4.6. Drugs used in nausea and vertigo
In April 2014, following a Europe-wide review, the MHRA issued advice to healthcare professionals relating to the use of domperidone, restricting its use to relief or nausea and vomiting, advising that it should be used at the lowest effective dose for the shortest possible time, and highlighting changes to the contraindications, dosing and duration of treatment of the medicine.
The full advice from the MHRA can be accessed here.
- Metoclopramide causes more frequent extra-pyramidal side effects than domperidone and is not indicated in patients less than 20 years of age except for limited indications when the dose should be determined on the basis of body weight.
- Metoclopramide should only be prescribed for short-term use (up to 5 days)
- It should not be used in children below 1 year of age
- It should only be used in children over 1 year as second-choice treatment for prevention of delayed nausea and vomiting after chemotherapy and for post-operative nausea and vomiting
For other available Formulary formulations, see Total Formulary entry below.
Restricted to use in accordance with regional CINV guideline. The prevention of nausea and vomiting associated with moderately emetogenic cancer chemotherapy is not recommended by SMC and remains non-formulary.
Restricted to use by consultant anaesthetists for use as a third line antiemetic for PONV in patients with previous failure of other formulary agents. This preparation should only be routinely held in theatre recovery areas for this indication. The use of droperidol for addition to a PCA containing opiates remains non-Formulary.
Restricted to use according to local protocol for the prevention of acute and delayed nausea and vomiting associated with highly emetogenic cisplatin-based cancer chemotherapy in adults.
Restricted to specialist initiation only. Prevention of nausea and vomiting associated with moderately or highly emetogenic chemotherapy is restricted to use in accordance with regional protocol. In the management of post-operative nausea and vomiting (PONV), restricted to use in patients refractory to routine antiemetics or with a substantial history of PONV. The transdermal patch preparation is only for use where oral administration is not appropriate because of swallowing difficulties.
Prolonged use can cause severe constipation and routine laxatives should be considered.
Restricted to specialist use for the prevention of acute and delayed nausea and vomiting associated with highly emetogenic cisplatin-based cancer chemotherapy. Refer to the regional antiemetic policy.
Restricted to specialist initiation in patients with an enhanced risk of aspiration or who experience difficulties in swallowing for the indications listed below.
- Prophylaxis of acute nausea and vomiting induced by moderately emetogenic chemotherapy.
- Prophylaxis and treatment of delayed nausea and vomiting induced by moderately to highly emetogenic chemotherapy.
- Prophylaxis and treatment of acute and delayed nausea and vomiting induced by highly emetogenic radiotherapy.
- Prophylaxis and treatment of post-operative nausea and vomiting (PONV).