complaints.nasal dryness.nausea.oculogyric crisis.
palpitations.paraesthesia.photosensitivity reaction.
seizure.skin reactions.speech disorder.
thrombocytopenia.tinnitus.tremor.urinary retention.
vision blurred.vomiting
SPECIFIC SIDE-EFFECTS
▶Rare or very rare
▶With oral useAgitation (more common at high doses)
▶Frequency not known
▶With oral useLevel of consciousness decreased
▶With parenteral useChills.consciousness impaired.pain.
paralysis.sensation of pressure.thrombophlebitis
lPREGNANCYManufacturer 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.
lBREAST FEEDINGNo 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
are breast-feeding.
lHEPATIC IMPAIRMENTAvoid in severe liver disease—
increased risk of coma.
lDIRECTIONS FOR ADMINISTRATIONFor administrationby
mouth, tablets may be crushed.
Mixing and compatibility for the use of syringe drivers in palliative
careCyclizine may precipitate at concentrations above
10 mg/mL or in the presence of sodium chloride 0. 9 %oras
the concentration of diamorphine relative to cyclizine
increases; mixtures of diamorphine and cyclizine are also
likely to precipitate after 24 hours.
lPATIENT AND CARER ADVICE
Driving and skilled tasksDrowsiness may affect
performance of skilled tasks (e.g. cycling, driving); effects
of alcohol enhanced.
lMEDICINAL 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 solution,
suppository
Tablet
CAUTIONARY AND ADVISORY LABELS 2
▶Cyclizine (Non-proprietary)
Cyclizine hydrochloride 50 mgCyclizine 50 mg tablets|
30 tabletp£ 2. 24 – £ 5. 00 | 100 tabletp£ 13. 64 DT = £ 7. 47
Solution for injection
▶Cyclizine (Non-proprietary)
Cyclizine lactate 50 mg per 1 mlCyclizine 50 mg/ 1 ml solution for
injection ampoules| 5 ampouleP£ 13. 54 DT = £ 13. 54
ANTIEMETICS AND ANTINAUSEANTS›
CANNABINOIDS
Nabilone
lINDICATIONS AND DOSE
Nausea and vomiting caused by cytotoxic chemotherapy,
unresponsive to conventional antiemetics (preferably in
hospital setting) (under close medical supervision)
▶BY MOUTH
▶Child:(consult local protocol)lUNLICENSED USENot licensed for use in children.
lCAUTIONSAdverse effects on mental state can persist for
48 – 72 hours after stopping.heart disease.history of
psychiatric disorder.hypertension
lINTERACTIONS→Appendix 1 : nabilone
lSIDE-EFFECTSAbdominal pain.appetite decreased.
concentration impaired.confusion.depression.dizziness
.drowsiness.drug use disorders.dry mouth.euphoric
mood.feeling of relaxation.hallucination.headache.
hypotension.movement disorders.nausea.psychosis.
sleep disorder.tachycardia.tremor.vertigo.visual
impairment
SIDE-EFFECTS, FURTHER INFORMATIONDrowsiness and
dizziness occur frequently with standard doses.
lPREGNANCYAvoid unless essential.
lBREAST FEEDINGAvoid—no information available.
lHEPATIC IMPAIRMENTAvoid in severe impairment.
lPATIENT AND CARER ADVICE
Behavioural effectsPatients should be made aware of
possible changes of mood and other adverse behavioural
effects.
Driving and skilled tasksDrowsiness may affect
performance of skilled tasks (e.g. driving).
Effects of alcohol enhanced.
For information on 2015 legislation regarding driving
whilst taking certain controlled drugs, including nabilone,
seeDrugs and skilled tasksunder Guidance on prescribing
p. 1.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: capsule
Capsule
CAUTIONARY AND ADVISORY LABELS 2
▶Nabilone (Non-proprietary)
Nabilone 250 microgramNabilone 250 microgram capsules|
20 capsuleP£ 150. 00 DT = £ 150. 00 b
Nabilone 1 mgNabilone 1 mg capsules| 20 capsuleP£ 196. 00
DT = £ 196. 00 bANTIEMETICS AND ANTINAUSEANTS›
DOPAMINE RECEPTOR ANTAGONISTSDomperidone 17-Oct-2016
lINDICATIONS AND DOSE
Relief of nausea and vomiting
▶BY MOUTH
▶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
Gastro-oesophageal reflux disease (but efficacy not
proven)
▶BY MOUTH
▶Neonate: 250 micrograms/kg 3 times a day, dose can be
increased if response inadequate, increased if necessary
up to 400 micrograms/kg 3 times a day, interrupt
treatment occasionally to assess recurrence—consider
restarting if symptoms recur, discontinue if response
inadequate at higher dose.▶Child: 250 micrograms/kg 3 times a day (max. per dose
10 mg), dose can be increased if response inadequate,
increased if necessary up to 400 micrograms/kg 3 times
a day (max. per dose 20 mg), interrupt treatment
occasionally to assess recurrence—consider restarting
if symptoms recur, discontinue if response inadequate
at higher doseBNFC 2018 – 2019 Nausea and labyrinth disorders 261
Nervous system4