Related guidance:
Nausea and Vomiting: treatment during pregnancy (SPS January 2022, updated April 2022)
The palliative care handbook, A Good Practice Guide (Wessex Palliative Physicians 2019)
| Therapeutic Area | Formulary Choices | Cost for 28 (unless otherwise stated) | Rationale for decision / comments |
|---|---|---|---|
| Antiemetics and Antinauseants | |||
| Dopamine receptor antagonists | Domperidone | Indication restricted to nausea and vomiting, new contraindications, and reduced dose and duration of use. See MHRA (December 2014) for Domperidone: risks of cardiac side effects. A European review confirmed a small increased risk of serious cardiac side effects. A higher risk was observed particularly in people older than 60 years, people taking daily oral domperidone doses of more than 30 mg, and those taking QT-prolonging medicines or CYP3A4 inhibitors at the same time as domperidone. The overall safety profile of domperidone, and in particular its cardiac risk and potential interactions with other medications, should be taken into account if there is a clinical need to use it at doses or durations greater than those authorised (eg, to control side effects of Parkinson’s disease treatment in some patients). |
|
| Domperidone is no longer licensed for use in children younger than 12 years or those weighing less than 35 kg. Results from a placebo-controlled study in children younger than 12 years with acute gastroenteritis did not show any difference in efficacy at relieving nausea and vomiting compared with placebo. See MHRA (December 2019) for Domperidone for nausea and vomiting: lack of efficacy in children; reminder of contraindications in adults and adolescents. | |||
| 10mg tablet: £0.66 (30) | Nausea and vomiting and acute migraine for adults and adolescents over 12 years of age and weighing 35 kg or more, the recommended maximum dose in 24 hours is 30 mg (10 mg up to three times a day) The maximum treatment duration should not usually exceed one week. |
||
| 1mg/ml oral suspension sugar free: £24.85 (200 ml) | |||
| Metoclopramide | Restricted dose and duration of use. See MHRA (December 2014) for Metoclopramide: risk of neurological adverse effects. The EU review has recommended changes that include a restriction to the dose and duration of use to help minimise the risk of potentially serious neurological adverse effects. The risk of acute neurological effects is higher in children than in adults. In adults, metoclopramide remains indicated for: prevention of postoperative nausea and vomiting radiotherapy-induced nausea and vomiting delayed (but not acute) chemotherapy-induced nausea and vomiting symptomatic treatment of nausea and vomiting, including that associated with acute migraine (where it may also be used to improve absorption of oral analgesics). In children, age 1–18 years, metoclopramide should only be used as a second-line option for prevention of delayed chemotherapy-induced nausea and vomiting, and for treatment of established postoperative nausea and vomiting. Use of metoclopramide is contraindicated in children younger than 1 year. |
||
| 10mg tablet: £0.98 | Nausea and vomiting and acute migraine for adults, the usual dose is 10 mg up to three times a day, the maximum dose in 24 hours is 30mg. For children age 1 year or older, the recommended dose is 0.1–0.15 mg per kg bodyweight, repeated up to 3 times a day - the maximum dose in 24 hours is 0.5 mg per kg bodyweight. Metoclopramide should only be prescribed for short-term use (up to 5 days). |
||
| 5mg/5ml oral solution sugar free: £19.79 (150 ml) | |||
| Antipsychotic- first generation | Prochlorperazine | 5mg tablet: £1.34 | Adults, nausea and vomiting acute attack, initially 20mg, then 10mg after 2 hours. Acute migraine, 10mg for 1 dose, to be taken as soon as migraine symptoms develop. Prevention 5-10mg 2-3 times a day. |
| 5mg/5ml oral solution: £3.34 (100 ml) | |||
| Prochlorperazine 3mg buccal tablets are non-formulary as not cost effective | |||
| Levomepromazine | 25mg tablet: £20.86 (84) | For palliative care as per Wessex palliative care handbook. | |
| 25mg/1ml solution for injection ampoule: £20.13 (10) | |||