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BNSSG Paediatric Joint Formulary

4.4 Nausea and labyrinth disorders

Last edited: 31-01-2024

4.4 Nausea and labyrinth disorders

First line drugs Second line drugs Specialist drugs Secondary care drugs


  • Rectal or parenteral administration of antiemetics will be required if vomiting has already started.
  • General and post-operative nausea and vomiting (PONV): refer to paediatric pain service acute pain management guideline



Cyclizine (TLS Green)

Cinnarizine (TLS Green)



Hyoscine hydrobromide patch (TLS Amber Specialist Recommended)


Antipsychotics (first-generation)

Droperidol (TLS Red)

  • On advice of palliative care
  • Droperidol is contraindicated in patients taking drugs that prolong the QT interval (avoid comcomitant administration of drugs that prolong QT interval), hypokalaemia, hypomagnesaemia and bradycardia

Haloperidol (TLS Blue)

Levomepromazine (TLS Blue)


Dopamine Receptor Antagonists 

Domperidone (TLS Green)

  • Domperidone is contraindicated in patients with conditions where the cardiac conduction is, or could be, impaired with underlying cardiac disease such as congestive heart failure receiving other medications known to prolong the QT or CYP3A4 inhibitors with severe hepatic impairment
  • MHRA Domperidone: risks of cardiac side effects

Metoclopramide (TLS Green)

  • Both metoclopramide and prochlorperazine may precipitate extrapyramidal effects especially in the young and the elderly. Domperidone is less likely to cause such a reaction
  • MHRA Metoclopramide: risk of neurological adverse effects
  • For treatment and prophylaxis of PONV, and prevention of nausea and vomiting caused by opioid analgesia in PCA
  • Contraindicated in patients <1 yr of age and for longer than 5 days (with exceptions of BMT and haematology and oncology patients)


5HT3 Receptor Antagonists

Ondansetron (TLS Amber Specialist Recommended)

  • For cytotoxic chemotherapy and radiotherapy induced vomiting

Palonosetron (TLS Red)

  • Alternative 2nd line for Post-operative Nausea and Vomiting

Specific indication:

Aprepitant (TLS Red)

  • Cytotoxic chemotherapy



Lorazepam (TLS Amber)

Dexamethasone (TLS Amber)



BRCH Headache Diagnosis and Management Algorithm (guidelines available from this link)

Prochlorperazine (buccal) (TLS Green)

Metoclopramide (TLS Green)

Domperidone (TLS Green)