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:

Where a formulary entry does not detail a medicine’s indications for use, the medicine can be assumed to be approved for all licensed indications.

Formulary approved "off-label" use is detailed separately.

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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Formulary  
   
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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Formulary  
   
04.06  Expand sub section  Phenothiazines and related drugs
Droperidol injection
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Formulary
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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Formulary  
   
04.06  Expand sub section  Domperidone and metoclopramide
Domperidone tabs, suspension
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Formulary  
Link  MHRA advice May 2014: Domperidone: risks of cardiac side effects
   
Domperidone tabs, suspension (use as galactagogue - off-label)
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Formulary
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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Formulary
Amber 2
 
   
04.06  Expand sub section  Neurokinin receptor antagonist
Aprepitant caps
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Formulary
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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Formulary
Red
 
   
04.06  Expand sub section  Hyoscine
Hyoscine hydrobromide 300 microgram chewable tablets (Kwells® - clozapine induced hypersalivation - off-label)
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Formulary
Red

Approved off-label indication:

Clozapine induced hypersalivation

Dose = 300 micrograms up to three times a day

 
   
Hyoscine hydrobromide patch
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Formulary  
   
04.06  Expand sub section  Other drugs for Ménière's disease
Betahistine dihydrochloride tabs
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Formulary  
   
 ....
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

Traffic Light Status Information

Status Description

Red

Specialist or hospital prescribing only. The responsibility for prescribing, monitoring, dose adjustment and review should remain with the specialist or hospital. 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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