Drugs List

Therapeutic Indications

Uses

Labyrinthine disorders
Motion sickness

For the control of labyrinthine disorders such as vertigo, tinnitus, nystagmus, nausea and vomiting such is as seen in Meniere's disease.

Prophylaxis and control of motion sickness.

Contraindications

Children under 5 years
Breastfeeding
Porphyria

Precautions and Warnings

Elderly
Benign prostatic hyperplasia
Epileptic disorder
Galactosaemia
Glucose-galactose malabsorption syndrome
Hepatic impairment
Hereditary fructose intolerance
Lactose intolerance
Narrow angle glaucoma
Parkinson's disease
Pregnancy
Pyloroduodenal obstruction
Renal impairment
Urinary retention

Advise ability to drive/operate machinery may be affected by side effects
Not all available brands are indicated for all uses
Some formulations contain lactose
Some formulations contain sucrose
Treatment may prevent a positive reaction to dermal reactivity indicators
Discontinue if extrapyramidal effects occur
Advise that effects are potentiated by CNS depressants (including alcohol)
Advise patient to take after food to reduce gastro-intestinal disturbances

Rare case of aggravation or appearance of extrapyramidal symptoms have occurred predominantly in the elderly. Treatment should be discontinued in such cases.

Pregnancy and Lactation

Pregnancy

Cinnarizine should be used with caution in pregnancy.

The manufacturer does not recommend the use of cinnarizine in pregnancy.

However, cinnarizine has shown no increase in birth defects after clinical use and Briggs' considers cinnarizine compatible with pregnancy.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Cinnarizine is contraindicated in breastfeeding.

At the time of writing there is no data on use of cinnarizine in breastfeeding. The molecular weight and elimination half-life suggest that the drug will be excreted into breast milk. A risk neonates cannot be excluded.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Aggravation of extrapyramidal symptoms
Anaphylaxis
Angioedema
Arrhythmias
Blood disorders
Blurred vision
Bronchospasm
Cholestatic jaundice
Confusion
Convulsions
Depression
Dizziness
Drowsiness
Dry mouth
Dyskinesia
Dyspepsia
Excitement (paradoxical)
Extrapyramidal effects
Fatigue
Gastro-intestinal disturbances
Glaucoma (closed angle)
Headache
Hyperhidrosis
Hypersensitivity reactions
Hypersomnia
Hypotension
Lethargy
Lichen planus
Lichenoid keratosis
Lupus erythematosus-like syndrome
Muscle rigidity
Nausea
Palpitations
Parkinsonism
Perspiration
Photosensitivity
Psychomotor impairment
Rash
Sleep disturbances
Somnolence
Tremor
Upper abdominal pain
Urinary retention
Vomiting
Weight gain

Presentation

Oral formulations of cinnarizine.

Drugs List

Therapeutic Indications

Uses

Labyrinthine disorders
Motion sickness

For the control of labyrinthine disorders such as vertigo, tinnitus, nystagmus, nausea and vomiting such is as seen in Meniere's disease.

Prophylaxis and control of motion sickness.

Dosage

It is recommended that cinnarizine is taken after meals to minimise gastric discomfort.

Adults

Elderly

Children

Contraindications

Children under 5 years
Breastfeeding
Porphyria

Precautions and Warnings

Elderly
Benign prostatic hyperplasia
Epileptic disorder
Galactosaemia
Glucose-galactose malabsorption syndrome
Hepatic impairment
Hereditary fructose intolerance
Lactose intolerance
Narrow angle glaucoma
Parkinson's disease
Pregnancy
Pyloroduodenal obstruction
Renal impairment
Urinary retention

Advise ability to drive/operate machinery may be affected by side effects
Not all available brands are indicated for all uses
Some formulations contain lactose
Some formulations contain sucrose
Treatment may prevent a positive reaction to dermal reactivity indicators
Discontinue if extrapyramidal effects occur
Advise that effects are potentiated by CNS depressants (including alcohol)
Advise patient to take after food to reduce gastro-intestinal disturbances

Rare case of aggravation or appearance of extrapyramidal symptoms have occurred predominantly in the elderly. Treatment should be discontinued in such cases.

Pregnancy and Lactation

Pregnancy

Cinnarizine should be used with caution in pregnancy.

The manufacturer does not recommend the use of cinnarizine in pregnancy.

However, cinnarizine has shown no increase in birth defects after clinical use and Briggs' considers cinnarizine compatible with pregnancy.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Cinnarizine is contraindicated in breastfeeding.

At the time of writing there is no data on use of cinnarizine in breastfeeding. The molecular weight and elimination half-life suggest that the drug will be excreted into breast milk. A risk neonates cannot be excluded.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Aggravation of extrapyramidal symptoms
Anaphylaxis
Angioedema
Arrhythmias
Blood disorders
Blurred vision
Bronchospasm
Cholestatic jaundice
Confusion
Convulsions
Depression
Dizziness
Drowsiness
Dry mouth
Dyskinesia
Dyspepsia
Excitement (paradoxical)
Extrapyramidal effects
Fatigue
Gastro-intestinal disturbances
Glaucoma (closed angle)
Headache
Hyperhidrosis
Hypersensitivity reactions
Hypersomnia
Hypotension
Lethargy
Lichen planus
Lichenoid keratosis
Lupus erythematosus-like syndrome
Muscle rigidity
Nausea
Palpitations
Parkinsonism
Perspiration
Photosensitivity
Psychomotor impairment
Rash
Sleep disturbances
Somnolence
Tremor
Upper abdominal pain
Urinary retention
Vomiting
Weight gain

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: December 2014

Reference Sources

Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

Joint Formulary Committee. British National Formulary(online) London: BMJ Group and Pharmaceutical Press. Accessed on 12 December 2014.

Martindale: The Complete Drug Reference, 37th edition (2011) ed. Sweetman, S. Pharmaceutical Press, London.

Paediatric Formulary Committee. BNF for Children (online) London: BMJ Group, Pharmaceutical Press, and RCPCH Publications. Accessed on 12 December 2014.

Summary of Product Characteristics: Cinnarizine 15mg. Janssen-Cilag Ltd. Revised July 2010.

Summary of Product Characteristics: Mylan Travel Sickness Tablets. Generics (UK) Ltd. Revised November 2011.

Summary of Product Characteristics: Stugeron 15mg. Janssen-Cilag Ltd. Revised May 2020.

Summary of Product Characteristics: Stugeron 15. McNeil Products Ltd. Revised August 2014.