netFormulary South East London Joint Medicines Formulary NHS
Guy's and St Thomas' NHS Foundation Trust
Kings College Hospital NHS Foundation Trust
Lewisham and Greenwich NHS Trust
 
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 Formulary Chapter 4: Central nervous system - Full Chapter
Notes:
In this section "SPECIALISTS" refer to medical prescribers specialising in Mental Health unless otherwise stated. At Guy's and St Thomas' and Lewisham Hospitals this would refer to SLAM employed consultants
 Details...
04.06  Expand sub section  Drugs used in nausea and vertigo
04.06  Expand sub section  Antihistamines
Cinnarizine tabs

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Cyclizine tabs, injection

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Formulary Follow local guidelines for use in post-operative nausea and vomiting
   
Promethazine tabs, elixir, injection

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04.06  Expand sub section  Phenothiazines and related drugs
Droperidol injection

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Red
Prophylaxis and treatment of postoperative nausea and vomiting in accordance with its marketing authorisation.
   
Prochlorperazine tabs, buccal tabs, syrup, injection

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04.06  Expand sub section  Domperidone and metoclopramide
Domperidone tabs, suspension

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Link  MHRA advice May 2014: Domperidone: risks of cardiac side effects    
Domperidone tabs, suspension (use as galactagogue - off-label)

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Red
Approved off-label indication:
  • Treatment of inadequate lactation
    Dose = 10mg three times a day
  •    
    Metoclopramide tabs, syrup, injection

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    Formulary Daily doses >30 mg and duration >5 days (off-label) may be used for symptom
    control in palliative care patients only

    Link  MHRA advice August 2013: Metoclopramide: risk of neurological adverse effects    
    04.06  Expand sub section  5HT3 antagonists to top
    Granisetron tabs, injection

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    Restricted Drug Restricted
    Amber 2
       
    Granisetron transdermal patch

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    Restricted Drug Restricted
    Red
    Prevention of nausea and vomiting associated with moderately or highly emetogenic chemotherapy

    Restricted to use where where oral antiemetic administration is complicated by factors making swallowing difficult
       
    Ondansetron tabs, injection

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    Amber 2
       
    04.06  Expand sub section  Neurokinin receptor antagonist
    Aprepitant caps

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    Red
    Approved for:
    Prevention of acute and delayed nausea and vomiting associated with highly emetogenic cisplatinbased cancer chemotherapy

    Prevention of nausea and vomiting associated with moderately emetogenic cancer chemotherapy only for subsequent chemotherapy cycles if the standard antiemetic regimen has failed with the initial chemotherapy cycle.
       
    Aprepitant caps

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    Restricted Drug Restricted
    Red
    Approved off-label indication:
    For the treatment of dihydroergotamine induced nausea where domperidone or 5HT3 antagonists have failed or are inappropriate
    For consultant headache specialist use only as per locally approved protocol
       
    04.06  Expand sub section  Cannabinoid
    Nabilone caps

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    Red
       
    04.06  Expand sub section  Hyoscine
    Hyoscine hydrobromide patch

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    04.06  Expand sub section  Other drugs for Ménière's disease
    Betahistine dihydrochloride tabs

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     ....
    Key
    note Notes First Choice Item First Choice item
    Section Title Section Title (top level) Non Formulary Item Non Formulary section
    Section Title Section Title (sub level)
    Cytotoxic Drug
    Cytotoxic Drug
    Restricted Drug
    Restricted Drug
    CD
    Controlled Drug
    Unlicensed Drug
    Unlicensed
    High Cost Medicine
    High Cost Medicine
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    Link to SPCs
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    Link to adult BNF
    Track Changes
    Display tracking information
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    Cancer Drugs Fund
    Cancer Drugs Fund
       

     

    Traffic Light Status Information

    Status Description
      Red   Specialist Prescribing only. The responsibility for prescribing, monitoring, dose adjustment and review should remain with the specialist. In very exceptional circumstances a specialist may discuss individual patient need for a RED drug to be prescribed by a GP and the GP should consider informing the Medicines Management team before a decision is made to prescribe for individual patients.   
      Amber 1   Treatment can be initiated in primary care after a recommendation from an appropriate specialist  
      Amber 2   Specialist initiation followed by maintenance prescribing in primary care  
      Amber 3   Specialist initiation with ongoing monitoring required. After dose stabilisation GPs can be requested to take over prescribing responsibilities using the approved APC shared care documentation  
      Green   Specialist and non-specialist initiation  
      Grey   Not recommended for prescribing  

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