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
 Formulary Chapter 4: Central nervous system - Full Chapter

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

04.06  Expand sub section  Drugs used in nausea and vertigo
04.06  Expand sub section  Antihistamines
04.06  Expand sub section  Phenothiazines and related drugs
04.06  Expand sub section  Domperidone and metoclopramide
04.06  Expand sub section  5HT3 antagonists to top
04.06  Expand sub section  Neurokinin receptor antagonist
Aprepitant caps (licensed use)
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Approved for:

Prevention of acute and delayed nausea and vomiting associated with highly emetogenic cisplatin based 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 (dihydroergotamine induced nausea - off-label)
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Restricted Drug Restricted

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

Netupitant with palonosetron caps  (Akynzeo)
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Approved for:

  • Prevention of acute and delayed nausea and vomiting associated with highly emetogenic cancer chemotherapy
  • Second line use in moderately emetogenic chemotherapy regimens in patients who have experienced nausea and/or vomiting on their initial antinausea regimen.
04.06  Expand sub section  Cannabinoid
04.06  Expand sub section  Hyoscine
04.06  Expand sub section  Other drugs for nausea, vomiting and vertigo
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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Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHS England

Traffic Light Status Information

Status Description


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  


Specialist and non-specialist initiation  


Not recommended for prescribing