Not recommended for patients aged 20 years and below due to risk of dystonic reactions.

MHRA guidance - metroclopramide: risk of neurological adverse effects

Specialist recommendation (unlicensed).

There is now a UK licensed metolazone 5mg tablet available (Xaqua®). There are significant differences in bioavailability between Xaqua® and alternative unlicensed imported metolazone preparations.

Xaqua® tablets have up to approximately twice the bioavailability of other metolazone preparations.

If switching from another metolazone product to Xaqua® tablets or vice versa, a dose adjustment may be necessary, and individualised titration based on patient's response and tolerability is advised.

More information available from Specialist Pharmacy Service (SPS). We are awaiting guidance on switching to the licensed product – in the mean time please ensure that the patients are not inadvertently switched between products.

Hospital only

Malodorous tumours and skin ulcers

Rozex for rosacea

Unlicensed.

Use with local trust approval. Available from "Special order" manufacturers or specialist importing companies. 

Umbrella service only

Palliative care only

3rd line after non-pharmacological intervention, 2nd line after pharmacological therapy. Supported with an ESCA.

For hospital use only