developing dopamine dysregulation syndrome; addictionlike symptoms should be reported.
Sudden onset of sleep Excessive daytime sleepiness and
sudden onset of sleep can occur with dopamine-receptor
Patients starting treatment with these drugs should be
warned of the risk and of the need to exercise caution
when driving or operating machinery. Those who have
experienced excessive sedation or sudden onset of sleep
should refrain from driving or operating machines until
these effects have stopped occurring.
Management of excessive daytime sleepiness should
focus on the identification of an underlying cause, such as
depression or concomitant medication. Patients should be
counselled on improving sleep behaviour.
Hypotensive reactions Hypotensive reactions can occur in
some patients taking dopamine-receptor agonists; these
can be particularly problematic during the first few days of
treatment and care should be exercised when driving or
l NATIONAL FUNDING/ACCESS DECISIONS
Scottish Medicines Consortium (SMC) decisions
The Scottish Medicines Consortium has advised that
Neupro ® is accepted for restricted use for the treatment of
advanced Parkinson’s disease in combination with
levodopa where the transdermal route would facilitate
The Scottish Medicines Consortium has advised that
Neupro ® is accepted as monotherapy for the treatment of
early-stage idiopathic Parkinson’s disease (June 2007).
The Scottish Medicines Consortium has advised (April
2009) that rotigotine (Neupro ®) is accepted for restricted
use within NHS Scotland for the symptomatic treatment of
moderate to severe idiopathic restless legs syndrome in
adults with a baseline score of 15 points or more on the
International Restless Legs Scale.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 10
Rotigotine 1 mg per 24 hour Neupro 1mg/24hours transdermal
patches | 28 patch P £77.24 DT = £77.24
Rotigotine 2 mg per 24 hour Neupro 2mg/24hours transdermal
patches | 28 patch P £81.10 DT = £81.10
Rotigotine 3 mg per 24 hour Neupro 3mg/24hours transdermal
patches | 28 patch P £102.35 DT = £102.35
Rotigotine 4 mg per 24 hour Neupro 4mg/24hours transdermal
patches | 28 patch P £123.60 DT = £123.60
Rotigotine 6 mg per 24 hour Neupro 6mg/24hours transdermal
patches | 28 patch P £149.93 DT = £149.93
Rotigotine 8 mg per 24 hour Neupro 8mg/24hours transdermal
patches | 28 patch P £149.93 DT = £149.93
DOPAMINERGIC DRUGS › MONOAMINE-OXIDASE
l DRUG ACTION Rasagiline is a monoamine-oxidase B
l INTERACTIONS → Appendix 1: monoamine-oxidase B
hypotension . sleep disorders . urinary urgency . vertigo . vomiting . weight decreased
▶ Uncommon Appetite decreased . confusion
l PREGNANCY Manufacturer advises avoid—no information
l BREAST FEEDING Use with caution—may suppress
l HEPATIC IMPAIRMENT Manufacturer advises caution in
mild impairment; avoid in moderate to severe impairment
l TREATMENT CESSATION Avoid abrupt withdrawal.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: oral suspension, oral
▶ Rasagiline (Non-proprietary)
Rasagiline 1 mg Rasagiline 1mg tablets | 28 tablet P £70.72 DT
Rasagiline 1 mg Azilect 1mg tablets | 28 tablet P £70.72 DT =
l DRUG ACTION Safinamide is a monoamine-oxidase-B
Parkinson’s disease, as an adjunct to levodopa alone or in
combination with other antiparkinsonian drugs, for midto late-stage fluctuations
▶ Adult: 50 mg once daily, increased if necessary to
l CAUTIONS Hypertension (may raise blood pressure). may
exacerbate pre-existing dyskinesia (requiring levodopa
l INTERACTIONS → Appendix 1: monoamine-oxidase B
abnormal . sensation of pressure . sexual dysfunction . skin
reactions . sweat changes . syncope .temperature
BNF 78 Parkinson’s disease 427
l PREGNANCY Manufacturer advises avoid—toxicity in
l BREAST FEEDING Manufacturer advises avoid—present in
l HEPATIC IMPAIRMENT Manufacturer advises caution in
moderate impairment; avoid in severe impairment.
Dose adjustments Manufacturer advises max. daily dose
should not exceed 50 mg daily in moderate impairment.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Xadago (Profile Pharma Ltd) A
Safinamide (as Safinamide methansulfonate) 50 mg Xadago
50mg tablets | 30 tablet P £69.00 DT = £69.00
Safinamide (as Safinamide methansulfonate) 100 mg Xadago
100mg tablets | 30 tablet P £69.00 DT = £69.00
l DRUG ACTION Selegiline is a monoamine-oxidase-B
Parkinson’s disease, used alone or as adjunct to cobeneldopa or co-careldopa to reduce ’end of dose’
deterioration | Symptomatic parkinsonism
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Adult: Initially 5 mg once daily for 2–4 weeks, then
increased if tolerated to 10 mg daily, dose to be taken
▶ BY MOUTH USING ORAL LYOPHILISATE
▶ Adult: 1.25 mg once daily, dose to be taken before
DOSE EQUIVALENCE AND CONVERSION
▶ 1.25-mg oral lyophilisate is equivalent to 10-mg tablet.
▶ Patients receiving 10 mg conventional selegiline
hydrochloride tablets can be switched to oral
lyophilisates (Zelapar ®) 1.25 mg.
l CONTRA-INDICATIONS Active duodenal ulceration . active
gastric ulceration . avoid or use with great caution in
postural hypotension (when used in combination with
predisposed to confusion and psychosis . psychosis . uncontrolled hypertension
l INTERACTIONS → Appendix 1: monoamine-oxidase B
▶ Common or very common Arrhythmias . arthralgia . back
▶ Uncommon Alopecia . angina pectoris . anxiety . appetite
decreased . chest pain . dyspnoea . leucopenia . mood
▶ Frequency not known Hypersexuality
SIDE-EFFECTS, FURTHER INFORMATION Side-effects of
levodopa may be increased—concurrent levodopa dosage
can be reduced by 10–30% in steps of 10% every 3–4 days.
l PREGNANCY Avoid—no information available.
l BREAST FEEDING Avoid—no information available.
l HEPATIC IMPAIRMENT Manufacturer advises caution in
l RENAL IMPAIRMENT Use with caution in severe
l TREATMENT CESSATION Avoid abrupt withdrawal.
l DIRECTIONS FOR ADMINISTRATION Oral lyophilisates
should be placed on the tongue and allowed to dissolve.
Advise patient not to drink, rinse, or wash mouth out for
5 minutes after taking the tablet.
l PATIENT AND CARER ADVICE Patients or carers should be
advised on how to administer selegiline hydrochloride oral
Drugs and driving Prescribers and other healthcare
professionals should advise patients if treatment is likely
to affect their ability to perform skilled tasks (e.g. driving).
This applies especially to drugs with sedative effects;
patients should be warned that these effects are increased
by alcohol. General information about a patient’s fitness to
drive is available from the Driver and Vehicle Licensing
2015 legislation regarding driving whilst taking certain
drugs, may also apply to selegiline, see Drugs and driving
under Guidance on prescribing p. 1.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: oral solution
▶ Eldepryl (Orion Pharma (UK) Ltd)
Selegiline hydrochloride 5 mg Eldepryl 5mg tablets | 100 tablet P £16.52 DT = £16.52
Selegiline hydrochloride 10 mg Eldepryl 10mg tablets |
100 tablet P £32.23 DT = £32.23
EXCIPIENTS: May contain Aspartame
Selegiline hydrochloride 1.25 mg Zelapar 1.25mg oral lyophilisates
sugar-free | 30 tablet P £43.16 DT = £43.16
Nausea and labyrinth disorders
Antiemetics should be prescribed only when the cause of
vomiting is known because otherwise they may delay
diagnosis, particularly in children. Antiemetics are
unnecessary and sometimes harmful when the cause can be
treated, such as in diabetic ketoacidosis, or in digoxin p. 109
If antiemetic drug treatment is indicated, the drug is
chosen according to the aetiology of vomiting.
Antihistamines are effective against nausea and vomiting
resulting from many underlying conditions. There is no
evidence that any one antihistamine is superior to another
but their duration of action and incidence of adverse effects
(drowsiness and antimuscarinic effects) differ.
428 Nausea and labyrinth disorders BNF 78
The phenothiazines are dopamine antagonists and act
centrally by blocking the chemoreceptor trigger zone. They
are of considerable value for the prophylaxis and treatment
of nausea and vomiting associated with diffuse neoplastic
disease, radiation sickness, and the emesis caused by drugs
such as opioids, general anaesthetics, and cytotoxics.
Prochlorperazine p. 389, perphenazine, and trifluoperazine
p. 390 are less sedating than chlorpromazine hydrochloride
p. 384; severe dystonic reactions sometimes occur with
phenothiazines, especially in children. Some phenothiazines
are available as rectal suppositories, which can be useful in
patients with persistent vomiting or with severe nausea;
prochlorperazine can also be administered as a buccal tablet
which is placed between the upper lip and the gum.
Other antipsychotic drugs including haloperidol p. 386 and
levomepromazine p. 441 are used for the relief of nausea and
Metoclopramide hydrochloride p. 432 is an effective
antiemetic and its activity closely resembles that of the
phenothiazines. Metoclopramide hydrochloride also acts
directly on the gastro-intestinal tract and it may be superior
to the phenothiazines for emesis associated with
gastroduodenal, hepatic, and biliary disease.
Domperidone p. 431 acts at the chemoreceptor trigger
zone; it is licensed only for the relief of nausea and vomiting.
It has the advantage over metoclopramide hydrochloride and
the phenothiazines of being less likely to cause central
effects such as sedation and dystonic reactions because it
does not readily cross the blood-brain barrier. In Parkinson’s
disease, it can be used to treat nausea caused by
Granisetron p. 435 and ondansetron p. 436 are of value in
the management of nausea and vomiting in patients
receiving cytotoxics and in postoperative nausea and
vomiting. Palonosetron p. 437 is licensed for prevention of
nausea and vomiting associated with moderately or highly
emetogenic cytotoxic chemotherapy. Palonosetron is also
available in combination with netupitant, a neurokinin
1-receptor antagonist, for the prevention of acute and
delayed nausea and vomiting associated with moderately
emetogenic chemotherapy and highly emetogenic cisplatinbased chemotherapy.
Dexamethasone p. 675 has antiemetic effects and it is used
in vomiting associated with cancer chemotherapy. It can be
used alone or with metoclopramide hydrochloride,
prochlorperazine, lorazepam p. 339, or a 5HT3-receptor
Aprepitant p. 433, fosaprepitant p. 434, and rolapitant
p. 434 are neurokinin 1-receptor antagonists. Aprepitant is
licensed for the prevention of nausea and vomiting
associated with highly and moderately emetogenic
chemotherapy; fosaprepitant is licensed for the prevention
of acute and delayed nausea and vomiting associated with
highly emetogenic cisplatin-based chemotherapy and the
prevention of nausea and vomiting associated with
moderately emetogenic chemotherapy; rolapitant is licensed
for the prevention of delayed nausea and vomiting
associated with highly and moderately emetogenic
chemotherapy. These drugs are given with dexamethasone
and a 5HT3-receptor antagonist.
Nabilone p. 431 is a synthetic cannabinoid with antiemetic
properties. It may be used for nausea and vomiting caused by
cytotoxic chemotherapy that is unresponsive to
Nausea in the first trimester of pregnancy is generally mild
and does not require drug therapy. On rare occasions if
vomiting is severe, short-term treatment with an
antihistamine, such as promethazine, may be required.
Prochlorperazine or metoclopramide hydrochloride are
alternatives. If symptoms do not settle in 24 to 48 hours then
specialist opinion should be sought. Hyperemesis
gravidarum is a more serious condition, which requires
regular antiemetic therapy, intravenous fluid and electrolyte
replacement and sometimes nutritional support.
Supplementation with thiamine p. 1080 must be considered
in order to reduce the risk of Wernicke’s encephalopathy.
Postoperative nausea and vomiting
The incidence of postoperative nausea and vomiting
depends on many factors including the anaesthetic used, and
the type and duration of surgery. Other risk factors include
female sex, non-smokers, a history of postoperative nausea
and vomiting or motion sickness, and intraoperative and
postoperative use of opioids. Therapy to prevent
postoperative nausea and vomiting should be based on the
assessed risk of postoperative nausea and vomiting in each
patient. Drugs used include 5HT3-receptor antagonists,
droperidol p. 440, dexamethasone, some phenothiazines
(e.g. prochlorperazine), and antihistamines (e.g. cyclizine
p. 430). A combination of two or more antiemetic drugs that
have different mechanisms of action is often indicated in
those at high risk of postoperative nausea and vomiting or
where postoperative vomiting presents a particular danger
(e.g. in some types of surgery). When a prophylactic
antiemetic drug has failed, postoperative nausea and
vomiting should be treated with one or more drugs from a
Antiemetics should be given to prevent motion sickness
rather than after nausea or vomiting develop. The most
effective drug for the prevention of motion sickness is
hyoscine hydrobromide p. 439. The sedating antihistamines
are slightly less effective against motion sickness, but are
generally better tolerated than hyoscine. If a sedative effect
is desired promethazine is useful, but generally a slightly
less sedating antihistamine such as cyclizine or cinnarizine
p. 438 is preferred. Domperidone, metoclopramide
hydrochloride, 5HT3-receptor antagonists, and the
phenothiazines (except the antihistamine phenothiazine
promethazine) are ineffective in motion sickness.
Management of vestibular diseases is aimed at treating the
underlying cause as well as treating symptoms of the balance
disturbance and associated nausea and vomiting. Vertigo
and nausea associated with Ménière’s disease and middleear surgery can be difficult to treat.
Betahistine dihydrochloride p. 441 is an analogue of
histamine and is claimed to reduce endolymphatic pressure
by improving the microcirculation. Betahistine
dihydrochloride is licensed for vertigo, tinnitus, and hearing
loss associated with Ménière’s disease.
A diuretic alone or combined with salt restriction may
provide some benefit in vertigo associated with Ménière’s
disease; antihistamines (such as cinnarizine), and
phenothiazines (such as prochlorperazine) are also used.
Where possible, prochlorperazine should be reserved for the
Nausea caused by cytotoxic chemotherapy,
Antiemetics have a role in the management of nausea and
vomiting induced by cytotoxic chemotherapy, in palliative
care, and associated with migraine.
Other drugs used for Nausea and labyrinth disorders
Paracetamol with metoclopramide, p. 476 . Promethazine
BNF 78 Nausea and labyrinth disorders 429
ANTIEMETICS AND ANTINAUSEANTS ›
Nausea | Vomiting | Vertigo | Motion sickness | Labyrinthine
▶ Adult: 50 mg up to 3 times a day, for motion sickness,
take 1–2 hours before departure
▶ BY INTRAVENOUS INJECTION, OR BY INTRAMUSCULAR
Nausea and vomiting of known cause | Nausea and
vomiting associated with vestibular disorders
▶ BY MOUTH, OR BY INTRAVENOUS INJECTION
▶ Child 1 month–5 years: 0.5–1 mg/kg up to 3 times a day
(max. per dose 25 mg), intravenous injection to be
given over 3–5 minutes, for motion sickness, take
▶ Child 6–11 years: 25 mg up to 3 times a day, intravenous
injection to be given over 3–5 minutes, for motion
sickness, take 1–2 hours before departure
▶ Child 12–17 years: 50 mg up to 3 times a day,
intravenous injection to be given over 3–5 minutes, for
motion sickness, take 1–2 hours before departure
▶ Child 2–5 years: 12.5 mg up to 3 times a day
▶ Child 6–11 years: 25 mg up to 3 times a day
▶ Child 12–17 years: 50 mg up to 3 times a day
▶ BY CONTINUOUS INTRAVENOUS INFUSION, OR BY
▶ Child 1–23 months: 3 mg/kg, dose to be given over
▶ Child 2–5 years: 50 mg, dose to be given over 24 hours
▶ Child 6–11 years: 75 mg, dose to be given over 24 hours
▶ Child 12–17 years: 150 mg, dose to be given over
Nausea and vomiting in palliative care
▶ Child 1–23 months: 3 mg/kg, dose to be given over
▶ Child 2–5 years: 50 mg, dose to be given over 24 hours
▶ Child 6–11 years: 75 mg, dose to be given over 24 hours
▶ Child 12–17 years: 150 mg, dose to be given over
▶ Adult: 150 mg, dose to be given over 24 hours
▶ Child 1 month–5 years: 0.5–1 mg/kg up to 3 times a day
▶ Child 6–11 years: 25 mg up to 3 times a day
▶ Child 12–17 years: 50 mg up to 3 times a day
▶ Adult: 50 mg up to 3 times a day
▶ Child 1 month–5 years: 0.5–1 mg/kg up to 3 times a day
(max. per dose 25 mg), intravenous injection to be
▶ Child 6–11 years: 25 mg up to 3 times a day, intravenous
injection to be given over 3–5 minutes
▶ Child 12–17 years: 50 mg up to 3 times a day,
intravenous injection to be given over 3–5 minutes
▶ BY CONTINUOUS INTRAVENOUS INFUSION
▶ Child 1–23 months: 3 mg/kg, dose to be given over
▶ Child 2–5 years: 50 mg, dose to be given over 24 hours
▶ Child 6–11 years: 75 mg, dose to be given over 24 hours
▶ Child 12–17 years: 150 mg, dose to be given over
▶ Child 2–5 years: 12.5 mg up to 3 times a day
▶ Child 6–11 years: 25 mg up to 3 times a day
▶ Child 12–17 years: 50 mg up to 3 times a day
▶ In children Tablets not licensed for use in children under
6 years. Injection not licensed for use in children.
l CAUTIONS Epilepsy . glaucoma (in children). may
counteract haemodynamic benefits of opioids . neuromuscular disorders—increased risk of transient
paralysis with intravenous use . prostatic hypertrophy (in
adults). pyloroduodenal obstruction . severe heart
failure—may cause fall in cardiac output and associated
increase in heart rate, mean arterial pressure and
pulmonary wedge pressure . susceptibility to angle-closure
glaucoma (in adults). urinary retention
l INTERACTIONS → Appendix 1: antihistamines, sedating
▶ Rare or very rare Agitation (more common at high doses). angle closure glaucoma . depression
▶ With oral use Level of consciousness decreased
l PREGNANCY Manufacturer advises avoid; however, there
is no evidence of teratogenicity. The use of sedating
antihistamines in the latter part of the third trimester may
cause adverse effects in neonates such as irritability,
paradoxical excitability, and tremor.
l BREAST FEEDING No information available. Most
antihistamines are present in breast milk in varying
amounts; although not known to be harmful, most
manufacturers advise avoiding their use in mothers who
l HEPATIC IMPAIRMENT Manufacturer advises caution.
l DIRECTIONS FOR ADMINISTRATION For administration by
mouth, tablets may be crushed.
Mixing and compatibility for the use of syringe drivers in palliative
care Cyclizine may precipitate at concentrations above
10 mg/mL or in the presence of sodium chloride 0.9% or as
the concentration of diamorphine relative to cyclizine
increases; mixtures of diamorphine and cyclizine are also
likely to precipitate after 24 hours.
l PRESCRIBING AND DISPENSING INFORMATION
Palliative care For further information on the use of
cyclizine in palliative care, see www.medicinescomplete.
com/#/content/palliative/antihistaminic-antimuscarinic-antiemetics.
Driving and skilled tasks Drowsiness may affect
performance of skilled tasks (e.g. cycling, driving); effects
430 Nausea and labyrinth disorders BNF 78
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: oral suspension, oral
CAUTIONARY AND ADVISORY LABELS 2
Cyclizine lactate 50 mg per 1 ml Cyclizine 50mg/1ml solution for
injection ampoules | 5 ampoule P £16.25–£17.78 DT = £16.25 | 10 ampoule P £25.00
Doxylamine with pyridoxine 11-Oct-2018
l DRUG ACTION Doxylamine is a first-generation
antihistamine which selectively binds H1 receptors in the
brain; pyridoxine (vitamin B6) is a water-soluble vitamin.
Nausea and vomiting in pregnancy
▶ Adult: 20/20 mg once daily for 2 days, to be taken at
bedtime; increased if necessary to 10/10 mg, to be
taken in the morning and 20/20 mg, to be taken at
bedtime; increased if necessary to 10/10 mg, to be
taken in the morning, 10/10 mg, to be taken midafternoon and 20/20 mg, to be taken at bedtime;
DOSE EQUIVALENCE AND CONVERSION
▶ Dose expressed as x/y mg of doxylamine/pyridoxine.
l CAUTIONS Asthma . bladder neck obstruction . increased
intra-ocular pressure . narrow angle glaucoma . pyloroduodenal obstruction . stenosing peptic ulcer
l INTERACTIONS → Appendix 1: antihistamines, sedating
▶ Common or very common Dizziness . drowsiness . dry
reactions . sleep disorders .tachycardia . urinary disorders . vertigo . vision disorders
Driving and skilled tasks Manufacturer advises patients and
carers should be counselled on the effects on driving and
performance of skilled tasks—increased risk of somnolence
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 2, 23, 25
▶ Xonvea (Alliance Pharmaceuticals Ltd)
Doxylamine succinate 10 mg, Pyridoxine hydrochloride
10 mg Xonvea 10mg/10mg gastro-resistant tablets | 20 tablet P £28.50 DT = £28.50
ANTIEMETICS AND ANTINAUSEANTS ›
Nausea and vomiting caused by cytotoxic chemotherapy,
unresponsive to conventional antiemetics (preferably in
hospital setting) (under close medical supervision)
▶ Adult: Initially 1 mg twice daily, increased if necessary
to 2 mg twice daily throughout each cycle of cytotoxic
therapy and, if necessary, for 48 hours after the last
dose of each cycle, the first dose should be taken the
night before initiation of cytotoxic treatment and the
second dose 1–3 hours before the first dose of cytotoxic
drug, daily dose maximum should be given in 3 divided
l CAUTIONS Adverse effects on mental state can persist for
48–72 hours after stopping . elderly . heart disease . history
of psychiatric disorder. hypertension
l INTERACTIONS → Appendix 1: nabilone
SIDE-EFFECTS, FURTHER INFORMATION Drowsiness and
dizziness occur frequently with standard doses.
l PREGNANCY Avoid unless essential.
l BREAST FEEDING Avoid—no information available.
l HEPATIC IMPAIRMENT Manufacturer advises avoid in
severe impairment (primarily biliary excretion).
Behavioural effects Patients should be made aware of
possible changes of mood and other adverse behavioural
Driving and skilled tasks Drowsiness may affect
performance of skilled tasks (e.g. driving).
For information on 2015 legislation regarding driving
whilst taking certain controlled drugs, including nabilone,
see Drugs and driving under Guidance on prescribing p. 1.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: capsule
CAUTIONARY AND ADVISORY LABELS 2
Nabilone 250 microgram Nabilone 250microgram capsules | 20 capsule P £150.00 DT = £150.00b
Nabilone 1 mg Nabilone 1mg capsules | 20 capsule P £196.00
ANTIEMETICS AND ANTINAUSEANTS ›
▶ Child (body-weight up to 35 kg): 250 micrograms/kg up to
3 times a day; maximum 750 micrograms/kg per day
▶ Child 12–17 years (body-weight 35 kg and above): 10 mg up
to 3 times a day; maximum 30 mg per day continued→
BNF 78 Nausea and labyrinth disorders 431
▶ Adult (body-weight 35 kg and above): 10 mg up to 3 times
Gastro-intestinal pain in palliative care
▶ Adult: 10 mg 3 times a day, before meals
▶ In children Not licensed for use in children for gastrooesophageal reflux disease.
REDUCED DOSE AND DURATION OF USE
The benefits and risks of domperidone have been
reviewed. As domperidone is associated with a small
increased risk of serious cardiac side-effects, the
following restrictions to indication, dose and duration of
treatment have been made, and new contra-indications
. Domperidone should only be used for the relief of the
symptoms of nausea and vomiting;
. Domperidone should be used at the lowest effective
dose for the shortest possible duration (max.
treatment duration should not normally exceed
. Domperidone is contra-indicated for use in conditions
where cardiac conduction is, or could be impaired, or
where there is underlying cardiac disease, when
administered concomitantly with drugs that prolong
the QT interval or potent CYP3A4 inhibitors, and in
. The recommended dose in adults and adolescents over
12 years and over 35 kg is 10 mg up to 3 times daily;
. The recommended dose in children under 35 kg is
250 micrograms/kg up to 3 times daily;
. Oral liquid formulations should be given via an
appropriately designed, graduated oral syringe to
This advice does not apply to unlicensed uses of
domperidone (e.g. palliative care).
l CONTRA-INDICATIONS Cardiac disease . conditions where
gastrointestinal motility harmful (in adults) . mechanical
obstruction (in children). mechanical perforation (in
children). predisposition to cardiac conduction disorders
l CAUTIONS Children . if there are cardiac concerns, obtain
ECG before and during treatment (in children). patients
over 60 years—increased risk of ventricular arrhythmia (in
l INTERACTIONS → Appendix 1: domperidone
▶ Common or very common Dry mouth
l PREGNANCY Use only if potential benefit outweighs risk.
l BREAST FEEDING Amount too small to be harmful.
l HEPATIC IMPAIRMENT Manufacturer advises avoid in
moderate to severe impairment.
Dose adjustments Reduce frequency.
l PRESCRIBING AND DISPENSING INFORMATION
Palliative care For further information on the use of
domperidone in palliative care, see www.medicinescomplete.
com/#/content/palliative/domperidone.
Arrhythmia Patients and their carers should be told how to
recognise signs of arrhythmia and advised to seek medical
attention if symptoms such as palpitation or syncope
domperidone-gastro-oesophageal-reflux
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: oral suspension
CAUTIONARY AND ADVISORY LABELS 22
▶ Domperidone (Non-proprietary)
Domperidone 1 mg per 1 ml Domperidone 1mg/ml oral suspension
sugar free sugar-free | 200 ml P £25.67 DT = £21.52
CAUTIONARY AND ADVISORY LABELS 22
▶ Domperidone (Non-proprietary)
Domperidone (as Domperidone maleate) 10 mg Domperidone
10mg tablets | 30 tablet P £2.71 DT = £0.94 | 100 tablet P £9.04 DT = £3.13
Domperidone (as Domperidone maleate) 10 mg Motilium 10mg
tablets | 30 tablet P £2.71 DT = £0.94 | 100 tablet P £9.04 DT
Metoclopramide hydrochloride 10-Aug-2018
Symptomatic treatment of nausea and vomiting including
that associated with acute migraine | Delayed (but not
acute) chemotherapy-induced nausea and vomiting |
Radiotherapy-induced nausea and vomiting | Prevention
of postoperative nausea and vomiting
▶ BY MOUTH, OR BY INTRAMUSCULAR INJECTION, OR BY SLOW
▶ Adult (body-weight up to 60 kg): Up to
500 micrograms/kg daily in 3 divided doses, when
administered by slow intravenous injection, to be given
▶ Adult (body-weight 60 kg and above): 10 mg up to 3 times
a day, when administered by slow intravenous
injection, to be given over at least 3 minutes
▶ BY MOUTH, OR BY INTRAMUSCULAR INJECTION, OR BY
▶ Adult: 10 mg every 6–8 hours
Nausea and vomiting in palliative care
▶ BY MOUTH, OR BY SLOW INTRAVENOUS INJECTION, OR BY
▶ Adult: 10 mg for 1 dose, to be administered as soon as
migraine symptoms develop; intravenous injection to
be given over at least 3 minutes
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