dimenhydrinate (Dramamine)

Dosing and uses of Dramamine (dimenhydrinate)

• Adult
• Pediatric
• Geriatric

 

Adult dosage forms and strengths

injectable solution

• 50mg/mL

tablet

• 50mg

tablet, chewable

• 50mg

 

Prevention of Motion Sickness

50-100 mg PO/IV/IM q4-6hr PRN, 30 minutes before exposure to motion; not to exceed 400 mg/day

 

Meniere's Disease (Off-label)

25-50 mg PO q8hr for maintenance

50 mg IM for acute attack

 

Administration

IV: 50 mg in 10 mL NS over 2 minutes

 

Pediatric dosage forms and strengths

injectable solution

• 50mg/mL

tablet, chewable

• 50mg

tablet

• 50mg

 

Prevention of Motion Sickness

General dose: 1.25 mg/kg or 37.5 mg/sq.meter IV/IM q6hr; not exceed 300 mg/day

2-6 years old: 12.5-25 mg PO q6-8hr; no more than 75 mg/day

6-12 years old: 12.5-25 mg PO q6-8hr; no more than 150 mg/day

>12 years old: Same as adult dosing

 

Geriatric dosage forms and strengths

 

Prevention of Motion Sickness

50-100 mg PO/IV/IM q4-6hr PRN, 30 minutes before exposure to motion; not to exceed 400 mg/day

 

Meniere's Disease (Off-label)

25-50 mg PO q8hr for maintenance, 50 mg IM for acute attack

 

Dramamine (dimenhydrinate) adverse (side) effects

Varies in incidence and severity with the individual drug; also individual patients vary in susceptibility

 

Frequency not defined

Paradoxical CNS stimulation (children and occasionally in adults)

CNS depression

Drowsiness

Sedation ranging from mild drowsiness to deep sleep (most frequent)

Dizziness

Lassitude

Disturbed coordination

Muscular weakness

Restlessness, insomnia, tremors, euphoria, nervousness, delirium, palpitation, seizures is less common

Epigastric distress

Anorexia

Nausea

Vomiting

Diarrhea

Constipation

Cholestasis, hepatitis, hepatic failure, hepatic function abnormality, jaundice is rare

Eczema, pruritus, inflammation, papular rash, erythema on exposed skin may occur with topical formulation

Tachycardia, palpitation ECG changes (eg, widened QRS)

Arrhythmias (eg, extrasystole, heart block)

Hypotension

Hypertension

Dizziness, sedation, and hypotension may occur in geriatric patients

Dryness of mouth, nose, and throat

Dysuria

Urinary retention

Impotence

Vertigo

Visual disturbances

Blurred vision

Diplopia; tinnitus

Acute labyrinthitis

Insomnia

Tremors

Nervousness

Irritability

Facial dyskinesia

Tightness of the chest

Thickening of bronchial secretions

Wheezing

Nasal stuffiness

Sweating

Chills

Early menses

Toxic psychosis

Headache

Faintness

Paresthesia

Agranulocytosis

Hemolytic anemia

Leukopenia

Thrombocytopenia

Pancytopenia

 

Warnings

Contraindications

Documented hypersensitivity to dimenhydrinate or diphenhydramine

Lower respiratory disease, eg, asthma (controversial)

Preemies and neonates

Nursing women

 

Cautions

May impair ability to drive or operate heavy machinery

May mask early signs of ototoxicity if given concomitantly with ototoxic drugs (eg, aminoglycosides)

Patients with seizures, angle-closure glaucoma, enlargement of prostate gland, asthma, emphysema, acute hepatic insufficiency

 

Pregnancy and lactation

Pregnancy category: B

Lactation: Crosses into breast milk, discontinue drug or do not nurse

 

Pregnancy categories

A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA: Information not available.

 

Pharmacology of Dramamine (dimenhydrinate)

Mechanism of action

Ethanolamine H1 antagonist containing diphenhydramine and 8-chloro-theophylline; pharmacological effects principally result from diphenhydramine moiety, has CNS depressant, anticholinergic, antiemetic, antihistamine, and local anesthetic effects

Antiemetic action may result from inhibiting vestibular stimulation, and inhibiting acetylcholine

 

Pharmacokinetics

Half-Life: unknown, (half-life of diphenhydramine is about 3.5 hr)

Duration: 3-6 hr

Onset: 20-30 min (IM); 15-30 min (PO); almost immediately (IV)

Bioavailability: Well absorbed

Metabolism: Extensively metabolized in the liver, based on data for diphenhydramine

Excretion: Principally in urine (as metabolites)

 

Administration

IV Compatibilities

Solution: compatible with most common solvents

Additive: amikacin, amobarbital (at 1 g amobarbital/500 mg dimenhydrinate), calcium gluconate, chloramphenicol sodium succinate, corticotropin, heparin, hydroxyzine, norepinephrine, penicillin G, pentobarbital, phenobarbital, KCl, prochlorperazine, vancomycin, vitamin B/C

Syringe: atropine, codeine, diatrizoate meglumine, diatrizoate sodium, diphenhydramine, droperidol, fentanyl, heparin, hydromorphone, hyoscine, iothalamate meglumine, iothalamate sodium, meperidine, metoclopramide, morphine, pentazocine, perphenazine, ranitidine, scopolamine

Y-site: acyclovir

 

IV Incompatibilities

Additive: aminophylline (at 1g/L aminophylline and 500 mg/L dimenhydrinate; may be compatible at lower conc), ammonium chloride(?), hydrocortisone (at 500 mg hydrocortisone and 500 mg dimenhydrinate; may be compatible at lower conc), thiopentaL

Syringe: butorphanol, chlorpromazine, glycopyrrolate, hydroxyzine, iodipamide, midazolam, nalbuphine, papaveretum, pentobarbital, prochlorperazine, promazine, promethazine, thiopentaL

 

IV Administration

50 mg in 10 mL NS over 2 min

 

Storage

Do not use if cloudy or contains a precipitate

Store at controlled room temp 15-30°C

Protect from freezing