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Monday, February 7, 2011

Dimenhydrinate

Posted by Sampil 5:23 PM, under | No comments

dimenhydrinate
(dye men hye' dri nate)
Oral preparations:
Apo-Dimenhydrinate (CAN), Calm-X, Children’s Dramamine, Dimetabs, Dramamine, Gravol (CAN), Triptone
Parenteral preparations:
Dinate, Dramanate, Dymenate, Hydrate

Pregnancy Category B

Drug classes
Anti–motion sickness drug
Antihistamine
Anticholinergic

Therapeutic actions
Antihistamine with antiemetic and anticholinergic activity; depresses hyperstimulated labyrinthine function; may block synapses in the vomiting center; peripheral anticholinergic effects may contribute to anti–motion sickness efficacy.

Indications
·        Prevention and treatment of nausea, vomiting, or vertigo of motion sickness

Contraindications and cautions
·        Contraindicated with allergy to dimenhydrinate or its components, lactation.
·        Use cautiously with narrow-angle glaucoma, stenosing peptic ulcer, symptomatic prostatic hypertrophy, bronchial asthma, bladder neck obstruction, pyloroduodenal obstruction, cardiac arrhythmias, pregnancy.

Available forms
Tablets—50 mg; chewable tablets—50 mg; injection—50 mg/mL; liquid—12.5 mg/4 mL, 12.5 mg/5 mL; 15.62 mg/5 mL

Dosages
ADULTS
Oral
50–100 mg q 4–6 hr PO; for prophylaxis, first dose should be taken 30 min before exposure to motion. Do not exceed 400 mg in 24 hr.
Parenteral
50 mg IM as needed; 50 mg in 10 mL sodium chloride injection given IV over 10 min.
PEDIATRIC PATIENTS 6-12 YR
25–50 mg PO q 6–8 hr, not to exceed 150 mg/24 hr.
PEDIATRIC PATIENTS 2-6 YR
Up to 25 mg PO q 6–8 hr, not to exceed 75 mg/24 hr.
PEDIATRIC PATIENTS < 2 YR
Only on advice of physician; 1.25 mg/kg IM qid, not to exceed 30 mg/24 hr.
NEONATES
Contraindicated.
GERIATRIC PATIENTS
Can cause dizziness, sedation, syncope, confusion, and hypotension in elderly patients; use with caution.

Pharmacokinetics
Route
Onset
Peak
Duration
Oral
15–30 min
2 hr
3–6 hr
IM
20–30 min
1–2 hr
3–6 hr
IV
Immediate
1–2 hr
3–6 hr
Metabolism: Hepatic; T1/2: Unknown
Distribution: Crosses placenta; enters breast milk
Excretion: Urine

IV facts
Preparation: Dilute 50 mg in 10 mL sodium chloride injection.
Infusion: Administer by direct IV injection over 2 min.
Incompatibilities: Do not combine with tetracycline, thiopental.
Y-site incompatibilities: Do not mix with aminophylline, heparin, hydrocortisone, hydroxyzine, phenobarbital, phenytoin, prednisolone, promethazine.

Adverse effects
·        CNS: Drowsiness, confusion, nervousness, restlessness, headache, dizziness, vertigo, lassitude, tingling, heaviness and weakness of hands; insomnia and excitement (especially in children), hallucinations, seizures, death, blurring of vision, diplopia
·        CV: Hypotension, palpitations, tachycardia
·        Dermatologic: Urticaria, drug rash, photosensitivity
·        GI: Epigastric distress, anorexia, nausea, vomiting, diarrhea or constipation; dryness of mouth, nose, and throat
·        GU: Urinary hesitancy, urinary retention
·        Respiratory: Nasal stuffiness, chest tightness, thickening of bronchial secretions, anaphylaxis
·        Other: In geriatric patients may cause mental status changes, excessive sedation, constipation; in men, may cause urinary retension.

Interactions
·        Increased depressant effects with alcohol, other CNS depressants

Nursing considerations
Assessment
·        History: Allergy to dimenhydrinate or its components, lactation, narrow-angle glaucoma, stenosing peptic ulcer, symptomatic prostatic hypertrophy, bronchial asthma, bladder neck obstruction, pyloroduodenal obstruction, cardiac arrhythmias
·        Physical: Skin color, lesions, texture; orientation, reflexes, affect; vision examination; P, BP; R, adventitious sounds; bowel sounds; prostate palpation; CBC

Interventions
·        WARNING: Keep epinephrine 1:1,000 readily available when using parenteral preparations; hypersensitivity reactions, including anaphylaxis, have occurred.

Teaching points
·        Take drug as prescribed; avoid excessive dosage.
·        Drug works best if taken before motion sickness occurs.
·        Avoid alcohol; serious sedation could occur.
·        You may experience these side effects: Dizziness, sedation, drowsiness (use caution if driving or performing tasks that require alertness); epigastric distress, diarrhea or constipation (take drug with food); dry mouth (use frequent mouth care, suck sugarless lozenges); thickening of bronchial secretions, dryness of nasal mucosa (try another motion sickness remedy).
·        Report difficulty breathing, hallucinations, tremors, loss of coordination, unusual bleeding or bruising, visual disturbances, irregular heartbeat.

Adverse effects in Italic are most common; those in Bold are life-threatening.

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