment guidelines which are mentioned in the report. Because the medicinal product is not reimbursed from the GVS, the cost of using this medicinal product must be paid by the next of kin after the patient's death. Although the cost of this medicinal product is relatively low, this leads to painful situations.
Zorginstituut's advice
The Zorginstituut recommends the Minister to include levomepromazine (Nozinan®) in List 1B of the Health Insurance Regulation, imposing some conditions (List 2). Inclusion in List 1B will lead to limited additional costs.
List 2 conditions for levomepromazine
Only for administration to an insured person for:
- palliative sedation, or;
- nausea and vomiting in the palliative phase in accordance with the guidelines accepted by the relevant physicians’ associations in the Netherlands.
This report is a summary of recommendations by Zorginstituut Nederland. The original text is in Dutch.