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 Formulary Chapter 4: Central nervous system - Full Chapter
Notes:

CNS-related Prescribing Guidance

Please see our Prescribing Guidelines page for all prescribing guidance relating to this chapter.

CNS-related Shared Care Agreements

Please see our Shared Care Agreements page for all shared care agreements (SCAs) relating to this chapter.

 

 Details...
04.06  Expand sub section  Drugs used in nausea and vertigo
 note 
  • Haloperidol and levomepromazine (section 4.2.1) are also used for the relief of nausea.
  • Treat the underlying cause of nausea before starting an anti-emetic wherever possible.
  • Both metoclopramide and prochlorperazine may precipitate extrapyramidal effects especially in the young and the elderly.
  • Ondansetron is less sedating and suitable for use in day case.

 Pregnancy: Please see the SPS Q&A: How can nausea and vomiting be treated during pregnancy? (Updated November 2019)

04.06  Expand sub section  Vomiting during pregnancy
04.06  Expand sub section  Postoperative nausea and vomiting
04.06  Expand sub section  Motion sickness
04.06  Expand sub section  Other vestibular disorders to top
04.06  Expand sub section  Cytotoxic chemotherapy
04.06  Expand sub section  Palliative care
04.06  Expand sub section  Migraine
04.06  Expand sub section  Antihistamines
04.06  Expand sub section  Phenothiazines and related drugs to top
04.06  Expand sub section  Domperidone and metoclopramide
Domperidone 
(Oral)
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  • Green when used within licensed indication which is SHORT –TERM relief of symptoms of nausea and vomiting in adults and adolescents over 12 years and weighing more than 35 kg. For use in GI pain in palliative care see Chapter 21
  • Amber for longer-term or off-label use
  • Tablet 10mg
  • Suspension 5mg in 5ml
  • Prescribe in line with MHRA advice and BSW domperidone guidance (links below)

 

 
Link  BSW Domperidone Guidance
Link  MHRA Drug Safety Update (Dec 2019): Domperidone for nausea and vomiting: lack of efficacy in children; reminder of contraindications in adults and adolescents
Link  MHRA Drug Safety Update Dec 2014: Domperidone: risks of cardiac side effects
   
Metoclopramide 
(Oral, injection)
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  • Green for short-term use (maximum 5 days)
  • Amber for long-term use (off-label)
  • Tablet 10mg
  • Syrup 5mg in 5ml
  • Injection 10mg in 2ml
  • Metoclopramide and prochlorperazine are associated with a high risk of dystonias and oculogyric crises particularly in children, young adults and the elderly. 
  • Severe reactions to metoclopramide should be treated with procyclidine injection
  • Metoclopramide should not be prescribed for patients with Parkinson's disease.
 
Link  MHRA DSU Dec 2014 Metoclopramide: risk of neurological adverse effects
   
04.06  Expand sub section  5HT3 antagonists
04.06  Expand sub section  Neurokinin receptor antagonist
04.06  Expand sub section  Cannabinoid
04.06  Expand sub section  Hyoscine to top
04.06  Expand sub section  Other drugs for Ménière's disease
 ....
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG
Blueteq
High Cost Drug Approval System

Traffic Light Status Information

Status Description

Red

RED - Hospital only – to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment.  

Amber

Amber medicines are considered suitable for GP prescribing following specialist initiation or recommendation.  

Amber with Shared Care

Shared Care - these medicines require specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.  

Green

These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations.  

Self

Suitable for patient to be directed to buy themselves  

Grey

Not currently used. We intend to include this TLS in future to highlight where a decision to use this medicine is under review.   

Black

(In use from Oct 2020) Used where a decision has been made by the BSW APC not to routinely commission this preparation for its licensed indications. Do not prescribe.   

Red Specialist Centre

Not currently used. We intend to include this TLS in future to highlight where this medicine and indication is ONLY available through a Specialist Centre according to a NICE Highly Specialised Technology or NHSE Specialised Commission Circular / Policy.  

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