Advice on metoclopramide and benzodiazepines updated in the BNF
Restrictions on the use of metoclopramide in both adults and children have been updated in November’s changes to the British National Formulary and BNF for Children.
Following a review of the benefits and risks, the Medicines and Healthcare products Regulatory Agency concluded that the risk of neurological adverse effects such as extrapyramidal disorders and tardive dyskinesia outweigh the benefits in long-term or high-dose treatment. The European Medicines Agency also advised on new restrictions to metoclopramide over the summer.
Advice on withdrawal of benzodiazepines has also been updated; there is now more information on how to taper the dose of benzodiazepines for long-term users. These patients may require a much longer withdrawal period than short-term users of benzodiazepines.
Other changes to the BNF include a new indication for the monoclonal antibody, ustekinumab. It is now licensed for symptomatic treatment of active psoriatic arthritis, either in combination with methotrexate or alone, in adults who have had an inadequate response to one or more antirheumatic drugs.
Additionally, a new indication for canakinumab has been added to the BNFC; it is now licensed for the treatment of paediatric active juvenile idiopathic arthritis, with methotrexate or alone, in children who have an inadequate response to non-steroidal anti-inflammatory drugs and systemic corticosteroids.
Restrictions on the use of metoclopramide
Metoclopramide should now only be used in adults for the prevention of postoperative nausea and vomiting, radiotherapy-induced nausea and vomiting, delayed chemotherapy-induced nausea and vomiting and symptomatic treatment of nausea and vomiting, including that associated with acute migraine. Children should only receive metoclopramide as a second-line option for the prevention of delayed chemotherapy–induced nausea and vomiting and for treatment of established postoperative nausea and vomiting. Children under one year of age should not be given metoclopramide.
The BNF 66 is now available as an eBook for iPhone, iPod touch or iPad users from the Apple iTunes store.
Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2013.11130511
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