Dimenhydrinate

(die-men-HIGH-drih-nate)

Calm-X, Children’s Dramamine, Dimetabs, Dinate, Dramamine, Dramanate, Dymenate, Hydrate, Triptone, Apo-Dimenhydrinate, Gravol, PMS-Dimenhydrinate, Travel Tabs

Class: Antiemetic antivertigo/anticholinergic

 Action Directly inhibits labyrinthine stimulation for up to 3 hr.

 Indications Prevention and treatment of motion sickness, dizziness, nausea, vomiting. Unlabeled use(s): Treatment of Meniere’s disease, nausea and vomiting of pregnancy, postoperative nausea and vomiting.

 Contraindications Use in neonates; allergic reactions to diphenhydramine.

 Route/Dosage

Motion Sickness

ADULTS: PO 50 to 100 mg 30 min prior to travel, followed by 50 to 100 mg q 4 to 6 hr (maximum 400 mg/day). IM 50 mg prn. IV 50 mg in 10 ml of Sodium Chloride for Injection administered over 2 min. CHILDREN (6 to 12 YR): PO 25 to 50 mg q 6 to 8 hr (maximum 150 mg/day). IM 1.25 mg/kg qid (maximum 300 mg/day). CHILDREN (2 to 6 YR): PO Up to 12.5 to 25 mg q 6 to 8 hr (maximum 75 mg/day). IM 1.25 mg/kg qid (maximum 300 mg/day).

 Interactions

Alcohol, CNS depressants: Enhances CNS depressant effects. Aminoglycosides: May mask signs of aminoglycoside-related ototoxicity. Anticholinergic drugs: Causes additive anticholinergic effects. Incompatibilities: Ammonium chloride, amobarbital, butorphanol, chlorpromazine, glycopyrrolate, heparin, hydrocortisone, hydroxyzine, midazolam, pentobarbital, phenobarbital, phenytoin, prednisolone, prochlorperazine, promethazine, tetracycline, theophylline, thiopental, trifluoperazine.

 Lab Test Interferences May cause false elevation in serum theophylline levels.

 Adverse Reactions

CV: Palpitations; hypotension; tachycardia. CNS: Sedation; hallucinations; delirium; drowsiness; confusion, nervousness; restlessness; headache; insomnia; tingling, heaviness and weakness of hands; vertigo; dizziness; lassitude; excitation. DERM: Fixed drug eruption; photosensitivity. EENT: Diminished night vision; decreased color discrimination; exacerbation of narrow-angle glaucoma; blurred vision; diplopia; nasal stuffiness; dryness of nose and throat. GI: Nausea; vomiting; diarrhea; GI distress; constipation; anorexia; dry mouth. GU: Prostatic enlargement; difficult or painful urination. RESP: Tightness of chest; wheezing; thickening of bronchial secretions. OTHER: Anaphylaxis.

 Precautions

Pregnancy: Category B. Lactation: Excreted in breast milk. Children: Safety and efficacy in children < 2 yr not established. Special risk patients: Use caution in patients with asthma, prostatic hypertrophy, narrow-angle glaucoma, stenosing peptic ulcer, cardiac arrhythmias. Hypersensitivity: Previous reactions to diphenhydramine.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

• Administer with food or milk to minimize nausea or GI distress.
• When administering drug IM, use Z-track method to avoid SC irritation.
• When administering drug IV, confirm correct catheter or needle placement. Note that this drug should never be given intra-arterially.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Assess drug history for concomitant use of other CNS depressants, alcohol and nonprescription CNS depressants, which could have additive effect.
• Take safety precautions if drowsiness or dizziness occurs.
• Assess patient’s nutritional status, weigh patient daily and monitor I&O if drug is given to stop or prevent nausea and vomiting.
• If a paradoxical effect occurs (insomnia, CNS stimulation), notify physician.
• If visual or auditory disturbances occur (blurred vision/tinnitus, hearing loss), notify the physician.

OVERDOSAGE: SIGNS & SYMPTOMS   Drowsiness, hallucinations, convulsions, coma, respiratory depression

 Patient/Family Education

• Advise patient to take medication 30 to 60 min before activity that may produce nausea or motion sickness.
• Instruct patient to report these symptoms to physician: drowsiness, nervousness, dry mouth, insomnia, constipation and blurred vision.
• If dimenhydrinate is being given as antiemetic, instruct patient to report nausea and vomiting to the physician.
• Instruct patient to take sips of water frequently, suck on ice chips or sugarless hard candy or chew sugarless gum if dry mouth occurs and to relieve constipation with increased fiber in diet and good hydration.
• Caution patient to avoid intake of alcoholic beverages or other CNS depressants.
• Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.

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This entry was posted on Thursday, February 22nd, 2007 at 9:40 pm and is filed under Drug Facts. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.