BNF for Children 2011-2012

BNFC 2011–2012 4.6 Drugs used in nausea and vertigo 193Motion sicknessAntiemetics should be given to prevent motion sicknessrather than after nausea or vomiting develop. The mosteffective drug for the prevention of motion sickness ishyoscine hydrobromide. For children over 10 yearsold, a transdermal hyoscine patch provides prolongedactivity but it needs to be applied several hours beforetravelling. The sedating antihistamines are slightly lesseffective against motion sickness, but are generallybetter tolerated than hyoscine. If a sedative effect isdesired promethazine is useful, but generally a slightlyless sedating antihistamine such as cyclizine or cinnarizineis preferred. The 5HT 3 -receptor antagonists,domperidone, metoclopramide, and the phenothiazines(except the antihistamine phenothiazine promethazine)are ineffective in motion sickness.Other vestibular disordersManagement of vestibular diseases is aimed at treatingthe underlying cause as well as treating symptoms of thebalance disturbance and associated nausea and vomiting.Antihistamines (such as cinnarizine), and phenothiazines(such as prochlorperazine) are effective forprophylaxis and treatment of nausea and vertigo resultingfrom vestibular disorders; however, when nauseaand vertigo are associated with middle ear surgery,treatment can be difficult.Cytotoxic chemotherapyFor the management of nausea and vomiting induced bycytotoxic chemotherapy, see section 8.1.Palliative careFor the management of nausea and vomiting in palliativecare, see p. 19 and p. 20.MigraineFor the management of nausea and vomiting associatedwith migraine, see p. 214.AntihistaminesCINNARIZINECautions section 3.4.1Contra-indications section 3.4.1Hepatic impairment section 3.4.1Renal impairment use with caution—no informationavailablePregnancy section 3.4.1Breast-feeding section 3.4.1Side-effects section 3.4.1; also rarely weight gain,sweating, lichen planus, and lupus-like skin reactionsIndication and doseRelief of symptoms of vestibular disorders. By mouthChild 5–12 years 15 mg 3 times dailyChild 12–18 years 30 mg 3 times dailyMotion sickness. By mouthChild 5–12 years 15 mg 2 hours before travel then7.5 mg every 8 hours during journey if necessaryChild 12–18 years 30 mg 2 hours before travelthen 15 mg every 8 hours during journey ifnecessaryCinnarizine (Non-proprietary)Tablets, cinnarizine 15 mg, net price 84-tab pack =£8.84. Label: 2Stugeron c (Janssen)Tablets, scored, cinnarizine 15 mg, net price 15-tabpack = £1.55, 100-tab pack = £4.18. Label: 2CYCLIZINECautions section 3.4.1; severe heart failure; maycounteract haemodynamic benefits of opioids; interactions:Appendix 1 (antihistamines)Skilled tasks Drowsiness may affect performance of skilledtasks (e.g. driving); effects of alcohol enhancedContra-indications section 3.4.1Hepatic impairment section 3.4.1Pregnancy section 3.4.1Breast-feeding no information availableSide-effects section 3.4.1Licensed use tablets not licensed for use in childrenunder 6 years; injection not licensed for use inchildrenIndication and doseNausea and vomiting of known cause; nauseaand vomiting associated with vestibular disordersand palliative care. By mouth or by intravenous injection over 3–5minutesChild 1 month–6 years 0.5–1 mg/kg up to 3times daily; max. single dose 25 mgChild 6–12 years 25 mg up to 3 times dailyChild 12–18 years 50 mg up to 3 times dailyNote For motion sickness, take 1–2 hours before departure. By rectumChild 2–6 years 12.5 mg up to 3 times dailyChild 6–12 years 25 mg up to 3 times dailyChild 12–18 years 50 mg up to 3 times daily. By continuous intravenous or subcutaneousinfusionChild 1 month–2 years 3 mg/kg over 24 hoursChild 2–5 years 50 mg over 24 hoursChild 6–12 years 75 mg over 24 hoursChild 12–18 years 150 mg over 24 hoursAdministration for administration by mouth, tabletsmay be crushedValoid c (Amdipharm)Tablets, scored, cyclizine hydrochloride 50 mg, netprice 100-tab pack = £7.41. Label: 2InjectionA, cyclizine lactate 50 mg/mL, net price 1-mL amp = 51p4 Central nervous system