DOCSLIB.ORG

Summary of Product Characteristics

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Summary of Product Characteristics SUMMARY OF PRODUCT CHARACTERISTICS 1. NAME OF THE MEDICINAL PRODUCT Dimenhydrinate [MAH] 6.2 mg/ml solution for injection 2. QUALITATIVE AND QUANTITATIVE COMPOSITION 1 ml solution for injection contains 6.2 mg dimenhydrinate. 1 ampoule of 10 ml solution for injection contains 62 mg dimenhydrinate. For the full list of excipients, see section 6.1 3. PHARMACEUTICAL FORM Solution for injection Clear, colourless solution with a pH of 6.5 – 7.5 4. CLINICAL PARTICULARS 4.1 Therapeutic indications Dimenhydrinate [MAH] can be used for prophylaxis and symptomatic treatment of nausea and vomiting of different genesis, in particular kinetosis. Note: Dimenhydrinate is not appropriate as a sole agent for treatment of chemotherapy induced nausea and vomiting. 4.2 Posology and method of administration Posology Usual dose for: Adults and adolescents aged 14 years and over: 1 – 3 ampoules (corresponding to 62 – 186 mg dimenhydrinate) per day. The maximum daily dose of 400 mg should not be exceeded. Children aged 6 to 14 years: 1 – 3 times daily 25 – 50 mg dimenhydrinate. The maximum daily dose of 150 mg should not be exceeded. Children ≥ 6 kg bodyweight: 1 – 3 times daily 1.25 mg dimenhydrinate/kg body weight. Method of administration For prophylaxis of motion sickness the first dose is given approx. ½ - 1 hour before start of journey. For the treatment of nausea and vomiting the doses are administered at regularly intervals throughout the day. 1 Dimenhydrinate [MAH] is administered very slowly by intravenous injection (10 ml in not less than 2 min). When applied via an injection port of an i.v. cannula the venous access should be flushed afterwards with Sodium chloride 9 mg/ml (0.9 %) solution for injection or Ringer’s solution. For administration of an intravenous infusion, Dimenhydrinate [MAH] can be added to the following solutions for infusion: Glucose 5 % or 10 % Sodium chloride 9 mg/ml (0.9 %) solution for injection Ringer’s solution Dimenhydrinate [MAH] is intended for short term use only. Therefore, a doctor should be consulted if symptoms persist. At the latest 2 weeks after start of treatment it should be checked whether treatment with Dimenhydrinate [MAH] is still necessary. 4.3 Contraindications Dimenhydrinate [MAH] is contraindicated in patients with: - hypersensitivity to dimenhydrinate or other antihistamines, - acute asthma attack, - narrow-angle glaucoma, - pheochromocytoma, - porphyria, - prostatic hypertrophy with generation of residual urine, - seizures/convulsions (epilepsy, eclampsia). 4.4 Special warnings and precautions for use Dimenhydrinate [MAH] should be used with caution in patients with: - impaired liver function, - hypokalaemia, hypomagnesaemia, - cardiac dysrhythmia/arrhythmia (e.g. tachycardia), - bradycardia, - congenital long QT syndrome or other clinical significant cardiac disorders (particularly coronary heart disease, conduction disturbance), - concomitant treatment with medicinal products that also cause prolongation of the QT interval (e.g. antiarrhythmic drugs class IA or III, antibiotics, malaria drugs, antihistamines, neuroleptics) or lead to hypokalaemia (see section 4.5), - chronic breathing difficulties and asthma, - pyloric stenosis. 4.5 Interaction with other medicinal products and other forms of interaction If used concomitantly, the effects of dimenhydrinate and other CNS depressants (antipsychotic drugs, hypnotics, sedatives, analgesics, narcotics) may be enhanced. The anticholinergic effect of dimenhydrinate (see section 4.8) may be potentiated in a non- predictable way if taken concomitantly with other agents with anticholinergic activity (e.g. atropine, biperiden, or tricyclic antidepressants). When dimenhydrinate is given in conjunction with monoamine oxidase inhibitors enteroparesis that may be life-threatening, urinary retention or an increased intraocular pressure may develop. In addition, a drop in blood pressure may occur and central nervous system and breathing dysfunctions may be enhanced. Therefore, dimenhydrinate must not be used in conjunction with monoamine oxidase inhibitors. 2 The concomitant use of medicinal products that also prolong the QT interval (e.g. antiarrhythmic drugs class IA or III, antibiotics, malaria drugs, neuroleptics) or lead to hypokalaemia (e.g. certain diuretics) should be avoided (see section 4.4, 4.9 and 5.3). The concomitant use of dimenhydrinate with antihypertensive medicinal products can lead to increased tiredness or to increased hypotensive effect. Dimenhydrinate may cause false-negative results in allergy tests. Caution should be used if dimenhydrinate is given during therapy with aminoglycoside antibiotics because it may mask ototoxic symptoms. Alcohol consumption should be avoided during dimenhydrinate treatment because alcohol can change or increase the effects of dimenhydrinate in a non-predictable manner. The ability to drive and use machines is further impaired. 4.6 Fertility, pregnancy and lactation Pregnancy There are inconsistent reports about the safe use of Dimenhydrinate [MAH] during pregnancy. A prospective study on pregnant women did not reveal any evidence for a relationship between dimenhydrinate treatment and malformations. Another study described an association between cardiovascular defects or inguinal hernia with dimenhydrinate exposition during pregnancy. A case-control study included 38,151 new-borns without congenital malformations and 22,843 with congenital malformations of whom a total of 2,640 children were exposed to dimenhydrinate. Dimenhydrinate showed no evidence of teratogenic potential. There are no indications that dimenhydrinate application leads to a higher abortion rate during the first trimester of pregnancy. Dimenhydrinate can stimulate preterm uterine contractions and increases the risk for premature labour. Animal studies with dimenhydrinate are insufficient with respect to reproductive toxicity (see section 5.3). Dimenhydrinate [MAH] should only be used during pregnancy if a therapy without medication or a treatment with other, safe medicinal products were not effective. Dimenhydrinate [MAH] should not be used during the third trimester because it can trigger preterm uterine contractions. Breastfeeding Dimenhydrinate is excreted into human breast milk. There are no data about the use of dimenhydrinate during breast feeding. Because undesirable effects on a nursing infant such as increased irritability cannot be excluded, either Dimenhydrinate [MAH] treatment should be discontinued or breast feeding should be discontinued. Fertility No data are available (see section 5.3). 4.7 Effects on ability to drive and use machines Drowsiness, disturbances of memory and a decreased ability to concentrate may negatively influence the ability to drive and use machines. This has to be considered especially after an insufficient sleeping period, when starting treatment, when changing medication or when concomitantly alcohol is used (see also section 4.5). 4.8 Undesirable effects 3 The frequency of undesirable effects listed in table 1 is classified according to the following convention: Very common ≥1/10 Common ≥1/100 to <1/10 Uncommon ≥1/1,000 to <1/100 Rare ≥1/10,000 to <1/1,000 Very rare <1/10,000 Not known cannot be estimated from the available data Especially at the beginning of the treatment undesirable effects such as somnolence, drowsiness, dizziness, and muscle weakness may occur depending on the individual susceptibility and dose. These side effects can last into the following day. Table 1: Adverse reactions reported with dimenhydrinate System organ class Frequency Blood and lymphatic Not known system disorders In exceptional cases blood cell damages can occur. Psychiatric disorders Common mood swings Not known drug dependence Nervous system Very Common disorders somnolence, drowsiness, dizziness Common restlessness, agitation, insomnia, anxiety, tremor Eye disorders Common visual disturbances, increased intraocular pressure Cardiac disorders Common tachycardia Gastrointestinal Common disorders nausea, pain in the stomach region, vomiting, obstipation, diarrhoea Hepato-biliary Not known disorders liver dysfunction (cholestatic icterus) Skin and subcutaneous Common tissue disorders dryness of mouth, nasal obstruction Not known allergic skin reactions and sensitivity to light (direct sun exposure should be avoided) Musculoskeletal and Very Common connective tissue muscle weakness disorders Renal and urinary Common disorders urinary dysfunctions 4 Sudden discontinuation after long-term daily treatment can temporarily cause insomnia. Therefore, treatment should be discontinued by gradually decreasing the dose in these cases. As with other medicinal products with a hypnotic effect, development of drug dependence cannot be ruled out after long-term therapy. Therefore, the indication for a treatment longer than only short-term should be carefully checked. Paediatric population Particularly in children, there is the possibility of paradoxical reactions such as restlessness, excitation, insomnia, anxiety and shaking (tremor). 4.9 Overdose Intoxications with dimenhydrinate, the active substance of Dimenhydrinate [MAH] can be life-threatening. Children are at special risk. In case of overdose or intoxication with Dimenhydrinate [MAH] immediate medical attention is needed. The signs of overdose with Dimenhydrinate [MAH] are mainly characterised by different stages of impaired consciousness, ranging from strong drowsiness to coma - depending on the applied dose. Apart from this, signs of the anticholinergic syndrome
Load more

Recommended publications
  • (Antimuscarinic) Drugs?
    © July - August 2018 How well do you know your anticholinergic (antimuscarinic) drugs? nticholinergic drugs, prescribed for a variety of clini- Acal conditions, are amongst the most frequently used prescription drugs in BC (Table 1). Also referred to as “an- timuscarinics,” such drugs specifically block muscarinic receptors for acetylcholine (ACh).1 Muscarinic ACh recep- tors are important in the parasympathetic nervous system that governs heart rate, exocrine glands, smooth muscles, clude drugs whose active metabolites are potent- as well as brain function. In contrast, nicotinic ACh recep- ly antimuscarinic,5 or which often cause typical tors stimulate contraction of striated muscles. This Letter is AC adverse effects such as dry mouth or urinary intended to remind clinicians of commonly used drugs that retention.6 People taking antihistamines, antide- have anticholinergic (AC), or technically, antimuscarinic pressants, antipsychotics, opioids, antimuscarinic properties, and of their potential adverse effects. inhalers, or many other drugs need to know that Beneficial and harmful effects of anticholinergic drugs have blockade of ACh receptors can cause bothersome been known for centuries. In Homer’s Odyssey, the nymph or even dangerous adverse effects (Table 3). pharmacologist Circe utilized central effects of atropinics Subtle and not-so-subtle toxicity in the common plant jimson weed (Datura stramonium) to cause delusions in the crew of Odysseus. Believing they Students often learn the adverse effects of anticho- had been turned into pigs, they could be herded.2 linergics from a mnemonic, e.g.: “Blind as a bat, Sometimes a drug is recommended specifically for its an- mad as a hatter, red as a beet, hot as a hare, dry as ticholinergic potency.
    [Show full text]
  • Drugs That Can Cause Delirium (Anticholinergic / Toxic Metabolites)
    Drugs that can Cause Delirium (anticholinergic / toxic metabolites) Deliriants (drugs causing delirium) Prescription drugs . Central acting agents – Sedative hypnotics (e.g., benzodiazepines) – Anticonvulsants (e.g., barbiturates) – Antiparkinsonian agents (e.g., benztropine, trihexyphenidyl) . Analgesics – Narcotics (NB. meperidine*) – Non-steroidal anti-inflammatory drugs* . Antihistamines (first generation, e.g., hydroxyzine) . Gastrointestinal agents – Antispasmodics – H2-blockers* . Antinauseants – Scopolamine – Dimenhydrinate . Antibiotics – Fluoroquinolones* . Psychotropic medications – Tricyclic antidepressants – Lithium* . Cardiac medications – Antiarrhythmics – Digitalis* – Antihypertensives (b-blockers, methyldopa) . Miscellaneous – Skeletal muscle relaxants – Steroids Over the counter medications and complementary/alternative medications . Antihistamines (NB. first generation) – diphenhydramine, chlorpheniramine). Antinauseants – dimenhydrinate, scopolamine . Liquid medications containing alcohol . Mandrake . Henbane . Jimson weed . Atropa belladonna extract * Requires adjustment in renal impairment. From: K Alagiakrishnan, C A Wiens. (2004). An approach to drug induced delirium in the elderly. Postgrad Med J, 80, 388–393. Delirium in the Older Person: A Medical Emergency. Island Health www.viha.ca/mhas/resources/delirium/ Drugs that can cause delirium. Reviewed: 8-2014 Some commonly used medications with moderate to high anticholinergic properties and alternative suggestions Type of medication Alternatives with less deliriogenic
    [Show full text]
  • Stability and Compatibility of Combinations of Hydromorphone
    The Canadian Journal of Hospital Pharmacy - Volume 46, No. 2, April 1993 61 Stability and Compatibility of Combinations oman of Hydromorphone and Dimenhydrinate, ations Lorazepam or Prochlorperazine Jnally >hoto- Scott E. Walker, John Iazzetta, Carlo De Angelis and Danny W.C. Lau laser :ii, in­ figure ABSTRACT RESUME .Each The stability and compatibility of combinations of hydro­ On a melange diverses solutions d'hydromorphone .rabic morphone (2, 10 and 40 mg/ml) admixed separately with (2, 10 et 40 mg/ml) avec, separemen( un volume egal :onse- dimenhydrinate (50 mg/ml), prochlorperazine (5 mg/ml), d'une solution soit de dimenhydrate (50 mglmL), de 1ld be or lorazepam (4 mg/ml) were tested over a seven-day prochlorperazine (5 mglmL) ou de lorazepam (4 mglmL), Jarate period at 4°C, 23°C and 37°C In addition to visual pour verifier la compatibilite de ces trois medicaments avec lished inspection and pH, the concentration of each component l'hydromorphone et determiner la stabilite du melange ie ac­ in the binary mixture was determined by a stability­ binaire pendant sept jours a 4°C, a 23°C et a 37°C ion to indi.cating lifjuid chromatographic method Each test was En plus d'effectuer wz examen visuel et de deter­ ipt. completed at time zero, one, four, six and seven days after miner le pH, on a dose !es composants des melanges par mixing equal volumes of each medication. une methode de chromatographie en phase lifjuide indi­ The hydromorphone-dimenhydrinate combination was quant la stabilite. On a analyse !es melanges au moment compatible and stable for 24 hours.
    [Show full text]
  • Chapter 34 • Drugs Used to Treat Nausea and Vomiting
    • Chapter 34 • Drugs Used to Treat Nausea and Vomiting • Learning Objectives • Compare the purposes of using antiemetic products • State the therapeutic classes of antiemetics • Discuss scheduling of antiemetics for maximum benefit • Nausea and Vomiting • Nausea : the sensation of abdominal discomfort that is intermittently accompanied by a desire to vomit • Vomiting (emesis): the forceful expulsion of gastric contents up the esophagus and out of the mouth • Regurgitation : the rising of gastric or esophageal contents to the pharynx as a result of stomach pressure • Common Causes of Nausea and Vomiting • Postoperative nausea and vomiting • Motion sickness • Pregnancy Hyperemesis gravidarum: a condition in pregnancy in which starvation, dehydration, and acidosis are superimposed on the vomiting syndrome • Common Causes of Nausea and Vomiting (cont’d) • Psychogenic vomiting: self-induced or involuntary vomiting in response to threatening or distasteful situations • Chemotherapy-induced emesis (CIE) Anticipatory nausea and vomiting: triggered by sight and smell associated with treatment Acute CIE: stimulated directly by chemotherapy 1 to 6 hours after treatment Delayed emesis: occurs 24 to 120 hours after treatment; may be induced by metabolic by-products of chemotherapy • Drug Therapy for Selected Causes of Nausea and Vomiting • Postoperative nausea and vomiting (PONV) • Antiemetics include: Dopamine antagonists Anticholinergic agents Serotonin antagonists H2 antagonists (cimetidine, ranitidine) • Nursing Process for Nausea and Vomiting
    [Show full text]
  • Motion Sickness Traveler Summary Key Points Motion Sickness Consists of a Group of Signs and Symptoms That Develop in Response to Real Or Perceived Motion
    Motion Sickness Traveler Summary Key Points Motion sickness consists of a group of signs and symptoms that develop in response to real or perceived motion. Symptoms include dizziness, nausea, and vomiting. Prevention includes: Eating light meals Avoiding alcohol Sitting in the front seat of a car, over the wings on an airplane, or mid-deck on ships and facing forward in buses and trains Avoiding tasks requiring a close focus (e.g., reading) Using over-the-counter (OTC) or prescription medication OTC medications include: Dimenhydrinate, diphenhydramine, cyclizine, or meclizine: take 1 hour before departure and continue during the trip. These medications can cause sedation; do not mix with alcohol. Read labels carefully. Check for cautions regarding use in certain conditions. Prescription medications include: Scopolamine patches: place behind the ear; change every 3 days; apply 8 hours before the first incidence of rough weather or rough roads. Dry mouth and dry eyes may result. Patches do not work if cut in half. More than 1 patch should never be applied; hallucinations or psychosis may result. Strong sedatives (such as promethazine or prochlorperazine): take orally or by suppository after onset of severe symptoms, but anticipate sleep for a number of hours. A cruise medical clinic may administer injectable promethazine if absolutely necessary. Introduction The human body has a delicate system of equilibrium that relies on fluids in the inner ear, visual sensors, and other physical input to maintain a sense of balance. When incoming signals are in conflict—for example, when the body is at rest yet the eyes sense movement—this system is disturbed, causing the symptoms of motion sickness.
    [Show full text]
  • Medicines Classification Committee
    Medicines Classification Committee Meeting date 1 May 2017 58th Meeting Title Reclassification of Sedating Antihistamines Medsafe Pharmacovigilance Submitted by Paper type For decision Team Proposal for The Medicines Adverse Reactions Committee (MARC) recommended that the reclassification to committee consider reclassifying sedating antihistamines to prescription prescription medicines when used in children under 6 years of age for the treatment of medicine for some nausea and vomiting and travel sickness [exact wording to be determined by indications the committee]. Reason for The purpose of this document is to provide the committee with an overview submission of the information provided to the MARC about safety concerns associated with sedating antihistamines and reasons for recommendations. Associated March 2013 Children and Sedating Antihistamines Prescriber Update articles February 2010 Cough and cold medicines clarification – antihistamines Medsafe website Safety information: Use of cough and cold medicines in children – new advice Medicines for Alimemazine Diphenhydramine consideration Brompheniramine Doxylamine Chlorpheniramine Meclozine Cyclizine Promethazine Dexchlorpheniramine New Zealand Some oral sedating antihistamines available without exposure to a prescription (pharmacist-only and pharmacy only), sedating therefore usage data is not easily available. antihistamines Table of Contents 1.0 PURPOSE ......................................................................................................................................
    [Show full text]
  • A Comparison of the Anti-Emetic Effects of Dimenhydrinate, Promethazine
    A COMPARISON OF THE ANTI-EMETIC EFFECTS OF DIMENHYDRINATE, PROMETHAZINE HYD]ROCHLORIDE AND CHLORPROMAZINE FOLLOWING ANAESTHESIA DOREEN CAPLIN, M.D.*, and CODE SMXTH, 1VLD.*= Vo~rriNc during the immediate postoperalave period is a frequent complica- tion of anaesthesia m children Dimenhydrinate, promethazme hydrochloride, and chlorpromazine have all been recommended as effeclave anti-emetic drugs (1, 2, 3). A comparison o; the chmcal efficacy of these three agents was made with a carefully selected and controlled group of patients. A group of patients undergoing operalaon for correction of squint was chosen for this study for the following reasons: 1. They were reputed to have a relatively high incidence of post-anaesthetic vomzlang, a prerequisite for ~he demonstratmn of anti-emetic action in a relatively small series of cases 2. There was no operatJve interference with or disease of the gastro-intestinal tract. 3. All operations lasted between one-half and one hour. 4. All pataents were on the same ward with the result that observations were made by the same nursing personnel throughout the proleet, 5. All cases were electave and had receaved nothing by mouth for at least four hours prior to induction, ~md had received no solid food since the evening prior to operation. The cases used in the study were drawn from both public and private patients of certain eye-surgeons and were elther treated or placed in the control group on a completely random basis. The first comparison was made between 40 cases treated with dimenhydrinate and 40 untreated controls. Towards the completaon of this series, optimistic reports of the effectiveness of promethazine hydrochlorlde and chlorpromazine prompted us to conduct a second serms consislang ~f 20 cases treated with promethazme hydrochlorlde, 25 casestreated with chlorpromazine and 20 un- treated controls.
    [Show full text]
  • Dimenhydrinate Use for Children with Vomiting
    Child Health Update Dimenhydrinate use for children with vomiting Paul Enarson MD PhD FRCPC Serge Gouin MD CM FRCPC ABP(PEM) Ran D. Goldman MD FRCPC Abstract Question Dimenhydrinate is an over-the-counter drug that is commonly used for the treatment of nausea and vomiting. Many of my adult patients use it, but is it safe and useful in the pediatric population? Answer Dimenhydrinate appears to be safe for use in the pediatric population. While little literature has been published about adverse effects of this medication, family physicians need to identify the cause of the vomiting before considering if the drug will be effective and need to ensure that patients safely use the medication and avoid potential interaction of the drug with other products. Résumé Question Le dimenhydrinate est un médicament en vente libre communément utilisé pour traiter la nausée et les vomissements. Beaucoup de mes patients adultes l’utilisent, mais est-il sûr et efficace pour les enfants? Réponse L’utilisation du dimenhydrinate semble sécuritaire pour la population pédiatrique. Même s’il y a peu d’ouvrages médicaux publiés sur les effets indésirables de ce médicament, les médecins de famille doivent d’abord identifier la cause des vomissements avant de pouvoir déterminer si ce médicament sera efficace et doivent s’assurer que les patients l’utilisent de manière sécuritaire et évitent des interactions possibles du médicament avec d’autres produits. imenhydrinate is a nonprescription ethanolamine, con- dimenhydrinate in children older than 6 years of age. All Dsisting of 53% to 56% diphenhydramine and 44% to adverse events after acute exposures to dimenhydrinate in 47% 8-chlorotheophylline.1 The main indication for dimen- children younger than age 6 were reported in case reports, hydrinate is nausea, vomiting, or dizziness due to motion case series, or personal communications.1 All but one of sickness, but it is commonly used to relieve nausea and these reports were of children receiving doses exceeding vomiting from a variety of conditions.
    [Show full text]
  • Proposal for the Inclusion of Anti-Emetic Medicines for The
    PROPOSAL FOR THE INCLUSION OF ANTI-EMETIC MEDICATIONS (FOR CHILDREN) IN THE WHO MODEL LIST OF ESSENTIAL MEDICINES Marc Bevan, Kent Johnson, Elizabeth Seil and Jane Robertson Discipline of Clinical Pharmacology School of Medicine and Public Health Faculty of Health University of Newcastle Level 5, Clinical Sciences Building, NM2 Calvary Mater Hospital Edith Street, Waratah, 2298 New South Wales AUSTRALIA Tel +61-02-49211726 Fax + 61-02-49602088 WHO EML – Anti-emetics – January 2009 1. Summary statement of the proposal Anti-emetic medications (anti-histamines, dopamine antagonists, serotonin 5-HT3 antagonists, steroids and anti-cholinergics) are proposed for inclusion in the World Health Organization (WHO) Model List of Essential Medicines for the management of postoperative nausea and vomiting in children. 2. Name of focal point in WHO submitting or supporting the application 3. Name of the organisation preparing the application Discipline of Clinical Pharmacology, School of Medicine and Public Health, Faculty of Health, University of Newcastle, Level 5, Clinical Sciences Building, NM2, Calvary Mater Hospital, Edith Street, Waratah, 2298, New South Wales, Australia. 4. Treatments reviewed in the proposal The proposal reviews relevant data regarding the use of five classes of anti-emetic medications for the management of postoperative nausea and vomiting in children: o Anti-histamines (e.g. cyclizine, dimenhydrinate, promethazine) o Dopamine antagonists (e.g. droperidol, metoclopramide, perphenazine) o Serotonin 5-HT3 antagonists (e.g. granisetron, ondansetron, tropisetron) o Steroids (e.g. dexamethasone) o Anti-cholinergics (e.g. hyoscine) It should be noted that two treatments (promethazine and metoclopramide) are currently listed on the WHO Model List of Essential Medicines as anti-emetic medications for children (WHO, 2007).
    [Show full text]
  • Pain Management (Updated 26-09-2018)
    Pain Management (Updated 26-09-2018) Signs and Symptoms: There are numerous situations when pain control is required. The intent of this protocol is to offer a stepwise progression in pain management ranging for minor pain to pain associated with traumatic injury. Considerations: 1. Non-traumatic pain may include, but is not limited to: a. Acute headache (pain that is typical for patient- especially if known diagnosis of migraines) b. Back pain/poorly localized pain, worse with movement and no neurological symptoms c. Musculoskeletal/joint/neck pain d. Pain from infection that is being treated 2. For traumatic or severe pain when the cause of pain is known. If decreased LOC, BP < 90, loss of radial pulse or hypotension, consider Hypovolemia Protocol 3.3 or Cardiac Chest Pain Protocol 1.1 (CFHS Med Tech Protocol manual – 4th Ed). Contraindications: Allergy to an indicated medication. Management: Children: Mild/Moderate Pain Severe Pain (4-16 yo) 2 Acetaminophen 15mg/kg PO q 6hr prn Morphine 0.1mg/kg IV over 1min to a max (Max 75mg/kg/day not to exceed 4000mg) of 2.5 mg ± or Ibuprofen 10mg/kg PO q 8hr prn 2 Morphine 0.1mg to 0.2mg/kg IM (Max 40mg/kg/day not to exceed 2400mg) Adjunct (Nausea & Vomiting) – Ondansetron 2 to 4mg PO or 0.1mg/kg IV, q 8hr prn Adults: Management as per Figure 1 – Adult Pain Protocol Disposition: 1. Consider evacuation for patients requiring opioid or ketamine use. Notes: 1 Meloxicam preferred NSAID as it does not exert an antiplatelet effect plus efficient once daily dosing.
    [Show full text]
  • Efficacy and Pharmacological Appropriateness of Cinnarizine And
    International Journal of Environmental Research and Public Health Article Efficacy and Pharmacological Appropriateness of Cinnarizine and Dimenhydrinate in the Treatment of Vertigo and Related Symptoms Fulvio Plescia 1 , Pietro Salvago 2, Francesco Dispenza 3, Giuseppe Messina 4,5 , Emanuele Cannizzaro 1 and Francesco Martines 2,* 1 Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities “Giuseppe D’Alessandro”, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy; [email protected] (F.P.); [email protected] (E.C.) 2 Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata (BiND), Sezione di Audiologia, Università Degli Studi di Palermo, Via del Vespro 129, 90127 Palermo, Italy; [email protected] 3 UOC Otorinolaringoiatria, A.O.U.P. “Paolo Giaccone”, Via del Vespro 129, 90127 Palermo, Italy; [email protected] 4 Department of Psychological, Pedagogical and Human Movement Sciences, University of Palermo, Via Giovanni Pascoli 6, Palermo 90144, Italy; [email protected] 5 PosturaLab Center, 90127 Palermo, Italy * Correspondence: [email protected] Abstract: Vertigo is not itself a disease, but rather a symptom of various syndromes and disorders that jeopardize balance function, which is essential for daily activities. It is an abnormal sensation of motion that usually occurs in the absence of motion, or when a motion is sensed inaccurately. Due to Citation: Plescia, F.; Salvago, P.; the complexity of the etiopathogenesis of vertigo, many pharmacological treatments have been tested Dispenza, F.; Messina, G.; Cannizzaro, for efficacy on vertigo. Among these drugs, cinnarizine, usually given together with dimenhydrinate, E.; Martines, F. Efficacy and appears to be the first-line pharmacotherapy for the management of vertigo and inner ear disorders.
    [Show full text]
  • Medications to Avoid Before Skin Testing
    PLEASE STOP ANTIHISTAMINES 5 DAYS PRIOR TO NEW PATIENT APPOINTMENTS OR ALLERGY SKIN TESTING *Do not stop asthma medications or any other medications that do not contain antihistamine! **If you have major hives or swelling, do not stop your antihistamines. ***Please call us if you have questions about any of your medications interfering with skin testing. ****Do not use oil, cream or lotion on the back or arms for 24 hours prior to skin testing. COMMON MEDICATIONS CONTAINING ANTIHISTAMINES • Actifed (chlorpheniramine) • Elavil (amitriptyline) • Advil PM, Advil Allergy • Excedrin PM • Alavert/Claritin (loratadine) • Fexofenadine (Allegra) • Allegra (fexofenadine) • Hydroxyzine (Atarax, Vistaril) • Alka Seltzer P.M. • Imipramine (Tofranil) • Amitriptyline (Elavil) • Levocetirizine (Xyzal) • Antivert (Meclizine) • Loratadine (Claritin) • Astelin Nasal Spray (azelastine) • Meclizine (Antivert, Bonine) • Astepro Nasal Spray (azelastine) • Norpramine (desipramine) • Atarax (hydroxyzine) • Nortriptyline (Pamelor) • Azelastine nose spray (Astepro, Astelin) • Nyquil • Benadryl (diphenhydramine) • Nytol • Bonine (meclizine) • Olopatadine (Patanase nasal spray) • Cetirizine (Zyrtec) • Pamelor (nortriptyline) • Chlorpheniramine (Chlor-Trimeton, Actifed, • Patanase Nasal Spray (olopatadine) Tussionex) • PBZ (pyribenzamine) • Chlor-Trimeton (chlorpheniramine) • Pediacare • Clarinex (desloratadine) • Periactin (Cyproheptadine) • Claritin (loratadine) • Phenergan (promethazine) • Clemastine (Tavist) • Promethazine (Phenergan) • Cogentin (for Parkinson's
    [Show full text]