East Sussex - Better Together
NHS

4.6 Drugs used in nausea and vertigo

Anti-emetics should be prescribed only when the cause of vomiting is known because otherwise they may delay diagnosis, particularly in children. The following table and diagram summarise the actions and uses of the most commonly used anti-emetics and can be used as a guide to choosing an appropriate agent.

The underlying cause of the nausea should be treated before starting treatment with an anti-emetic wherever possible. 

Refer to the ESHT clinical guideline on the use of anti-emetics in pregnancy

See BNF for further guidance on nausea and vomiting in patients receiving treatment for chemotherapy/ radiotherapy.

Only for use in the treatment of Meniere's disease

Pack
84 tablet
Pack
90 tablet

Domperidone is the preferred option for patients with Parkinson's disease.

MHRA Safety Update: Domperidone is contraindicated in patients with underlying cardiac conditions.

Pack
100 tablet
Pack
200 ml

Granisetron  is indicated in the prevention/ treatment of radiotherapy and chemotherapy nausea and vomiting and post operative nausea and vomiting.

Granisetron may be used 2nd line in post-operative nausea and vomiting where prochlorperazine/cyclizine is not effective.

The full course should be prescribed by secondary care.

Pack
10 tablet
Pack
5 tablet
Pack
10 ampoule
Pack
10 ampoule

2 patches in pack if purchased OTC

Pack
5 patch
EMA warning: For high dose and long-term use the benefits of metoclopramide outweigh the risks and a restriction on dosing and duration of treatment is recommended.

Metoclopramide (and to a lesser degree prochlorperazine) is associated with a high risk of dystonias and oculogyric crises particularly in children, young adults and the elderly. It is not licensed for use in people under 20 years of age

Severe reactions to metoclopramide should be treated with procyclidine injection, 5mg to 10mg given intra-muscularly, repeated if necessary after 20 minutes, maximum of 20mg daily. See the Children's BNF for doses in children. 

Pack
84 tablet
Pack
200 ml
Pack
10 ampoule

Nabilone is used for nausea and vomiting caused by cytotoxic chemotherapy that is unresponsive to conventional anti-emetics.

Pack
20 capsule

Akynzeo® (netupitant and palonosetron) is indicated for the prevention of acute and delayed nausea and vomiting associated with highly emetogenic chemotherapy.

Pack
1 capsule

Ondansetron is indicated in the prevention/ treatment of radiotherapy and chemotherapy nausea and vomiting and post operative nausea and vomiting.

Ondansetron may be used 2nd line in post-operative nausea and vomiting where prochlorperazine/cyclizine is not effective.

The full course should be prescribed by secondary care.

Pack
10 tablet
Pack
10 tablet
Pack
50 ml
Pack
10 ampoule
Pack
5 ampoule

Prochlorperazine 3mg buccal tablets available OTC (8 tablets)

To be used as an alternative to injection.  Prescribe in small quantities, not exceeding 10 tablets.

Pack
50 tablet
Pack
84 tablet
Pack
100 ml
Pack
10 ampoule
  • First Line Drugs
  • Second Line Drugs
  • Specialist Initiated Drugs
  • Specialist Only Drugs
  • Mixed Status