| Choice | Drug | Dosage |
|---|---|---|
| 1st Choice | Prochlorperazine tablets 5mg | Dose: Nausea and vomiting, acute attack, 20mg initially then 10mg after 2 hours; prevention 5-10mg 2-3 times daily |
| 3mg tablets (buccal) Reserve buccal tablets for active vomiting | 1-2 tablets twice daily; tablets are placed high between upper lip and gum and left to dissolve Short-term use only | |
| Or | ||
| Domperidone tablets 10mg; suspension 1mg/ml | Dose: 10mg up to 3 times daily; max 30mg daily | |
| Max length of treatment 1 week - see restrictions below | ||
| Or | ||
| Metoclopramide tablets 10mg; oral solution 5mg/5ml | Dose: For adult (body-weight 60kg and above): 10mg up to 3 times a day For adult (body-weight up to 60kg): up to 500micrograms/kg daily in 3 divided doses Max length of treatment 5 days - see restrictions below |
Prescribing Notes
- Metoclopramide is associated with neurological effects such as short-term extrapyramidal disorders and tardive dyskinesia. These side-effects usually occur in the young (especially girls and young women) and the very old; it is best avoided, if possible, in patients under 20 years old
- Metoclopramide should only be prescribed for short-term use (up to 5 days) for prevention of postoperative nausea and vomiting; radiotherapy-induced nausea and vomiting; delayed (but not acute) chemotherapy-induced nausea and vomiting; and symptomatic treatment of nausea and vomiting, including that associated with acute migraine (where it may also be used to improve absorption of oral analgesics). For further information see MHRA here
- Long-term metoclopramide and prochlorperazine may cause tardive dyskinesia in the elderly
- Domperidone does not cross the blood brain barrier; it is less likely than metoclopramide and prochlorperazine to cause sedation or dystonic reactions
- Domperidone is associated with a small risk of serious cardiac side effects. Its use is now restricted to the relief of symptoms of nausea and vomiting and the dosage and duration of use have been reduced. Treatment should generally only be given for up to one week. Domperidone is contraindicated in those with underlying cardiac conditions and other risk factors. Risks are higher in people older than 60 years. For further information see MHRA here
- Note that cyclizine has potential for abuse