lCAUTIONSAsthma.atopic allergy.bradycardia.cardiac
conduction disturbances.epilepsy.may mask underlying
disorders such as cerebral irritation.uncorrected
electrolyte imbalance
lINTERACTIONS→Appendix 1 : metoclopramide
lSIDE-EFFECTS
GENERAL SIDE-EFFECTS
▶Common or very commonAsthenia.depression.diarrhoea
.drowsiness.hypotension.menstrual cycle irregularities.
movement disorders.parkinsonism
▶UncommonArrhythmias.hallucination.
hyperprolactinaemia.level of consciousness decreased
▶Rare or very rareConfusion.galactorrhoea.seizure
▶Frequency not knownAtrioventricular block.blood
disorders.cardiac arrest.gynaecomastia.hypertension.
neuroleptic malignant syndrome.QT interval
prolongation.shock.syncope
SPECIFIC SIDE-EFFECTS
▶Frequency not known
▶With parenteral useAnxiety.dizziness.dyspnoea.oedema.
skin reactions.tremor.visual impairment
SIDE-EFFECTS, FURTHER INFORMATIONMetoclopramide
can induce acute dystonic reactions involving facial and
skeletal muscle spasms and oculogyric crises. These
dystonic effects are more common in the young, especially
girls and young women; they usually occur shortly after
starting treatment with metoclopramide and subside
within 24 hours of stopping it. Use of an antimuscarinic
drug such as procyclidine will abort dystonic attacks.
lPREGNANCYNot known to be harmful.
lBREAST FEEDINGSmall amount present in milk; avoid.
lHEPATIC IMPAIRMENT
Dose adjustmentsReduce dose.
lRENAL IMPAIRMENT
Dose adjustmentsAvoid or use small dose in severe
impairment; increased risk of extrapyramidal reactions.
lDIRECTIONS FOR ADMINISTRATIONOral liquid preparation
to be given via a graduated oral dosing syringe.
lPATIENT AND CARER ADVICECounselling on use of pipette
advised with oral solution.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral solution
Solution for injection
▶Metoclopramide hydrochloride (Non-proprietary)
Metoclopramide hydrochloride 5 mg per 1 mlMetoclopramide
10 mg/ 2 ml solution for injection ampoules| 5 ampouleP£ 1. 31 |
10 ampouleP£ 3. 30 DT = £ 3. 30
▶Maxolon(AMCo)
Metoclopramide hydrochloride 5 mg per 1 mlMaxolon 10 mg/ 2 ml
solution for injection ampoules| 12 ampouleP£ 3. 21
Maxolon High Dose 100 mg/ 20 ml solution for injection ampoules|
10 ampouleP£ 26. 68
Oral solution
▶Metoclopramide hydrochloride (Non-proprietary)
Metoclopramide hydrochloride 1 mg per 1 mlMetoclopramide
5 mg/ 5 ml oral solution sugar free sugar-free| 150 mlP£ 19. 77 DT
=£ 19. 77
Tablet
▶Metoclopramide hydrochloride (Non-proprietary)
Metoclopramide hydrochloride 10 mgMetoclopramide 10 mg
tablets| 28 tabletP£ 1. 40 DT = £ 0. 33
▶Maxolon(AMCo)
Metoclopramide hydrochloride 10 mgMaxolon 10 mg tablets|
84 tabletP£ 5. 24
ANTIEMETICS AND ANTINAUSEANTS›
NEUROKININ RECEPTOR ANTAGONISTSAprepitant 13-Sep-2017
lINDICATIONS AND DOSE
Adjunct treatment to prevent nausea and vomiting
associated with moderately and highly emetogenic
chemotherapy
▶BY MOUTH
▶Child 6 months–11 years (body-weight 6 kg and above):
(consult product literature)
▶Child 12–17 years:Initially 125 mg, dose to be taken
1 hour before chemotherapy, then 80 mg once daily for
2 days, dose to be taken 1 hour before chemotherapyor
in the morning if no chemotherapy is given, consult
product literature for dose of concomitant 5 HT 3 -
antagonist (and corticosteroid if required)lCONTRA-INDICATIONSAcute porphyrias p. 603
lINTERACTIONS→Appendix 1 : aprepitant
lSIDE-EFFECTS
▶Common or very commonAppetite decreased.asthenia.
constipation.gastrointestinal discomfort.headache.
hiccups
▶UncommonAnaemia.anxiety.burping.dizziness.
drowsiness.dry mouth.febrile neutropenia.
gastrointestinal disorders.hotflush.malaise.nausea.
palpitations.skin reactions.urinary disorders.vomiting
▶Rare or very rareBradycardia.cardiovascular disorder.
chest discomfort.cognitive disorder.conjunctivitis.
cough.disorientation.euphoric mood.gait abnormal.
hyperhidrosis.increased risk of infection.muscle spasms.
muscle weakness.oedema.oropharyngeal pain.
photosensitivity reaction.polydipsia.seborrhoea.severe
cutaneous adverse reactions (SCARs).sneezing.
stomatitis.taste altered.throat irritation.tinnitus.
weight decreased
▶Frequency not knownDysarthria.dyspnoea.insomnia.
miosis.sensation abnormal.visual acuity decreased.
wheezing
lCONCEPTION AND CONTRACEPTIONManufacturer advises
effectiveness of hormonal contraceptives may be
reduced—alternative non-hormonal methods of
contraception necessary during treatment and for
2 months after stopping aprepitant.
lPREGNANCYManufacturer advises avoid unless clearly
necessary—no information available.
lBREAST FEEDINGManufacturer advises avoid—present in
milk inanimalstudies.
lHEPATIC IMPAIRMENTManufacturer advises caution in
moderate-to-severe impairment—limited information
available.
lNATIONAL FUNDING/ACCESS DECISIONS
Scottish Medicines Consortium (SMC) Decisions
TheScottish Medicines Consortiumhas advised (June 2017 )
that aprepitant (Emend®) is accepted for use within NHS
Scotland as part of combination therapy, for the
prevention of nausea and vomiting associated with
moderately emetogenic cancer chemotherapy in infants,
toddlers and children from the age of six months to less
than 12 years (powder for oral suspension) and
adolescents from the age of 12 years to 17 years (hard
capsules).
TheScottish Medicines Consortiumhas advised (July
2017 ) that aprepitant (Emend®) is accepted for use within
NHS Scotland as part of combination therapy, for the
prevention of nausea and vomiting associated with highly
emetogenic cancer chemotherapy in children from the age
of six months to under 12 years (powder for oralBNFC 2018 – 2019 Nausea and labyrinth disorders 263
Nervous system4