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BNSSG Adult Joint Formulary

4.4 Nausea and labyrinth disorders

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Last edited: 24-10-2024

First line drugs

Second line drugs

Specialist drugs

Secondary care drugs

Antihistamines

Also refer to Chapter 16 - Palliative Care

Recommended: (TLS Green)

Prochlorperazine

Cyclizine

Pyridoxine hydrochloride / doxylamine succinate (Xonvea) tablets (TLS Amber Specialist Initiated)

For the treatment of nausea and vomiting of pregnancy in pregnant women aged 18 years or over who do not respond to conservative management
For use when a trial of first and second line antiemetics has not controlled symptoms

Antimuscarinics

Hyoscine hydrobromide patch

For treatment of nausea and vomiting associated with vestibular disorder and to reduce secretions in neurological conditions

Antipsychotics (first-generation)

Levomepromazine (TLS Blue)

On advice of palliative care

Haloperidol (TLS Blue)

On advice of palliative care

Droperidol (TLS Red)

For treatment and prophylaxis of PONV, and prevention of nausea and vomiting caused by opioid analgesia in PCA
Droperidol is contraindicated in patients taking drugs that prolong the QT interval (avoid concomitant administration of drugs that prolong QT interval), hypokalaemia, hypomagnesaemia and bradycardia

Dopamine receptor antagonists

MHRA Metoclopramide: risk of neurological adverse effects

MHRA Domperidone: risks of cardiac side effects

Domperidone (TLS Green)

Domperidone (off label) (TLS Blue)

after assessment and guidance from a trained professional skilled in breastfeeding support / after non-pharmacological measures have been tried to stimulate lactation.
To increase breastmilk supply (short course 10mg TDS for 7 days then a suggested reducing regimen such as 10mg BD for 7 days, then 10mg OD for 7 days, then stop.
See SPS guidance on Using domperidone for low milk supply

Metoclopramide

5HT₃ Receptor Antagonists

Recommended: (TLS Green)

Ondansetron

For cytotoxic chemotherapy and radiotherapy induced vomiting
Alternative 2nd line (Blue) for Post-operative Nausea and Vomiting

Alternative: (TLS Red)

Granisetron

Specific indication: (TLS Red)

Palonosetron

NBT ONLY - for patients with Hodgkin's lymphoma being treated with ABVD protocol

Neurokinin receptor antagonists

Aprepitant (TLS Red)

For use in Cytotoxic chemotherapy according to guidelines

Aprepitant (TLS Red)

For prevention of post-operative nausea and vomiting for patients attending for adult anti-reflux surgery

Fosaprepitant (TLS Red)

UHB only
For use in Cytotoxic chemotherapy according to guidelines

Netupitant 300mg / Palonosetron 0.5mg (Akynzeo^®) (TLS Red)

For haematology and oncology patients receiving highly emetogenic chemotherapy or those who have experienced breakthrough nausea and vomiting on a moderately emetogenic chemotherapy protocol despite optimal antiemetic therapy

Others

Dexamethasone

Cytotoxic chemotherapy (TLS Green)
For PONV (TLS Blue)

Lorazepam (TLS Green)

Pre-emptive chemotherapy induced nausea and vomiting

4.4.1 Meniere's disease

Recommended: (TLS Green)

Betahistine

Cinnarizine

Prochlorperazine

Hyoscine hydrobromide patch

For treatment of nausea and vomiting associated with vestibular disorder and to reduce secretions in neurological conditions

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4.4 Nausea and labyrinth disorders

Antihistamines

Prochlorperazine

Cyclizine

Pyridoxine hydrochloride / doxylamine succinate (Xonvea) tablets (TLS Amber Specialist Initiated)

Antimuscarinics

Hyoscine hydrobromide patch

Antipsychotics (first-generation)

Levomepromazine (TLS Blue)

Haloperidol (TLS Blue)

Droperidol (TLS Red)

Dopamine receptor antagonists

Domperidone (TLS Green)

Domperidone (off label) (TLS Blue)

Metoclopramide

5HT3 Receptor Antagonists

Ondansetron

Granisetron

Palonosetron

Neurokinin receptor antagonists

Aprepitant (TLS Red)

Aprepitant (TLS Red)

Fosaprepitant (TLS Red)

Netupitant 300mg / Palonosetron 0.5mg (Akynzeo®) (TLS Red)

Others

Dexamethasone

Lorazepam (TLS Green)

4.4.1 Meniere's disease

Betahistine

Cinnarizine

Prochlorperazine

Hyoscine hydrobromide patch

Contact Us

5HT₃ Receptor Antagonists

Netupitant 300mg / Palonosetron 0.5mg (Akynzeo^®) (TLS Red)