NHS Dudley Health Economy Medicines Formulary
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4.6 Drugs used in nausea and vertigo

General guidance
 

  • Anti-emetics should only be prescribed when the cause of vomiting is known, particularly in children. Anti-emetics are unnecessary and potentially harmful when the cause can be treated. In addition, prescribing before diagnosis may hinder subsequent diagnosis.
  • If anti-emetic drug therapy is indicated the choice of drug depends upon the aetiology of vomiting.
  • Vestibular disorders: - the most effective drug for the prevention of motion sickness is hyoscine, dosage should be kept as low as possible to minimise adverse effects which may otherwise limit treatment. Antihistamines are slightly less effective than hyoscine but adverse effects may be fewer. There is no evidence that any one drug is superior to another.
  • Ménière’s disease and middle-ear surgery: - vertigo and nausea associated with these conditions may be difficult to treat. Hyoscine, antihistamines and phenothiazines can be effective in the prophylaxis and treatment of these conditions.
  • Pregnancy: - nausea in the first trimester does not require drug treatment. If vomiting is severe specialist advice should be sought.
  • Phenothiazine anti-emetics such as prochlorperazine are of value for the prophylaxis and treatment of nausea and vomiting associated with diffuse neoplastic disease, radiation sickness, and the emesis caused by drugs such as opioid analgesics, general anaesthetics, and cytotoxic drugs.
  • Metoclopramide combines both central and peripheral actions and may be superior to a phenothiazine in the emesis associated with gastroduodenal, hepatic, and biliary disease.
  • Domperidone: risks of cardiac side effects - click here - MHRA Drug Safety Update - Indication restricted to nausea and vomiting, new contraindications, and reduced dose and duration of use (30 May 2014
  • Metoclopramide: risk of neurological adverse effects - click here.  MHRA Drug Safety Update - Restricted dose and duration of use (7 August 2013)

Recommended drugs

General nausea and vomiting

Prochlorperazine £

Metoclopramide £ - Metoclopramide: risk of neurological adverse effects - click here

Domperidone £ - Domperidone: risks of cardiac side effects - click here 

Motion sickness

Hyoscine Hydrobromide ££

Promethazine Hydrochloride ££

Cyclizine (non sedating) ££

Meniere's disease

Betahistine £

Cinnarizine ££

 

Drug Traffic Light Key:

Green – On Formulary

Amber – Restricted use, see local guidelines      

Purple – Specialist use/initiation

Red – Non Formulary

 

Relative Costs Key (where indicated):

£££££ - high

£££ - moderate

£ - low

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