Drugs used in nausea and vertigo 223

4.6 Drugs used in nausea and vertigo 223

C entral

nervous

syst em

4.6 Drugs used in nausea and vertigo BNF 57 Side-effects section 3.4.1

PROCHLORPERAZINE

Dose

. Indications 25–75 mg, max. 100 mg, daily; CHILD 5–10 years, 12.5– severe nausea, vomiting, vertigo, labyrin-

37.5 mg daily thine disorders (see notes above); other indications . Motion sickness prevention, ADULT and CHILD over 10

section 4.2.1

years, 25 mg at bedtime on night before travel or Cautions see under Prochlorperazine (section 4.2.1);

25 mg 1–2 hours before travel; CHILD 5–10 years, oral route only for children (avoid if under 10 kg);

12.5 mg at bedtime on night before travel or 12.5 mg elderly (see notes above) 1–2 hours before travel

Contra-indications see under Prochlorperazine (sec- . Severe vomiting in pregnancy [unlicensed], 25 mg at

tion 4.2.1)

bedtime, increased if necessary to max. 100 mg daily Side-effects see under Prochlorperazine (section (but see also Vomiting During Pregnancy, p. 222)

4.2.1); extrapyramidal symptoms, particularly in chil- Avomine dren, elderly, and debilitated c

(Manx) Tablets , scored, promethazine teoclate 25 mg. Net

Dose

price 10-tab pack = £1.13; 28-tab pack = £3.13. Note Doses are expressed as prochlorperazine maleate or Label: 2

mesilate; 1 mg prochlorperazine maleate : 1 mg prochlor- perazine mesilate

. By mouth , nausea and vomiting, acute attack, 20 mg initially then 10 mg after 2 hours; prevention 5–

tem Phenothiazines and related drugs

10 mg 2–3 times daily; CHILD (over 10 kg only)

sys 250 micrograms/kg 2–3 times daily

Labyrinthine disorders, 5 mg 3 times daily, gradually

CHLORPROMAZINE

increased if necessary to 30 mg daily in divided doses,

HYDROCHLORIDE

then reduced after several weeks to 5–10 mg daily;

nervous

CHILD not recommended l Indications nausea and vomiting of terminal illness

. By deep intramuscular injection , nausea and vomi- (where other drugs have failed or are not available);

ting, 12.5 mg when required followed if necessary

entra

C other indications (section 4.2.1 and section 15.1.4.1) after 6 hours by an oral dose, as above; CHILD and Cautions see Chlorpromazine Hydrochloride, section

ADOLESCENT under 18 years, see BNF for Children

4 4.2.1 Contra-indications see Chlorpromazine Hydro-

A Tablets , prochlorperazine maleate 5 mg, net price 28 Side-effects see Chlorpromazine Hydrochloride, sec-

Prochlorperazine (Non-proprietary) chloride, section 4.2.1

= £2.09, 84 = £4.14. Label: 2 tion 4.2.1 Dose

Stemetil c (Castlemead) A . By mouth , 10–25 mg every 4–6 hours; CHILD

Tablets , prochlorperazine maleate 5 mg (off-white), 500 micrograms/kg every 4–6 hours (1–5 years

net price 84-tab pack = £6.18. Label: 2 max. 40 mg daily, 6–12 years max. 75 mg daily)

Syrup , straw-coloured, prochlorperazine mesilate . By deep intramuscular injection initially 25 mg then

5 mg/5 mL. Net price 100-mL pack = £3.48. Label: 2 25–50 mg every 3–4 hours until vomiting stops; CHILD 500 micrograms/kg every 6–8 hours (1–5

Injection , prochlorperazine mesilate 12.5 mg/mL. years max. 40 mg daily, 6–12 years max. 75 mg

Net price 1-mL amp = 54p daily)

. By rectum in suppositories, chlorpromazine 100 mg every 6–8 hours [unlicensed]

1 Buccastem Buccal preparation c (R&C) A Preparations

Tablets (buccal) , pale yellow, prochlorperazine mal- Section 4.2.1

counselling, administration, see under Dose below Dose ADULT and CHILD over 12 years, 1–2 tablets twice daily; tablets are placed high between upper lip and gum and left to

PERPHENAZINE

dissolve

1. Prochlorperazine maleate can be sold to the public for adults severe nausea, vomiting (see notes

Indications

over 18 years (provided packs do not contain more than above); other indications (section 4.2.1)

24 mg) for the treatment of nausea and vomiting in Cautions see Perphenazine (section 4.2.1)

previously diagnosed migraine only (max. daily dose 12 mg) Contra-indications see Perphenazine (section 4.2.1)

Side-effects see Perphenazine (section 4.2.1); extra- pyramidal symptoms particularly in young adults, elderly, and debilitated

Dose

TRIFLUOPERAZINE

4 mg 3 times daily, adjusted according to response; max. 24 mg daily (chemotherapy-induced);

ELDERLY Indications severe nausea and vomiting (see notes quarter to half adult dose; CHILD under 14 years not

above); other indications (section 4.2.1) recommended

Cautions section 4.2.1 Contra-indications section 4.2.1

Preparations Side-effects section 4.2.1; extrapyramidal symptoms, Section 4.2.1

particularly in children, elderly, and debilitated

BNF 57

4.6 Drugs used in nausea and vertigo 225

Dose dix 2), renal impairment (Appendix 3); pregnancy . 2–4 mg daily in divided doses or as a single dose of a

(Appendix 4); interactions: Appendix 1 (metoclo- modified-release preparation; max. 6 mg daily; CHILD

pramide)

3–5 years up to 1 mg daily, 6–12 years up to 4 mg daily Contra-indications gastro-intestinal obstruction, per- foration or haemorrhage; 3–4 days after gastro-intes-

Preparations tinal surgery; phaeochromocytoma; breast-feeding Section 4.2.1

(Appendix 5) Side-effects extrapyramidal effects (especially in children and young adults—see p. 222), hyperprolac-

Domperidone and metoclopramide

tinaemia, occasionally tardive dyskinesia on pro- longed administration; also reported, anxiety, confu- sion, drowsiness, restlessness, diarrhoea, depression,

neuroleptic malignant syndrome, rashes, pruritus, Indications nausea and vomiting, dyspepsia, gastro-

DOMPERIDONE

oedema; cardiac conduction abnormalities reported oesophageal reflux

following intravenous administration; rarely Cautions

methaemoglobinaemia (more severe in G6PD defi- children; renal impairment (Appendix 3);

ciency)

1 (domperidone) Dose Contra-indications prolactinoma, hepatic impair-

breast-feeding (Appendix 5); interactions: Appendix

. By mouth or by intramuscular injection or by intra- ment; where increased gastro-intestinal motility

venous injection over 1–2 minutes, nausea and harmful; pregnancy (Appendix 4)

vomiting, 10 mg (5 mg in young adults 15–19 years Side-effects

under 60 kg) 3 times daily; CHILD up to 1 year (up to rarely gastro-intestinal disturbances

10 kg) 100 micrograms/kg (max. 1 mg) twice daily, (including cramps) and hyperprolactinaemia; very

1–3 years (10–14 kg) 1 mg 2–3 times daily, 3–5 years rarely extrapyramidal effects and rashes

(15–19 kg) 2 mg 2–3 times daily, 5–9 years (20– Dose

29 kg) 2.5 mg 3 times daily, 9–15 years (30 kg and . By mouth , ADULT and CHILD body-weight over 35 kg,

over) 5 mg 3 times daily 10–20 mg 3–4 times daily; max. 80 mg daily; CHILD

Note Daily dose of metoclopramide should not normally body-weight up to 35 kg (nausea and vomiting

exceed 500 micrograms/kg, particularly for children and only), 250–500 micrograms/kg 3–4 times daily;

young adults (restricted use, see above) max. 2.4 mg/kg daily

For diagnostic procedures, as a single dose 5–10

. By rectum , ADULT and CHILD body-weight over 35 kg, minutes before examination, 10–20 mg (10 mg in

entral C

60 mg twice daily; CHILD 15–35 kg (nausea and young adults 15–19 years); CHILD under 3 years 1 mg,

vomiting only), 30 mg twice daily; CHILD body- 3–5 years 2 mg, 5–9 years 2.5 mg, 9–14 years 5 mg weight under 15 kg, not recommended

Metoclopramide (Non-proprietary) A nervous

1 Domperidone (Non-proprietary) A Tablets , metoclopramide hydrochloride 10 mg, net Tablets , 10 mg (as maleate), net price 30-tab pack =

price 28-tab pack = 90p £1.37; 100-tab pack = £2.55

Oral solution , metoclopramide hydrochloride 5 mg/

syst

1. Domperidone can be sold to the public (provided packs do

5 mL, net price 200-mL pack = £3.83 not contain more than 200 mg) for the relief of postprandial

Note Sugar-free versions are available and can be ordered by symptoms of excessive fullness, nausea, epigastric bloating

em

specifying ‘sugar-free’ on the prescription

and belching occasionally accompanied by epigastric discomfort and heartburn (max. single dose 10 mg, max.

Injection , metoclopramide hydrochloride 5 mg/mL, daily dose 40 mg)

net price 2-mL amp = 26p Motilium c (Sanofi-Synthelabo)

A c Maxolon (Shire) A Tablets , f/c, domperidone 10 mg (as maleate). Net

Tablets , scored, metoclopramide hydrochloride price 30-tab pack = £2.82; 100-tab pack = £9.41

10 mg, net price 84-tab pack = £5.25 Suspension , sugar-free, domperidone 5 mg/5 mL.

Syrup , sugar-free, metoclopramide hydrochloride Net price 200-mL pack = £2.16

5 mg/5 mL. Net price 200-mL pack = £3.83 Suppositories domperidone 30 mg. Net price 10 =

Paediatric liquid , sugar-free, metoclopramide £3.18

hydrochloride 1 mg/mL. Net price 15-mL pack with pipette = £1.51. Counselling, use of pipette

METOCLOPRAMIDE

Injection , metoclopramide hydrochloride 5 mg/mL.

HYDROCHLORIDE Net price 2-mL amp = 27p

Indications adults, nausea and vomiting, particularly High-dose (with cytotoxic chemotherapy only) in gastro-intestinal disorders (section 1.2) and treat-

Maxolon High Dose c (Shire) A ment with cytotoxics or radiotherapy; migraine (sec-

Injection , metoclopramide hydrochloride 5 mg/mL. tion 4.7.4.1)

Net price 20-mL amp = £2.67. Patients under 20 years Use restricted to severe intract-

For dilution and use as an intravenous infusion in nausea and able vomiting of known cause, vomiting of radiotherapy and

vomiting associated with cytotoxic chemotherapy only cytotoxics, aid to gastro-intestinal intubation, premedication;

Dose by continuous intravenous infusion (preferred method), dose should be determined on the basis of body-weight

initially (before starting chemotherapy), 2–4 mg/kg over 15–20 Cautions elderly, young adults, and children (measure

minutes, then 3–5 mg/kg over 8–12 hours; max. in 24 hours, dose accurately, preferably with a pipette); atopic

10 mg/kg

allergy (including asthma); may mask underlying dis- By intermittent intravenous infusion , initially (before starting orders such as cerebral irritation; acute porphyria

chemotherapy), up to 2 mg/kg over at least 15 minutes then up to (section 9.8.2); epilepsy; hepatic impairment (Appen- 2 mg/kg over at least 15 minutes every 2 hours; max. in 24 hours,

10 mg/kg

4.6 Drugs used in nausea and vertigo BNF 57 Modified release

By intravenous injection (diluted in 15 mL sodium Maxolon SR c (Shire) AU

chloride 0.9% and given over not less than 30 Capsules , m/r, clear, enclosing white granules,

seconds) or by intravenous infusion (over 5 min- metoclopramide hydrochloride 15 mg. Net price 56-

utes), prevention, 3 mg before start of cytotoxic cap pack = £7.01. Label: 25

therapy (up to 2 additional 3-mg doses may be given Dose patients over 20 years, 1 capsule twice daily

within 24 hours); treatment, as for prevention (the two additional doses must not be given less than 10

Compound preparations (for migraine) minutes apart); max. 9 mg in 24 hours; CHILD , by Section 4.7.4.1

intravenous infusion , (over 5 minutes), prevention,

40 micrograms/kg (max. 3 mg) before start of cytotoxic therapy; treatment, as for prevention—

5HT 3 antagonists

one additional dose of 40 micrograms/kg (max.

3 mg) may be given within 24 hours (not less than

10 minutes after initial dose)

DOLASETRON MESILATE

. Postoperative nausea and vomiting, by intravenous

Indications (diluted to 5 mL and given over 30 sec-

injection

see under Dose onds), prevention, 1 mg before induction of anaes- Cautions concomitant administration of drugs that

thesia; treatment, 1 mg, given as for prevention; prolong QT interval, congestive heart failure;

max. 2 mg in one day; CHILD not recommended

tem

pregnancy (Appendix 4); breast-feeding (Appendix 5); Kytril interactions: Appendix 1 (dolasetron) c (Roche) A sys Contra-indications prolonged QT interval, cardiac

Tablets , f/c, granisetron (as hydrochloride) 1 mg, net conduction disorders

price 10-tab pack = £65.49; 2 mg, 5-tab pack = £65.49 Side-effects diarrhoea, constipation, dyspepsia,

Sterile solution , granisetron (as hydrochloride) 1 mg/ mL, for dilution and use as injection or infusion, net

nervous

bance; tachycardia, bradycardia, ECG changes, price 1-mL amp = £8.60, 3-mL amp = £25.79 flushing; fever, shivering; headache, sleep disorder,

abdominal pain, flatulence, anorexia, taste distur-

entra

C fatigue, dizziness, drowsiness, hypersensitivity reac-

ONDANSETRON

tions including rash, rarely intestinal obstruction,

4 pancreatitis, jaundice, oedema, cardiac arrhythmia,

Indications see under Dose bronchospasm, seizures, very rarely severe hypo-

Cautions QT interval prolongation (avoid concomitant tension following intravenous injection

administration of drugs that prolong QT interval); Dose

hepatic impairment (Appendix 2); pregnancy . Prevention of nausea and vomiting induced by cyto-

(Appendix 4); breast-feeding (Appendix 5); interac- toxic chemotherapy, by intravenous injection (over

tions: Appendix 1 (ondansetron)

30 seconds) or by intravenous infusion , ADULT over Side-effects constipation; headache; flushing; injec-

18 years, 100 mg 30 minutes before treatment tion site-reactions; less commonly hiccups, hypo- . Prevention of postoperative nausea and vomiting by

tension, bradycardia, chest pain, arrhythmias, move- intravenous injection (over 30 seconds) or by

ment disorders, seizures; on intravenous administration, intravenous infusion , ADULT over 18 years, 12.5 mg

rarely dizziness, transient visual disturbances (very at cessation of anaesthesia,

rarely transient blindness); suppositories may cause . Treatment of postoperative nausea and vomiting, by

rectal irritation

intravenous injection (over 30 seconds) or by

Dose

intravenous infusion , ADULT over 18 years, 12.5 mg . Moderately emetogenic chemotherapy or radiother-

Anzemet c (Amdipharm) TA , 8 mg 1–2 hours before treatment or , dolasetron mesilate 20 mg/mL, net price

apy, by mouth

Injection , 16 mg 1–2 hours before treatment or by

by rectum

0.625-mL (12.5-mg) amp = £4.00, 5-mL (100-mg) amp intramuscular injection or slow intravenous injec-

= £13.00 tion , 8 mg immediately before treatment

then by mouth , 8 mg every 12 hours for up to 5 days or by rectum , 16 mg daily for up to 5 days; CHILD , by

GRANISETRON

slow intravenous injection or by intravenous infu- sion over 15 minutes, 5 mg/m immediately before

Indications see under Dose chemotherapy then 4 mg by mouth every 12 hours Cautions pregnancy (Appendix 4) and breast-feeding

for up to 5 days (Appendix 5)

. Severely emetogenic chemotherapy, by intramuscu- Side-effects constipation, headache, rash; hyper-

lar injection or slow intravenous injection , 8 mg sensitivity reactions reported; rarely movement dis-

immediately before treatment, where necessary orders

followed by 2 further doses of 8 mg at intervals of 2– Dose

4 hours (or followed by 1 mg/hour by continuous . Nausea and vomiting induced by cytotoxic chemo-

intravenous infusion for up to 24 hours) therapy or radiotherapy, by mouth , 1–2 mg within 1

then by mouth , 8 mg every 12 hours for up to 5 days hour before start of treatment, then 2 mg daily in 1–

or by rectum , 16 mg daily for up to 5 days;

2 divided doses during treatment; when intravenous alternatively, by intravenous infusion over at least 15 infusion also used, max. combined total 9 mg in 24

minutes, 32 mg immediately before treatment or by hours; CHILD

20 micrograms/kg (max. 1 mg) within 1 rectum , 16 mg 1–2 hours before treatment hour before start of treatment, then 20 micrograms/

then by mouth , 8 mg every 12 hours for up to 5 days kg (max. 1 mg) twice daily for up to 5 days during

or by rectum , 16 mg daily for up to 5 days; CHILD , by treatment

slow intravenous injection , 5 mg/m immediately

BNF 57

4.6 Drugs used in nausea and vertigo 227

before chemotherapy then 4 mg by mouth every 12 Aloxi c (IS Pharmaceuticals) TA hours for up to 5 days

Injection , palonosetron (as hydrochloride) 50 micr- . Prevention of postoperative nausea and vomiting, by

ograms/mL, net price 5-mL amp = £55.89 mouth , 16 mg 1 hour before anaesthesia or 8 mg 1 hour before anaesthesia followed by 8 mg at inter- vals of 8 hours for 2 further doses alternatively, by intramuscular or slow intravenous

Neurokinin receptor antagonist

injection , 4 mg at induction of anaesthesia; CHILD over 2 years, by slow intravenous injection , 100 micrograms/kg (max. 4 mg) before, during, or

APREPITANT

after induction of anaesthesia Indications adjunct to dexamethasone and a 5HT . Treatment of postoperative nausea and vomiting, by

antagonist in preventing nausea and vomiting asso- intramuscular or slow intravenous injection , 4 mg;

ciated with moderately and highly emetogenic CHILD over 2 years, by slow intravenous injection ,

chemotherapy

100 micrograms/kg (max. 4 mg) Cautions hepatic impairment (Appendix 2); pregnancy Ondansetron (Non-proprietary) A (Appendix 4); interactions: Appendix 1 (aprepitant)

Tablets , ondansetron (as hydrochloride) 4 mg, net Contra-indications breast-feeding (Appendix 5) price 30-tab pack = £89.69; 8 mg, 10-tab pack =

Side-effects hiccups, dyspepsia, diarrhoea, constipa- £59.71

tion, anorexia; asthenia, headache, dizziness; less Brands include Ondemet

commonly weight changes, dry mouth, colitis, flatu- Injection , ondansetron (as hydrochloride) 2 mg/mL,

lence, stomatitis, abdominal pain, gastro-oesophageal net price 2-mL amp = £5.39, 4-mL amp = £10.79

reflux, duodenal ulcer, oedema, bradycardia, cough, Brands include Ondemet

disorientation, euphoria, anxiety, confusion, thirst, Zofran c (GSK) abnormal dreams, hyperglycaemia, polyuria, anae- A mia, dysuria, haematuria, myalgia, conjunctivitis,

Tablets , yellow, f/c, ondansetron (as hydrochloride)

4 mg, net price 30-tab pack = £107.91; 8 mg, 10-tab pharyngitis, sneezing, tinnitus, sweating, oily skin, pack = £71.94

pruritus, rash, acne, photosensitivity, flushing, hypo- Oral lyophilisates (Zofran Melt c

natraemia

), ondansetron 4 mg,

Dose

net price 10-tab pack = £35.97; 8 mg, 10-tab pack = £71.94. Counselling, administration

. ADULT over 18 years 125 mg 1 hour before chemo-

Excipients include aspartame (section 9.4.1)

therapy, then 80 mg daily as a single dose for the next Counselling Tablets should be placed on the tongue, allowed to

2 days; consult product literature for dose of conco-

entral C

disperse and swallowed mitant corticosteroid and 5HT antagonist Syrup , sugar-free, strawberry-flavoured, ondansetron

(as hydrochloride) 4 mg/5 mL, net price 50-mL pack c Emend (MSD) A = £35.97

nervous

Capsules , aprepitant 80 mg (white), net price 2-cap

pack = £31.61; 125 mg (white/pink), 5-cap pack = Injection , ondansetron (as hydrochloride) 2 mg/mL,

£79.03; 3-day pack of one 125-mg capsule and two 80- net price 2-mL amp = £5.99; 4-mL amp = £11.99

mg capsules = £47.42

syst

Suppositories , ondansetron 16 mg, net price 1 = £14.39

em FOSAPREPITANT

Note Fosaprepitant is a prodrug of aprepitant Indications

PALONOSETRON

prevention of nausea and vomiting Indications adjunct to dexamethasone and a 5HT induced by moderately and severely emetogenic

antagonist in preventing nausea and vomiting asso- chemotherapy

ciated with moderately and highly emetogenic Cautions history of constipation; intestinal obstruc-

chemotherapy

tion; concomitant administration of drugs that pro- Cautions hepatic impairment (Appendix 2); pregnancy long QT interval; pregnancy (Appendix 4); breast-

(Appendix 4); interactions: Appendix 1 (aprepitant) feeding (Appendix 5)

Contra-indications breast-feeding (Appendix 5) Driving Dizziness or drowsiness may affect performance of

Side-effects anorexia, constipation, diarrhoea, dys- skilled tasks (e.g. driving)

pepsia, hiccups; asthenia, dizziness, headache; less Side-effects diarrhoea, constipation; headache, dizzi-

commonly weight changes, abdominal pain, colitis, dry ness; less commonly dyspepsia, abdominal pain, dry

mouth, duodenal ulcer, flatulence, gastro-oeso- mouth, flatulence, changes in blood pressure, tachy-

phageal reflux, stomatitis, taste disturbances, brady- cardia, bradycardia, arrhythmia, myocardial ischae-

cardia, oedema, cough, abnormal dreams, anxiety, mia, hiccups, drowsiness, asthenia, insomnia, anxiety,

disorientation, confusion, euphoria, thirst, hyperglyc- euphoria, paraesthesia, peripheral neuropathy, ano-

aemia, dysuria, polyuria, flushing, neutropenia, anae- rexia, motion sickness, influenza-like symptoms,

mia, haematuria, hyponatraemia, myalgia, con- urinary retention, glycosuria, hyperglycaemia,

junctivitis, pharyngitis, sneezing, tinnitus, acne, electrolyte disturbance, arthralgia, eye irritation,

photosensitivity, flushing, pruritus, oily skin, rash, amblyopia, tinnitus, rash, pruritus

. By intravenous injection (over 30 seconds), . By intravenous infusion , over 15 minutes, ADULT 250 micrograms as a single dose 30 minutes before

over 18 years, 115 mg 30 minutes before chemo- treatment; do not repeat dose within 7 days; CHILD

therapy on day 1 of cycle (followed by aprepitant on and ADOLESCENT under 18 years not recommended

days 2 and 3 of cycle); consult product literature for

4.6 Drugs used in nausea and vertigo BNF 57 dose of concomitant corticosteroid and 5HT

Dose

antagonist . Motion sickness, by mouth , ADULT and CHILD over 10 Ivemend c (MSD) TA

years, 150–300 micrograms up to 30 minutes before Injection , powder for reconstitution, fosaprepitant (as

start of journey repeated every 6 hours if required; dimeglumine), net price 115-mg vial = £20.55

max. 900 micrograms daily; CHILD 3–4 years The Scottish Medicines Consortium (p. 3) has advised (September

75 micrograms up to 30 minutes before start of 2008) that fosaprepitant (Ivemend ) is accepted for restricted use

journey repeated after 6 hours if required, max. for the prevention of acute and delayed nausea and vomiting

150 micrograms daily; 4–10 years 75–150 micr- associated with highly emetogenic cisplatin-based chemotherapy

ograms up to 30 minutes before start of journey repeated every 6 hours if required; max. 450 micr- ograms daily

Cannabinoid

. Hypersalivation associated with clozapine therapy [unlicensed indication], by mouth , ADULT over 16 years, 300 micrograms up to 3 times daily; max.

900 micrograms daily Indications nausea and vomiting caused by cytotoxic

NABILONE

Joy Rides c (GSK Consumer Healthcare) chemotherapy, unresponsive to conventional anti-

Chewable tablets , raspberry-flavoured, hyoscine emetics (under close observation, preferably in hos-

hydrobromide 150 micrograms, net price 12-tab pack tem = £1.49. Label: 2, 24 pital setting) Cautions history of psychiatric disorder; elderly;

sys

hypertension; heart disease; adverse effects on mental Kwells c (Bayer Consumer Care)

state can persist for 48–72 hours after stopping; Chewable tablets , scored, hyoscine hydrobromide c

pregnancy (Appendix 4); interactions: Appendix 1 150 micrograms (Kwells Kids ) (white), net price 12- (nabilone)

tab pack = £1.52; 300 micrograms (pink), 12-tab pack

nervous

l = £1.52. Label: 2, 24

Driving Drowsiness may affect performance of skilled tasks

(e.g. driving); effects of alcohol enhanced

entra Contra-indications severe hepatic impairment;

Patches

C breast-feeding (Appendix 5) Scopoderm TTS c (Novartis Consumer Health) A

4 Side-effects drowsiness, vertigo, euphoria, dry

Patch , self-adhesive, pink, releasing hyoscine approx. mouth, ataxia, visual disturbance, concentration dif-

1 mg/72 hours when in contact with skin. Net price 2 ficulties, sleep disturbance, dysphoria, hypotension,

= £4.30. Label: 19, counselling, see below headache and nausea; also confusion, disorientation,

Dose motion sickness prevention, apply 1 patch to hairless area hallucinations, psychosis, depression, decreased

of skin behind ear 5–6 hours before journey; replace if necessary after 72 hours, siting replacement patch behind other ear; CHILD

coordination, tremors, tachycardia, decreased appe- under 10 years not recommended tite, and abdominal pain

Counselling Explain accompanying instructions to patient and in Behavioural effects Patients should be made aware of

particular emphasise advice to wash hands after handling and to possible changes of mood and other adverse behavioural

wash application site after removing, and to use one patch at a effects

time

Dose . Initially 1 mg twice daily, increased if necessary to

Parenteral preparations

2 mg twice daily, throughout each cycle of cytotoxic

Section 15.1.3

therapy and, if necessary, for 48 hours after the last dose of each cycle; max. 6 mg daily given in 3 divided doses. The first dose should be taken the night before initiation of cytotoxic treatment and the second dose

Other drugs for Me´nie`re’s disease

1–3 hours before the first dose of cytotoxic drug; Betahistine has been promoted as a specific treatment ADOLESCENT and CHILD under 18 years consult local

for Me´nie`re’s disease. treatment protocol [unlicensed use]

Nabilone (Valeant) A Capsules , blue/white, nabilone 1 mg. Net price 20-

BETAHISTINE DIHYDROCHLORIDE

cap pack = £125.84. Label: 2, counselling, Indications vertigo, tinnitus and hearing loss asso- behavioural effects

ciated with Me´nie`re’s disease Cautions asthma, history of peptic ulcer; pregnancy and breast-feeding; interactions: Appendix 1 (beta-

Hyoscine

histine) Contra-indications phaeochromocytoma Side-effects gastro-intestinal disturbances; headache,

HYOSCINE HYDROBROMIDE

rashes and pruritus reported (Scopolamine Hydrobromide)

Dose

Indications motion sickness; hypersalivation asso- . Initially 16 mg 3 times daily, preferably with food; ciated with clozapine therapy; premedication (section

maintenance 24–48 mg daily; CHILD not recom- 15.1.3); excessive respiratory secretions (see Pre-

mended

scribing in Palliative Care, p. 16) Cautions section 1.2

Betahistine Dihydrochloride (Non-proprietary) A Contra-indications

Tablets , betahistine dihydrochloride 8 mg, net price section 1.2

84-tab pack = £2.85, 120-tab pack = £1.56; 16 mg, 84- Side-effects section 1.2

tab pack = £2.38. Label: 21

Serc c (Solvay) A

Tablets , betahistine dihydrochloride 8 mg (Serc c -8 ), net price 120-tab pack = £9.04; 16 mg (Serc c -16 )

(scored), 84-tab pack = £12.65. Label: 21