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.

Antihistamines

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/mL

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

5HT3 antagonists

Nausea and vomiting

GREEN Ondansetron

tablets 4mg, 8mg

injection 8mg/4mL

RED Ondansetron - See 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

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

All material in this section is aimed at health care professionals, but is information currently held in the public domain,

members of the public seeking advice on medicine-related matters are advised to speak with their GP, pharmacist, nurse or contact NHS111 Service

Email: info.elmmb@nhs.net