ABSTRACT
Dimenidrinato é um anti-histamínico H1 do grupo das etanolaminas, com importantes propriedades anticolinérgicas, antisserotoninérgicas e sedativas. Relatamos um caso de uma mulher que após 14 dias de ter usado dimenidrinato, iniciou quadro de exantema e vasculite urticariforme, além de sintomas constitucionais. Avaliação laboratorial sem alterações. Biopsia de pele evidenciou dermatite de interface do tipo vacuolar e púrpura com leucocitoclasia e derrame pigmentar. Imunofluorescência positiva para IgG, com presença de fluorescência dos núcleos dos queratinócitos da epiderme. Tratada com corticoide oral por 2 meses até remissão completa do quadro, e posterior realização de teste intradérmico, que foi positivo na leitura de 48h. A reação de hipersensibilidade tardia observada foi relacionada a mecanismo misto de Gell e Coombs (III e IV), com positividade no teste cutâneo intradérmico de leitura tardia em 48h (reação tipo IV) e biópsia compatível com vasculite cutânea (reação tipo III); lesões exantemáticas (reação tipo IV) e urticária vasculítica (reação tipo III). O teste cutâneo com dimenidrinato positivo reforça o diagnóstico de reação de hipersensibilidade.
Dimenhydrinate is an H1 antihistamine from the ethanolamine group, with important anticholinergic, antiserotoninergic and sedative properties. We report the case of a woman who, after 14 days of using dimenhydrinate, developed rash and urticarial vasculitis, in addition to constitutional symptoms. Laboratory tests were normal. Skin biopsy revealed interface purpuric dermatitis with leukocytoclasia and pigment effusion. Immunofluorescence was positive for IgG, showing nuclear fluorescence of epidermal keratinocytes. She was treated with oral corticosteroid for 2 months until complete remission of symptoms. Subsequent intradermal test resulted positive on the 48-h reading. The delayed hypersensitivity reaction was related to a mixed Gell and Coombs mechanism (III and IV), with positive results in the intradermal cutaneous test on the 48-h reading (type IV reaction) and a biopsy compatible with cutaneous vasculitis (type III reaction), exanthematous lesions (type IV reaction,) and urticarial vasculitis (type III reaction). The positive skin test for dimenhydrinate reinforces the diagnosis of hypersensitivity reaction.
Subject(s)
Humans , Female , Adult , Vasculitis , Immunoglobulin G , Fluorescent Antibody Technique , Dimenhydrinate , Exanthema , Hypersensitivity , Hypersensitivity, Delayed , Purpura , Skin , Urticaria , Skin Tests , Keratinocytes , Ethanolamine , Dermatitis , Diagnosis , Epidermis , FluorescenceABSTRACT
Dimenhydinate, an antihistamine agent, is effective for treating motion sickness and has a value for both civil and military application. We searched PubMed, the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, Web of Science, BIOSIS Preview for related literatures. In this paper we reviewed the retrieved literatures and discussed the safety and efficacy of dimenhydrinate in the treatment of motion sickness. It was showed that although the first choice for motion sickness was scopolamine, dimenhydrinate was, however, the first choice for nausea and vomiting, which is partly because it can reduce gastric motility during motion sickness-inducing stimuli. Therefore, dimenhydrinate might be the first choice for treating motion sickness combined with vomiting and nausea.
ABSTRACT
Introducción. Las náuseas y vómitos postoperatorios (NVPO) son complicaciones frecuentes en los pacientes quirúrgicos. Se han publicado una serie de guías clínicas y revisiones que recomiendan diferentes fármacos para la profilaxis y tratamiento de NVPO. Los fármacos dexametasona (DEX) y dimenhidrinato (DIM) son ampliamente utilizados para este fin; sin embargo, la evidencia científica que apoya la efectividad del DIM en el contexto de NVPO, es escasa. Objetivo. Determinar la dosis del fármaco (DIM o DEX con mayor efectividad en la profilaxis de náuseas y vómitos postoperatorios en pacientes adultos sometidos a cirugía general y laparoscópica. Asimismo, determinar la aparición de náuseas, vómitos, náuseas y vómitos postoperatorios, necesidad de tratamiento de rescate y efectos adversos de ambos medicamentos. Material y Método. Ensayo clínico aleatorizado realizado en el Hospital II EsSalud de Talara, Piura, Perú con 102 participantes (18 hombres y 84 mujeres) con un riesgo bajo y moderado para NVPO (09 y 93 respectivamente), los que fueron asignados en dos grupos de 51 pacientes cada uno. Un grupo de pacientes recibió DEX (4 mg) y otro DIM (50 mg) luego de la inducción de la anestesia general. Resultados. La incidencia de NVPO en la población tratada con DEX fue de 7,84% y de 39,22% en la población de pacientes que recibieron DIM. Conclusiones. La administración de 4 mg de dexametasona en el acto anestésico provee mejor profilaxis de náuseas y vómitos postoperatorios respecto a 50 mg de dimenhidrinato.
Background. Postoperative nausea and vomiting (PONV) are common complications in surgical patients. There have been a number of clinical guidelines and reviews that recommend different drugs for prophylaxis and treatment of PONV. Dexamethasone and dimenhydrinate drugs are widely used in our country for this purpose, but the scientific evidence supporting the effectiveness of dimenhydrinate in the context of PONV, is scarce. Objective. To determine the dose of the drug (dimenhydrinate or dexamethasone) more effective in the prophylaxis of postoperative nausea and vomiting in adult patients undergoing general and laparoscopic surgery. Also determine the occurrence of nausea, vomiting, PONV, need for rescue treatment and adverse effects of both drugs. Material and Method. Clinic randomized trial performed in the Hospital II Essalud Talara, Piura, Peru, with 102 participants (18 men and 84 women) with a low or moderate risk for PONV (09 and 93 respectively), which were assigned into two groups of 51 patients each. A group of patients received dexamethasone (4 mg) and another dimenhydrinate (50 mg) after induction of general anesthesia. Results. The incidence of PONV in the dexamethasonetreated population was 7,84% and 39,22% in the population of patients who received dimenhydrinate. Conclusions. The dexamethasone administration of 4 mg during anesthesia provides better prophylaxis of postoperative nausea and vomiting over dimenhydrinate administration of 50 mg.
Subject(s)
Humans , Dexamethasone/therapeutic use , Dimenhydrinate/therapeutic use , Antibiotic ProphylaxisABSTRACT
Náusea e vômitos (NV) são os sintomas mais comuns durante a gravidez, geralmente iniciando-se entre a 6ª e a 8ª semana, atingindo a intensidade máxima em torno da 9ª semana e resolvendo-se até a 12ª semana. Embora sua etiologia seja, provavelmente, multifatorial, seu curso clínico se correlaciona com as concentrações plasmáticas da gonadotrofina coriônica humana. Por comprometerem a qualidade de vida, NV devem ser abordados com modificações dietéticas que incluem dieta fracionada e redução do consumo de alimentos gordurosos, entre outras. O uso de piridoxina pode melhorar a náusea de intensidade leve, embora não diminua significantemente os episódios de vômitos. Os anti-histamínicos são os medicamentos mais utilizados como terapia medicamentosa de primeira linha e têm sua segurança comprovada; dentre eles, o dimenidrinato determina início de ação mais rápido e menor sedação que a meclizina. Entre os antagonistas dopaminérgicos, a prometazina e a metoclopramida podem ser utilizadas, mas apresentam como desvantagem o potencial de eventos adversos maternos. O antagonista dos receptores 5-HT3, ondansetrona, pode ser considerado quando outros medicamentos não foram efetivos no tratamento de NV de intensidade grave. Do mesmo modo, os corticosteroides devem ter seu uso reservado para casos não responsivos a outros medicamentos e preferencialmente após a 10ª semana de gestação...
Subject(s)
Dimenhydrinate , Pregnancy , Meclizine , Nausea , Ondansetron , Pyridoxine , Promethazine , VomitingABSTRACT
BACKGROUND: Motion sickness is one of the major problems of aerospace medical concern. Vestibule plays an important role in giving rise to motion sickness. Drugs preventing motion sickness have a suppressive effect on the vestibular function through the antagonistic effect to some receptors in vesibular nuclei and vomiting center of central nervous system. We identified and quantified the effects of anti-motion sickness drugs on vestibule-ocular reflex in healthy human subjects. METHODS: Fourty-five healthy male subjects were grouped to one of placebo, dimenhydrinate 50 mg, scopolamine (1 patch), or both scopolamine and dimenhydrinate group, and received rotation chair test before and after drug administration to obtain Vestibulo-ocular reflex (VOR) gain and phase in sinusoidal harmonic acceleration (SHA) with frequencies of 0.01, 0.02, 0.04 and 0.08 Hz. The delta gain and the delta phase by the drug administration were obtained and analyzed as pharmacodynamic effects. RESULTS: Baseline gain and phase data were not different by the groups in all SHA frequencies. VOR gains were significantly decreased by 0.15~0.17 after dimenhydrinate administration. In the scopolamine group, there were significant decreases in 0.04 and 0.08 Hz by 0.14 and 0.15, respectively, but no difference in 0.01 and 0.02 Hz was observed. Increasing tendency in VOR phase lead was observed, especially in dimenhydrinate, but not significantly. There was no additive effect on the reduction of VOR gain when the two drugs were co-administered. CONCLUSION: We quantitatively characterized how much the VOR parameters were changed by the drugs with different kinds of mechanism. Dimenhydrinate reduced the VOR gain by around 0.16. However, scopolamine probably has a minimal or no additive effect on VOR suppression.
Subject(s)
Humans , Male , Acceleration , Central Nervous System , Dimenhydrinate , Motion Sickness , Reflex , Reflex, Vestibulo-Ocular , Scopolamine , VomitingABSTRACT
BACKGROUND AND OBJECTIVES: Dimenhydrinate is known to act on the vestibular system, causing vestiular suppression. But the effects related with therapeutic dosage on eye tracking tests and vestibulo-ocular reflex (VOR) are not clear yet. We performed this study to evaluate the effects of dimenhyrinate on eye tracking tests and VOR. MATERIALS AND METHODS: Twenty five healthy subjects, comprising of 12 men and 13 women between the ages of 15 and 69 (mean age=39) participated in this study. The assessment included saccade test, smooth pursuit test, optokinetic nystagmus test for eye tracking test and sinusoidal harmonic acceleration test for VOR test. Each test was performed before, and 2 hours and 4 hours after the oral intake of dimenhydrinate (therapeutic dosage: 50 mg). The subjects were kept alert by performing a calculation task and communicating with the investigator during tests. RESULTS: Analysis of results showed that latency was prolonged after 2 hours but was returned to initiae value after 4 hours. Gain was not changed in the saccade test as well as in the smooth pursuit test. Mean slow phase eye velocity (SPEV) decreased after 4 hours in optokinetic nystagmus test. Gain and phase lead decreased only at 0.01 Hz in sinusoidal harmonic acceleration test. CONCLUSION: Dimenhydrinate had minimal effects on eye tracking tests and VOR when the patient's alertness was kept during test.
Subject(s)
Female , Humans , Male , Acceleration , Dimenhydrinate , Nystagmus, Optokinetic , Pursuit, Smooth , Reflex, Vestibulo-Ocular , Research Personnel , SaccadesABSTRACT
Objective To observe the preventive effect against sea-sickness of “anti-sick syrup” and “prevent-sick syrup” on voyage at sea. Methods A double-blind controlled trial was carried out in landing craft. 986 volunteers unaccustomed to sailing in their fist voyage at sea were divided into four groups, control group and group A to C, with ingestion, half an hour before setting sail, of placebo syrup, “anti-sick syrup”, “prevent-sick syrup” and “anti-sick syrup” plus “prevent-sick syrup”, respectively. The symptoms of seasickness were then recorded. Results The prophylactic effects have shown in all the groups. However, the effects shown in control group were significantly less than that in other groups (P
ABSTRACT
Objective:To compare the pharmacokinetics and relative bioavailability of rapid oral disintegrating tablet of dimenhydrinate(RODTD) and those of market available tablet of dimenhydrinate(DMH).Methods: Eight healthy volunteers were evenly randomized into 2 groups,one group received RODTD(25 mg) and the other received available market tablet of dimenhydrinate(25 mg).The blood levels of DMH were determined by high performance liquid chromatography(HPLC) before and after drug administration in 2 groups.Chromatography conditions were: Nova-Pak C_(18)as chromatographic column, methanol triethylamine buffer((11),)flow rate: 1.0 ml/min,detection wavelength: 225 nm,and room temperature.The pharmacokinetics and relative bioavailability of RODTD and market available tablets were investigated.Results: The standard curve of DMH in the blank plasma was linear within the range of 5-500 ng/ml,with the regression equation being C=0.004 4 A+4.745 and R~(2)=(0.996.)The limit of detection was 2 ng/ml;the average recovery rate was(90.55?4.69)% and the RSD was 0.041%.The intra-day derivations of 3 different concentrations(low,middle,and high) of plasma were 9.27%,4.93%,and 2.95%,respectively((n=5),) and the inter-day derivations were 9.97%,3.81%,and 3.06%,respectively(n=5).Blood samples(3 ml) were subjected to HPLC assay and significant difference was found between the 2 forms of DMH. The pharmacokinetic parameters of RODTD were: AUC=(602.04?113.82) ng?h?ml~(-1),C_(max)=(95.86?21.28) ng?ml~(-1),and T_(Peak)=(1.8?0.32) h;the pharmacokinetic parameters of market available tablets were:AUC=(342.73?84.96) ng?h?ml~(-1),C_(max)=((46.34?)(10.32)) ng?ml~(-1),and T_(Peak)=(2.65?0.24) h.Statistical analysis showed there was significant difference in the relative bioavailability of 2 forms of DMH(P