4.6.1.2 Opioid-induced (not palliative care)

ChoiceDrugDosage
1st choicesCyclizine tablets 50mg; injection 50mg/mlDose:
Orally or by intramuscular or intravenous injection, 50mg up to three times daily
Or
Prochlorperazine tablets 5mg; syrup 5mg/ml; buccal tablets 3mg; injection 12.5mg/ml; Dose:
Acute attack, 20mg then 10mg after 2 hours; prevention 5-10mg 2-3 three times daily

Buccal tablets, 1-2 tablets twice daily

By deep intramuscular injection, 12.5mg when required followed if necessary after 6 hours by oral dose, as above

Prescribing Notes

  • Surgical patients receiving morphine should be prescribed prophylactic anti-emetics such as cyclizine or prochlorperazine.
  • Patients suffering an acute myocardial infarction should be given intravenous morphine or diamorphine; an antiemetic such as metoclopramide should be given concomitantly.

Nausea and vomiting associated with cytotoxic chemotherapy

See chapter 8 of the BNF.

Nausea and vomiting in palliative care

See palliative care section of the BNF.