netFormulary NHS
NHS Bath and North East Somerset, Swindon and Wiltshire CCG
Royal United Hospitals Bath NHS Foundation Trust
Great Western Hospitals NHS Foundation Trust
Salisbury NHS Foundation Trust
 Formulary Chapter 4: Central nervous system - Full Chapter

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.


04.06  Expand sub section  Drugs used in nausea and vertigo
  • 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
04.06  Expand sub section  5HT3 antagonists
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  • Tablet 4mg, 8mg
  • SyrupSF 4mg in 5ml
  • Injection 4mg in 2ml, 8mg in 4ml
  • Long term treatment is rarely justified or necessary. 
  • Ondansetron is used for the following groups of patients:
    • For the prevention of PONV: in patients classified as ‘high risk’.
    • In the treatment of PONV: for patients requiring rescue medicine.
    • In general patients: those with protracted nausea and vomiting who have failed to respond to two conventional anti-emetics at full dose. If the symptoms are severe, ondansetron may be prescribed after trying only one conventional anti-emetic.
  • See MHRA safety update link below: Recent epidemiological studies suggest exposure to ondansetron during the first trimester of pregnancy is associated with a small increased risk of the baby having a cleft lip and/or cleft palate. 
Link  MHRA Drug Safety update 27th Jan 2020: Ondansetron: small increased risk of oral clefts following use in the first 12 weeks of pregnancy
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
 Non Formulary Items
Dolasetron Mesilate

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Non Formulary

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Non Formulary
Granisetron transdermal patch

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Non Formulary
Palonosetron (Aloxi®)

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Non Formulary
Tropisetron (Navoban®)

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Non Formulary
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
Track Changes
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Link to adult BNF
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Link to SPCs
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHS England
High Cost Drug Approval System

Traffic Light Status Information

Status Description

Traffic LightRed

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

Traffic LightAmber

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

Traffic LightAmber 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.  

Traffic LightGreen

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

Traffic LightSelf

Suitable for patient to be directed to buy themselves  

Traffic LightGrey

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

Traffic LightBlack

(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.   

Traffic LightRed 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.