REMEDY : BNSSG referral pathways & Joint Formulary
Covid -19 Specific information
Patient Information & Safety-netting Bone & Soft Tissue - USC (2WW) Brain & CNS - USC (2WW) Breast - USC (2WW) Cancer of Unknown Primary - USC (2WW) Children & Young People – USC (2WW) Family History of Cancer Gynaecology - USC (2WW) Haematology - USC (2WW) Head & Neck incl Thyroid - USC (2WW) Lower GI - USC (2WW) Lung - USC (2WW) Non-Specific Symptoms - USC (2WW) - suspended Pancreas - USC (2WW) Skin - USC (2WW) Upper GI - USC (2WW) Urology - USC (2WW)
Advice & Guidance for GPs
Advice & Guidance Services Advice and Guidance Best Practice RAS on e-Referral
Biochemistry
Alkaline Phosophatase Clinical Biochemistry in Primary Care Creatinine Kinase Hyperkalaemia Hyperlipidaemia Hypomagnesaemia Lipid Advice & Guidance Service
Breast
Advice & Guidance Service Axillary masses Breast Implants (non-cancer) Breast Pain Breast Surgery Breastfeeding Family History of Breast Cancer Male Breast Symptoms Mastitis and Breast Abscess Nipple conditions
Cancer Screening
Bowel Cancer Screening Breast Cancer Screening Cervical Cancer Screening Pancreatic Cancer Surveillance Programme
Cancer Support
Advice & Guidance Service LD & Cancer Living with and beyond cancer (LWBC) Nutrition in cancer Physio for NBT Cancer patients Toxicity Risk Assessment Tool Rehab / prehab
Cardiology
Advice & Guidance Service Angina Arrhythmia Atrial Fibrillation and Flutter Cardiac Rehabilitation Cardiac Rhythm Analysis Dilated Ascending Aorta ECG - Open Access ECHO - requesting Heart Failure Hypertension Inherited Cardiac Conditions NT Pro BNP Testing Pacemakers Postural Orthostatic Tachycardia Syndrome (PoTS) Rapid Access Chest Pain Clinics Syncope and TLOC
Care of the Elderly
Active Ageing - South Glos Advice and guidance - Care of the Elderly Assistive Technology Service Falls & Balance Fracture Liaison Service Frailty Hearing Services Live Longer Better Movement Disorders NHS@home - Frailty pathway Rapid Assessment Clinic For Older People
Community Therapy
Community Therapy
Coroner
Avon Coroner
COVID-19
Acute Assessment COVID Medicine Delivery Unit (CMDU) COVID Oximetry @ Home Virtual Ward COVID Testing Long COVID TeamNet and Latest updates
Dementia
Dementia - Assessment & referral Dementia Prescribing Mental Capacity & Best Interest Decisions
Dermatology
Acne vulgaris Actinic Keratosis Advice & Guidance and guidelines Alopecia Basal Cell Carcinoma Benign Skin Lesions Bowens Disease Community Dermatology Service Cosmetic skin treatments Eczema Hidradenitis Suppurativa Hyperhidrosis Leg Ulcer Mole Mapping/Surveillance Pityriasis Rosea Pityriasis Versicolor Polymorphic Light Eruption Pruritis Psoriasis Rosacea Scabies Seborrhoeic Dermatitis Skin Camouflage Tinea Tissue Viability/Wound Care Service Unusual Appearance - Outlook Urticaria Vulval Skin Care Warts and Verrucas
Diabetes
Community Diabetes Specialist Service Diabetes & Nutrition Diabetes Advice and Guidance Diabetes Foot Care Diabetes Mellitus - Guidelines Diabetes self-management Diabetes Structured Education Diabetic Eye Screening Monogenic Diabetes Neuropathic Pain (Diabetic) Non-diabetic Hyperglycaemia and the National Diabetes Prevention Program Pregnancy and diabetes Rapid Access Diabetes Clinic Type 2 diabetes management Type 2 Path to Remission Programme
Dietetics & Nutrition
Advice & Guidance Service Local Services Malnutrition & Oral Nutritional Supplements Vitamin D Deficiency Weight management
Drug and Alcohol Misuse
Alcohol Misuse Opiate Dependence Non-opiate drug dependence Bristol Drug and Alcohol Service North Somerset Drug & Alcohol Service South Gloucestershire Drug & Alcohol Service Bristol Shared Care Breaking Free (Bristol & South Glos)
DVT and PE
DVT and SVT Pathway Pulmonary Embolus (suspected) Secondary Care DVT Services Unprovoked DVT
Enablement
Bristol Centre for Enablement Wheelchair Services
End of Life Care and Hospice
Bereavement support Death Certification and Cremation Forms End of Life Care End of life care - community support ReSPECT Plus St Peters Hospice Weston Hospice
Endocrinology
Advice and Guidance (Endocrinology) Adrenal incidentaloma Adrenal insufficiency Endocrinology Services - UHBW and NBT Gynaecomastia Hirsutism Hyperprolactinaemia Hyperthyroidism Hyponatraemia Hypothyroidism Male hypogonadism Polyuria Primary hyperparathyroidism (PHPTH) Secondary hypertension Sub Clinical hyperthyroidism Sub Clinical hypothyroidism Thyroid disease and pregnancy Thyroid eye disease
ENT
Advice & Guidance Service Anosmia Audiology (adult) Dizziness and Vertigo Ear wax and microsuction ENT HOT Clinic Epistaxis Hearing Problems Middle ear problems Moulded Ear Plugs Nasal Treatment Neck Lumps (including Goitre) Otitis Externa Rhinosinusitis & Nasal Polyps Snoring Speech & Language Tinnitus Tonsils Uvula
Fertility
Advice & Guidance Service Infertility Semen Analysis
Gastroenterology and Colorectal Surgery
Advice & Guidance Services Anaemia (Gastroenterology) Anal FIssure Barrett's oesophagus Coeliac Disease Colon Polyps Community Gastroenterology Clinic - InHealth Constipation in Adults Dyspepsia and Reflux Endoscopy Eosinophilic Oesophagitis Faecal Calprotectin FIT (Faecal Immunochemical Test) Gallstones (and polyps) Haemorrhoids and anal lesions Hiccups Inflammatory Bowel Disease (Confirmed) Inflammatory Bowel Disease (suspected) Irritable Bowel Syndrome Microscopic Colitis Pancreatitis (Acute) Pancreatitis (Chronic) and PEI Rectal Bleeding Stoma care Upper GI Bleed Urgent Gastroenterology Services
Gender Identity Genetics
Family History of Breast/Ovarian Cancer Family History of Colorectal Cancer Genetic Haemochromatosis Genetics - general Monogenic Diabetes
Gynaecology
Advice & Guidance Service Abnormal vaginal bleeding Cervical Conditions Dyspareunia Early Pregnancy Assessment Clinic Emergency Gynaecology Endometriosis Female Cosmetic Surgery Female Genital Mutilation Female Genitalia Surgery Female Urinary Incontinence Fibroids Hyperemesis Gravidarum Menopause Menstrual Disorders Mesh Complications Open Access Gynae Imaging Ovarian Conditions PCOS Pelvic Organ Prolapse Persistent Pelvic Pain (women) Premature Ovarian Insufficiency (POI) Recurrent Miscarriage Termination of Pregnancy Vaginal Discharge Vulval Skin Conditions
Haematology
Advice & Guidance Service Anaemia Blood Transfusions & Iron infusions Genetic Haemochromatosis Guidelines for Primary Care Leucocytosis (including neutrophilia and lymphocytosis) Macrocytosis Polycythaemia Sickle Cell & Thalassaemia Vitamin B12 Warfarin monitoring
Hepatology
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Homeless and Migrant Healthcare
Asylum Seeker and Refugee Health Homelessness Support
Imaging - see Radiology
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Max Fax and Dental
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Nursing
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Obstetrics
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Oncology
Advice & Guidance Service BHOC Acute Care Cancer Support Oncology Referrals
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Orthopaedics
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Physiotherapy
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Podiatry
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Prescribing
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Radiology imaging
Advice & Queries Direct Access Radiology (adults) Image Guided Steroid Injections MRI considerations Radiology Guidelines for Primary Care Spinal Imaging in Primary Care Ultrasound guidance
Respiratory
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Rheumatology
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Safeguarding
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Self Care
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Sexual Health
Advice & Guidance Service Chronic Pelvic Pain Syndrome (men) Contraception Emergency Contraception Gonorrhoea HIV LARC LARC Complex referrals Loss of Libido Monkeypox Pelvic Inflammatory Disease Post Birth Contraception Psychosexual Service Sexual assault/ abuse support Sexual Health Guidelines and Referral Syphilis
Sleep Medicine
Circadian Rhythm Disorder Insomnia Obstructive Sleep Apnoea (OSA) Parasomnias Primary Hypersomnias Restless Leg Syndrome
Social Care
Carer Support Social Care Support Services
Social Prescribing Speech & Language
Speech and language therapy (SLT) - community and outpatient services
Surgery
Advice & Guidance Service Cosmetic Treatment (including scar revision) Foreign Body Removal (soft tissue) Hernias (adults) Burns (adult) Pre-operative assessment Reconstructive Prosthetics Services Surgical Emergency Care
Urgent Care
Admission protocols Dementia Wrap Around Care - North Somerset Frailty - ACE Frailty - Urgent Care HOT Clinics & Rapid Access Live UEC Dashboard Medical Assessment/Admission and Weekday IUC Professional Line NHS@home Sirona Professional Lines Surgical Emergency Care Transport to Hospital Urgent Care, MIU & WIC Urgent Community Response - Sirona Urgent Urology Pathway
Urology
Acute Prostatitis Advice & Guidance Service Bladder & Bowel Self Care App Bladder & Bowel Services Chronic Prostatitis Circumcision in adults Erectile Dysfunction Female Urinary Incontinence Haematospermia Haematuria Hydrocele LUTS in men Mesh complications Penile Disorders Prostate - including PSA Renal Calculi Scrotal Swellings & Testicular Lumps & Pain Sterile Pyuria Trial Without Catheter (TWOC) Urgent Care and HOT clinic Urinary Tract Infections Urodynamics UTIs in Care Homes Varicocele Vasectomy
Vascular
Advice & Guidance Service Abdominal Aortic Aneurysm Aortic Dissection Arterial Leg Ulcers Carotid Artery Stenosis NHS Health Check Peripheral Arterial Disease Varicose Veins and Venous Leg Ulcers Vascular Hot Clinic Vascular Nurse Specialist Clinic
Weight Management
Digital Weight Management Introduction and Tier 1 Weight Management Low Calorie Diet Pilot Non-diabetic Hyperglycaemia and the National Diabetes Prevention Program (NDPP) Tier 2 Weight Management Services Tier 3 & 4 Weight Management Service - BNSSG Post Bariatric Surgery Monitoring
Advice and Guidance
Advice & Guidance
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ME/CFS
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COVID-19
COVID Medicine Delivery Unit (CMDU) Long COVID in children
Dental & Oral Health
Dental Referrals Mouth ulcers
Dermatology
Advice & Guidance - Dermatology Benign skin lesions in children Community Dermatology Services Dermoid Cysts Eczema Henoch-Schonlein Purpura Pilomatricoma
Development
Developmental impairment Dyspraxia / DCD in children Faltering Growth Motor Disorders Neonatal milk & vitamin guideline Sleep Disorders Speech and Language Therapy
Diabetes
Diabetes Mellitus in Children
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Drug and Alcohol Misuse
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Care Pathway
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Bristol Hospital Education Service (BHES)
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End of life care - children When a child dies
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ENT
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Chronic Abdominal Pain and IBD Coeliac disease (children) Constipation Diarrhoea and vomiting Faltering Growth Milk Related Problems Neonatal milk & vitamin guideline Reflux Disease
Gender Identity
Gender Identity in children and young people
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FGM in children (<18) Gynaecology (paediatric and adolescent) The Star Clinic Vulvovaginitis
Haematology
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Immunisation
Hep B vaccine for at risk infants Paediatric Immunisation TB screening and BCG
Infectious Diseases
Chicken Pox - parents guide Feverish illness Respiratory tract infections Scarlet Fever/ Group A Strep
Mental Health
Asylum & Refugee Clinic (ARC) Mental Health Resources for Children and Young People CAMHS mental health 24/7 emergency line CAMHS Referral information Happymaps
Milk Related Problems
Milk Related Problems
Neonatal
Hep B vaccine for at risk infants Jaundice Neonatal milk & vitamin requirements Sacral dimples and pits Umbilical Granuloma
Nephrology
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Neurology
Bell's Palsy Febrile Convulsions Fits, Faints and Funny Turns Headache Head injury Neuromuscular Neurosurgery Tics and Tourette's in children
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Orthopaedics
Back pain Hip Dysplasia Limping - acute limp in children Lower Limb Urgent & Non-urgent Referrals
Pain Management
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Home > Formulary : Adult > Chapters > 4. Central Nervous System >

BNSSG Adult Joint Formulary

4.4 Nausea and labyrinth disorders

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Last edited: 07-05-2024

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

Recommended: (TLS Green)

Domperidone

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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