Drugs List

Therapeutic Indications

Uses

Meniere's disease
Vertigo

Contraindications

Children under 18 years
Alcoholism
Breastfeeding
Epileptic disorder
Narrow angle glaucoma
Porphyria
Pregnancy
Raised intracranial pressure
Renal impairment - creatinine clearance below 25 ml/minute
Severe hepatic impairment
Urinary retention secondary to benign prostatic hyperplasia

Precautions and Warnings

Predisposition to glaucoma
Benign prostatic hyperplasia
Hepatic impairment
Hypertension
Hyperthyroidism
Hypotension
Mild renal impairment
Parkinson's disease
Pyloroduodenal obstruction
Raised intra-ocular pressure
Severe cardiac disorder

May mask ototoxicity caused by ototoxic drugs e.g. salicylates
Advise ability to drive/operate machinery may be affected by side effects
Review therapy after 4 weeks
Treatment may prevent a positive reaction to dermal reactivity indicators
Advise patient to avoid alcohol during treatment
Advise patient to take after food to reduce gastro-intestinal disturbances

Pregnancy and Lactation

Pregnancy

Cinnarizine and dimenhydrinate tablets are contraindicated in pregnancy.

The manufacture recommends against the use of cinnarizine and dimenhydrinate tablets in pregnancy.Cinnarizine and dimenhydrinate both have low teratogenic effect and have been used in pregnancy for many years. It is not known if cinnarizine crosses the placenta. The molecular weight and elimination half life suggest that exposure of the embryo and foetus should be expected. Dimenhydrinate may have an oxytoxic effect and may shorten labour.

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 and dimenhydrinate tablets are contraindicated in breastfeeding.

Dimenhydrinate and cinnarizine are excreted in low quantities in human breast milk.

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

Abdominal pain
Agranulocytosis
Amnesia
Aplastic anaemia
Chest tightness
Cholestatic jaundice
Constipation
Convulsions
Dazed feeling
Diarrhoea
Drowsiness
Dry mouth
Dyspepsia
Excitement (paradoxical)
Extrapyramidal effects
Fatigue
Glaucoma (closed angle)
Headache
Hypersensitivity reactions
Leucopenia
Lichen planus
Lupus erythematosus-like syndrome
Nausea
Nervousness
Paraesthesia
Perspiration
Photosensitivity
Rash
Skin reactions
Somnolence
Thrombocytopenia
Tinnitus
Tiredness
Tremor
Urinary hesitancy
Visual disturbances
Weight gain

Presentation

Tablets containing cinnarizine and dimenhydrinate

Drugs List

Therapeutic Indications

Uses

Meniere's disease
Vertigo

Dosage

Adults

Elderly

Contraindications

Children under 18 years
Alcoholism
Breastfeeding
Epileptic disorder
Narrow angle glaucoma
Porphyria
Pregnancy
Raised intracranial pressure
Renal impairment - creatinine clearance below 25 ml/minute
Severe hepatic impairment
Urinary retention secondary to benign prostatic hyperplasia

Precautions and Warnings

Predisposition to glaucoma
Benign prostatic hyperplasia
Hepatic impairment
Hypertension
Hyperthyroidism
Hypotension
Mild renal impairment
Parkinson's disease
Pyloroduodenal obstruction
Raised intra-ocular pressure
Severe cardiac disorder

May mask ototoxicity caused by ototoxic drugs e.g. salicylates
Advise ability to drive/operate machinery may be affected by side effects
Review therapy after 4 weeks
Treatment may prevent a positive reaction to dermal reactivity indicators
Advise patient to avoid alcohol during treatment
Advise patient to take after food to reduce gastro-intestinal disturbances

Pregnancy and Lactation

Pregnancy

Cinnarizine and dimenhydrinate tablets are contraindicated in pregnancy.

The manufacture recommends against the use of cinnarizine and dimenhydrinate tablets in pregnancy.Cinnarizine and dimenhydrinate both have low teratogenic effect and have been used in pregnancy for many years. It is not known if cinnarizine crosses the placenta. The molecular weight and elimination half life suggest that exposure of the embryo and foetus should be expected. Dimenhydrinate may have an oxytoxic effect and may shorten labour.

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 and dimenhydrinate tablets are contraindicated in breastfeeding.

Dimenhydrinate and cinnarizine are excreted in low quantities in human breast milk.

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

Abdominal pain
Agranulocytosis
Amnesia
Aplastic anaemia
Chest tightness
Cholestatic jaundice
Constipation
Convulsions
Dazed feeling
Diarrhoea
Drowsiness
Dry mouth
Dyspepsia
Excitement (paradoxical)
Extrapyramidal effects
Fatigue
Glaucoma (closed angle)
Headache
Hypersensitivity reactions
Leucopenia
Lichen planus
Lupus erythematosus-like syndrome
Nausea
Nervousness
Paraesthesia
Perspiration
Photosensitivity
Rash
Skin reactions
Somnolence
Thrombocytopenia
Tinnitus
Tiredness
Tremor
Urinary hesitancy
Visual disturbances
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: March 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. 66th ed. London: BMJ Group and Pharmaceutical Press; 2013. Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press https://www.medicinescomplete.com [Accessed on February 12, 2014].

Summary of Product Characteristics: Arlevert 20 mg/40mg tablets. Hennig Arzneimittel GmbH Co. KG. Revised January 2013