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4.6 Drugs used in nausea and vertigo

4.6 Drugs used in nausea and vertigo

These drugs should only be used when the cause of vomiting is known.  Drug treatment for vertigo is often not the most effective 
management strategy, and long treatment should generally be avoided. 
GREEN       Cyclizine tablets 50mg
GREEN       Doxylamine and pyridoxine 10mg/10mg tablets (Xonvea®)
                    (Indicated in the treatment of nausea and vomiting of pregnancy in women who do not respond to conservative
                     management. Suitable for initiation in Primary or Secondary care)
Phenothiazines and related drugs
Symptomatic relief of nausea from underlying disease, drug treatment, and Ménière’s disease.
Caution: prochlorperazine may cause dystonic reactions in the elderly.
GREEN      Prochlorperazine 
                   tablets 5mg
                   buccal tablets 3mg
                   syrup 5mg/5mL
                   suppositories 5mg
                   injection 12.5mg/mL
GREEN      Levomepromazine (methotrimeprazine)
                   tablets 25mg * 
                   injection 25mg/mL
                   * 25mg tablet to be quartered for 6mg dose
BLACK       Levomepromazine tablets 6mg
For the prevention and treatment of post operative nausea and vomiting:
RED           Droperidol injection 2.5mg/mL     
Domperidone and metoclopramide 
Symptomatic relief of nausea from underlying disease or drug treatment. Avoid use of metoclopramide in children and those 
under 20 years of age because of risk of dystonic reactions.
  **New updated advice for Domperidone**
Following a European review, the Medicines and Healthcare products Regulatory Agency (MHRA) is advising that domperidone
should not be used by people who have serious underlying heart conditions. It should only be used in the relief of symptoms of
nausea and vomiting and at the lowest effective dose for the shortest possible duration. Adults should take no more than three
10mg tablets per day. Domperidone should no longer be used to treat other conditions such as heartburn, bloating or relief of 
stomach discomfort.
MHRA Drug Safety Update 2019: Domperidone for nausea and vomiting: lack of efficacy in children; reminder of contraindications
                                                        in adults and adolescents
MHRA Drug Safety Update - Domperidone: risks of cardiac side effects
GREEN     Domperidone
                  tablets 10mg  
                  suspension 5mg/mL
GREEN     Metoclopramide
                  tablets 10mg
                  syrup 5mg/5mL
                  injection 10mg/2mL
Use of domperidone as a galactogogue during breastfeeding or expressing breastmilk
Domperidone as a galactogogue aids the initiation and maintenance of breast milk supply to meet the needs of a baby receiving breast milk, when non-drug methods have failed. A health professional should be involved in any decision to use domperidone. Domperidone is most likely to be needed for mothers whose babies are on the neonatal unit.
See Infant feeding manual guidance  [page 16]
GREEN     Domperidone 10mg tablets
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5HT3 antagonists
Nausea and vomiting  
GREEN      Ondansetron 
                   tablets 4mg, 8mg   
                   injection 8mg/4mL

RED           OndansetronSee MHRA Drug Safety Update January 2020
                   (Off licence use in hyperemesis, consultant initiation only)
                   tablets 4mg, 8mg
                   injection 8mg/4mL
Second line 
RED           Granisetron
                   tablets 1mg  
                   injection 1mg, 3mg
For post-operative nausea and vomiting in adults (not licensed for use in children) – see PONV guidelines.
RED           Dolasetron
                   injection 12.5mg/0.625mL 
Prevention of acute and delayed nausea and vomiting associated with highly emetogenic cisplatin-based cancer 
chemotherapy and moderately emetogenic cancer chemotherapy
RED         Netupitant/palonosetron capsules (Akynzeo®)
                oncology use only
Aprepitant is a neurokinin 1 receptor antagonist, is licensed for the prevention of acute and delayed nausea and vomiting
associated with cisplatin-based cytotoxic chemotherapy; 
it is given with dexamethasone and a 5HT3 antagonist. such as ondansetron.  Cancer network guidelines specify when this
medicine can be given, and these should be followed at all times. They are available online,click here to access them.
RED           Aprepitant 
                  capsules 80mg, 125mg
For vestibular disorders and hypersalivation 
GREEN      Hyoscine hydrobromide 
                   injection 400 microgram
                   tablets (sublingual) 300 microgram
                   patch 1mg/72 hours
AMBER      Glycopyrronium Liquid 1mg/5mL* (prescribe as Colonis Pharma Ltd brand)
                    (Tablets removed from formulary due to cost effectiveness of liquid June 2017)
                    *Use: Hypersalivation in adults and children [Non-Parkinson's disease]
                    *Use: Hypersalivation/Sialorrhoea in adults with Parkinson's Disease
Other drugs for Ménière’s disease 
GREEN      Betahistine 
                   tablets 8mg, 16mg 
GREEN      Cinnarizine 
                   tablets 15mg 
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