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Noroozbeygi A, Dehkordi MA, Masoomi M, Salarifar E. Comparing Epley Maneuver, Betahistine, and Dimenhydrinate in the Treatment of Benign Paroxysmal Positional Vertigo: A Prospective Study. Indian J Otolaryngol Head Neck Surg 2024; 76:794-803. [PMID: 38440440 PMCID: PMC10908696 DOI: 10.1007/s12070-023-04282-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/10/2023] [Indexed: 03/06/2024] Open
Abstract
Although the Epley maneuver is considered the primary treatment in BPPV, anti-vertigo medications are effective in residual symptoms. This study was designed to compare betahistine and dimenhydrinate plus the Epley maneuver and the Epley maneuver alone. This prospective cohort study was performed in Mashhad, Iran, from 2013 to 2015. 90 adult patients diagnosed with BPPV in hospitals and ENT clinics were selected through convenience sampling. Patients received betahistine 8 mg TDS or dimenhydrinate 50 mg once daily plus Epley or the Epley alone for four weeks. SF-36 and the DHI were used before and after the treatment. 49 were females (54.4%). The mean (SD) age was 47.9 (8.7) years. There was no significant difference between the groups in age (P = 0.753) and gender (P = 0.050).There were significant differences in all areas of SF-36 except for social activities in the dimenhydrinate group. There was a marginally significant difference between the betahistine and dimenhydrinate groups in role limitation due to physical health problems (P = 0.046). There were significant differences between the females and males in emotional well-being before and after treatment in the dimenhydrinate group (P = 0.014) and in terms of role limitation due to physical health problems in the Epley maneuver group (P = 0.022). Older patients in the betahistine group had better social activities after treatment (P = 0.048). In severe forms of BPPV, betahistine or dimenhydrinate might effectively reduce the symptoms.
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Affiliation(s)
- Amin Noroozbeygi
- Mashhad Azad University of Medical Sciences, Mashhad, Iran
- Mashhad Azad University of Medical Sciences, Mashahd, Iran
| | - Mahboubeh Adami Dehkordi
- ENT Specialist, Mashhad Azad University of Medical Sciences, Mashhad, Iran
- Mashhad Azad University of Medical Sciences, Mashahd, Iran
| | - Mahya Masoomi
- Mashhad Azad University of Medical Sciences, Mashhad, Iran
- Mashhad Azad University of Medical Sciences, Mashahd, Iran
| | - Elnaz Salarifar
- Mashhad Azad University of Medical Sciences, Mashhad, Iran
- Mashhad Azad University of Medical Sciences, Mashahd, Iran
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Sahin S, Calapoglu F, Ozbek Yazici S, Ozmen I. Investigation of binding interaction behavior between antiemetic drugs and Trypsin by spectroscopy and molecular docking. Spectrochim Acta A Mol Biomol Spectrosc 2021; 258:119817. [PMID: 33901946 DOI: 10.1016/j.saa.2021.119817] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/01/2021] [Accepted: 04/08/2021] [Indexed: 06/12/2023]
Abstract
Antiemetic drugs are used to control excessive vomiting and nausea and generally absorbed through gastrointestinal tract. In present study, the in-vitro binding interactions two of the antiemetic drugs (dimenhydrinate and ondansetron) between Trypsin (Tsn) secreted from pancreas to small intestine for protein digestion were investigated by fluorescence emission spectroscopy (FES), UV-VIS spectroscopy, synchronous fluorescence spectroscopy (SFS), FT-IR spectroscopy and molecular modeling methods. Also, the effect of these drugs on the catalytic activity of Tsn was determined. The fluorescence quenching experiments indicated that each drugs quenched the intrinsic fluorescence of Tsn with their increased concentrations. The results of SFS and UV-VIS spectra proved the interaction of dimenhydrinate and ondansetron with Tsn. FT-IR spectra showed that the secondary structure of enzyme was altered in the presence of the drugs. All these spectroscopy results were validated and explained by molecular docking studies. Both drugs have inhibition effect on the catalytic activity of Tsn and the IC50 values were determined as 2.6 × 10-4 M and 6.4 × 10-4 M for dimenhydrinate and ondansetron, respectively. Docking results revealed that the hydrogen bond interaction of dimenhydrinate with active-site residue Ser195 and ondansetron with active-site residues His57 and Ser195 hydrogen bonds might be cause the inhibition of enzyme activity. The results of this study can provide valuable information in the field of pharmacokinetics and pharmacodynamics.
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Affiliation(s)
- Selmihan Sahin
- Faculty of Arts and Sciences, Department of Chemistry, Suleyman Demirel University, Cunur, Isparta 32260, Turkey.
| | - Furkan Calapoglu
- Faculty of Arts and Sciences, Department of Chemistry, Suleyman Demirel University, Cunur, Isparta 32260, Turkey
| | - Sercan Ozbek Yazici
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Burdur Mehmet Akif Ersoy University, Istiklal Yerleskesi, Burdur 15100, Turkey
| | - Ismail Ozmen
- Faculty of Arts and Sciences, Department of Chemistry, Suleyman Demirel University, Cunur, Isparta 32260, Turkey
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Bahji A, Kasurak E, Sterling M, Good L. Misuse and dependence of dimenhydrinate: A mixed studies systematic review. J Psychiatr Res 2021; 136:581-8. [PMID: 33153760 DOI: 10.1016/j.jpsychires.2020.10.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 10/16/2020] [Accepted: 10/23/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Dimenhydrinate (DMH) is an antihistamine used to treat nausea and vomiting. Although widely available in pharmacies as an over the counter medication, there have been reports of potential DMH tolerance and dependence and a possible euphoric potential accompanying heavy use (>100 mg/day). Despite the potential for misuse, there is a gap in the literature concerning patterns, characteristics, and potential mechanisms of DMH misuse. AIMS This review aimed to synthesize evidence on the pharmacology, clinical effects, and management of DMH misuse and dependence to inform clinical decision making and relevant drug policy. METHODS We conducted a systematic review in accordance with the PRISMA guidelines and using Cochrane collaboration methods. We searched seven databases from their inception through July 2019. To be included in the review, studies needed to measure or focus on one or more dimensions of morbidity or mortality related to the misuse of DMH. Quantitative, qualitative and mixed-method studies were included in order to capture the breadth of possible studies. Studies were excluded if they did not fit into the conceptual framework of the study of if they focused primarily on the misuse of other substances. A narrative synthesis of study findings was pursued given the limited capacity for a quantitative meta-analysis. FINDINGS We identified 24 studies, which described a range of neuropsychiatric sequelae related to DMH consumption, including seizures, psychosis, depression, intoxication (resembling anticholinergic syndrome) and withdrawal. The sedative and euphoric properties, readily available nature, and low cost of DMH appear to facilitate DMH dependence, which were more commonly reported among individuals who had concurrent psychiatric disorders, displaying symptoms such as low motivation, poor concentration, and delirium. The overall quality of studies identified by this review was low-largely because the majority of studies were case reports or review articles, with few intervention or cohort studies. CONCLUSIONS There is some evidence to suggest the existence of DMH-related syndromes involving intoxication, withdrawal, and dependence, more commonly among long-term, heavy DMH consumers. However, higher quality studies are needed to confirm preliminary findings that there may be a biological basis for such syndromes.
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Ercin D, Erdur B, Turkcuer I, Seyit M, Ozen M, Yilmaz A, Zincir Ercin DO. Comparison of efficacy dimenhydrinate and metoclopramide in the treatment of nausea due to vertigo; a randomized study. Am J Emerg Med 2020; 40:77-82. [PMID: 33360021 DOI: 10.1016/j.ajem.2020.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 12/04/2020] [Accepted: 12/05/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND This study aimed to compare the therapeutic efficacy of dimenhydrinate and metoclopramide in patients with nausea and vertigo. METHODS A prospective, double-blind, randomized clinical trial was performed on patients who presented to the emergency department (ED) with nausea and vertigo in the six month period between Nov 1st 2012 and May 1st 2013. Adult patients who were 18 to 65 years old presenting to the ED with nausea and vertigo or motion sickness were included in the study. A total of 200 patients were divided into 2 groups who were admitted to ED with complaints of vertigo accompanied by nausea. In the first group, 50 mg dimenhydrinate and 10 mg metoclopramide infusions were given intravenously for 15 min. The efficacy of treatment was measured by using a 10 mm Visual Analog Scale (VAS) performed at 0, 15 and the 30th minute. The primary outcome variable was a reduction in vertigo intensity documented on the VAS at the 30th minute after medication administration. RESULTS A total of 200 patients were included in the randomization (n=100 in both groups). The baseline vertigo VAS scores were 7.57±1.42 in the dimenhydrinate (DMT) group and 7.27±1.40 in the metoclopramide (MTP) group (p=0.09). In the 30th minute of treatment, the average vertigo VAS score was 2.46 ± 2.39 in the DMT group and 2.31±1.96 in the MTP group; no significant differences were detected between groups. The baseline nausea VAS scores were 7.62±1.48 in the DMT group and 7.45±1.27 in the MTP group (p=0.36). In the 30th minute of treatment the average vertigo VAS score decreased to 2.27±2.24 in the DMT group and 2.70±2.48 in the MTP group, no significant differences were detected between groups. No significant differences were detected between nausea VAS changes and vertigo VAS changes at 30th minutes of the treatment (p=0.06, p=0.85 respectively). Rescue medication need was similar in both treatment groups (p=0.94). No significant differences were detected about the side effects which are sedation (p=0.56) and hypotension (p=0.57). CONCLUSIONS In conclusion, this prospective, double-blind, randomized study showed that both DMT and MTP have similar efficacy in reducing nausea and vertigo symptoms in the ED.
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Affiliation(s)
- Dogan Ercin
- Kafkas University Faculty of Medicine, Department of Emergency Medicine, Kars, Turkey.
| | - Bulent Erdur
- Pamukkale University Faculty of Medicine, Department of Emergency Medicine, Denizli, Turkey
| | - Ibrahim Turkcuer
- Pamukkale University Faculty of Medicine, Department of Emergency Medicine, Denizli, Turkey
| | - Murat Seyit
- Pamukkale University Faculty of Medicine, Department of Emergency Medicine, Denizli, Turkey
| | - Mert Ozen
- Pamukkale University Faculty of Medicine, Department of Emergency Medicine, Denizli, Turkey
| | - Atakan Yilmaz
- Pamukkale University Faculty of Medicine, Department of Emergency Medicine, Denizli, Turkey
| | - Dilek Ozge Zincir Ercin
- Kafkas University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Kars, Turkey
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Muhammad N, Ullah S, Abu-Izneid T, Rauf A, Shehzad O, Atif M, Khan H, Naz H, Herrera-Calderon O, Khalil AA, Uddin MS. The pharmacological basis of Cuscuta reflexa whole plant as an antiemetic agent in pigeons. Toxicol Rep 2020; 7:1305-1310. [PMID: 33024704 PMCID: PMC7529608 DOI: 10.1016/j.toxrep.2020.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 08/13/2020] [Accepted: 09/20/2020] [Indexed: 01/17/2023] Open
Abstract
Cuscuta reflexa has been traditionally used as an antiemetic. Additionally, it has been used in various herbal formulations for the treatment of emesis. So far, there is no scientific evidence of the plant extract as antiemetic. Therefore, this study was intended to assess the antiemetic activity of Juice (JCR), aqueous (CRAE) and methanolic extract (CRME) of C. reflexa in pigeons. Emesis was induced through GIT irritants like ampicillin (300 mg/kg, IM), copper sulphate (100 mg/kg, PO), conc. sodium chloride solution (1600 mg/kg, PO) and cisplatin (5-HT3 receptor stimulator) (6 mg/kg, IM). Dimenhydrinate acted as a positive control (2 mg/kg; IM). JCR [(1 ml/kg (1 %) and 1 ml/kg (2 %)], CRAE, and CRME were administered intramuscularly at different doses (50, 100 and 200 mg/kg) to each pigeon (n = 6). In each group, calculation of total number of jerks & vomiting episodes, and vomiting-weight was carried out to evaluate its antiemetic activity. The JCR exhibited a significant (p < 0.05) antiemetic impact on both the frequency and onset of emesis at 1 ml/kg (2 %) against various emesis mediator, except sodium chloride. Similarly, CRAE and CRME elicited marked dose dependent inhibition both on onset and frequency of emesis with highly significant (p < 0.001) effect at 200 mg/kg. The study reflects that juice, aqueous and methanolic extract of C. reflexa have significant antiemetic potential and possess pharmacological active constituent(s) that interfered with the emetic mediators by acting through GIT irritation and 5-HT3 receptor stimulations. Results of this study provide a scientific background to its traditional antiemetic uses.
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Affiliation(s)
- Naveed Muhammad
- Department of Pharmacy, Abdul Wali Khan University, Mardan, 23200, Pakistan
| | - Sana Ullah
- Department of Pharmacy, Abdul Wali Khan University, Mardan, 23200, Pakistan
| | - Tareq Abu-Izneid
- Pharmaceutical Sciences Department, College of Pharmacy, Al Ain University, Al Ain Campus, United Arab Emirates
| | - Abdur Rauf
- Department of Chemistry, University of Swabi, KPK, Pakistan
| | - Omer Shehzad
- Department of Pharmacy, Abdul Wali Khan University, Mardan, 23200, Pakistan
| | - Muhammad Atif
- Department of Pharmacy, Abdul Wali Khan University, Mardan, 23200, Pakistan
| | - Haroon Khan
- Department of Pharmacy, Abdul Wali Khan University, Mardan, 23200, Pakistan
| | - Humira Naz
- Shaheed Benazir Bhutto Women University Peshawar, KPK, Pakistan
| | - Oscar Herrera-Calderon
- Academic Department of Pharmacology, Bromatology and Toxicology, Faculty of Pharmacy and Biochemistry, Universidad Nacional Mayor de San Marcos, Jr Puno 1002, Lima 15001, Peru
| | - Anees Ahmed Khalil
- University Institute of Diet and Nutritional Sciences, Faculty of Allied Health Sciences, The University of Lahore, Pakistan
| | - Md Sahab Uddin
- Pharmakon Neuroscience Research Network, Dhaka, Bangladesh
- Department of Phramacy, Southeast University, Dhaka, Bangladesh
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Leichner C, Baus RA, Jelkmann M, Plautz M, Barthelmes J, Dünnhaupt S, Bernkop-Schnürch A. In vitro evaluation of a self-emulsifying drug delivery system (SEDDS) for nasal administration of dimenhydrinate. Drug Deliv Transl Res 2019; 9:945-55. [PMID: 30877627 DOI: 10.1007/s13346-019-00634-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The objective of the study was the development and in vitro characterization of a self-emulsifying drug delivery system (SEDDS) for the nasal application of dimenhydrinate. Final composition of SEDDS was established based on drug solubility and stability studies. Dimenhydrinate was loaded into the SEDDS pre-concentrates to 7.5% (m/v). The droplet size of the final SEDDS formulations was in a range between 60 and 220 nm. Permeability, as well as tissue toxicity, of the formulations was investigated using bovine nasal mucosa. Enhancement in permeation up to 2.8-fold compared to pure dimenhydrinate was confirmed. Furthermore, toxicity studies did not reveal any serious tissue damages related to the SEDDS. Additionally, irritation potential of SEDDS was evaluated in ciliary beat frequency measurements. Incorporation of dimenhydrinate into SEDDS might therefore be considered as a promising approach within the field of nasal delivery of antiemetics by utilizing permeation enhancement strategy.
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Jadhav YG, Galgatte UC, Chaudhari PD. Overcoming Poor Solubility of Dimenhydrinate: Development, Optimization and Evaluation of Fast Dissolving Oral Film. Adv Pharm Bull 2019; 8:721-725. [PMID: 30607345 PMCID: PMC6311638 DOI: 10.15171/apb.2018.081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 07/03/2018] [Accepted: 10/07/2018] [Indexed: 11/09/2022] Open
Abstract
Purpose: To develop fast dissolving oral film to address vomiting and nausea in pediatric population. Methods: Oral films of Dimenhydrinate were prepared by solvent casting method by using hydroxypropylmethyl cellulose E5 (HPMC E5), polyethylene glycol 400 (PEG 400) and croscarmellose sodium. Solubility of dimenhydrinate was enhanced by ethanol as a co-solvent. To make dimenhydrinate palatable sodium saccharin and peppermint oil were used. All films were evaluated for mechanical parameters, surface pH, morphology, disintegration time and percent dissolution. Results: Films were smooth, acceptable and white in colour. For optimized batch, drug content (99.106%), disintegration time (25 sec), dissolution (99.10% in 210 sec), surface pH (6.81) were acceptable. Conclusion: Optimized batch, due to its potential to deliver through fast dissolving film, can be developed for clinical use.
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Affiliation(s)
- Yuvraj Govindrao Jadhav
- Department of Pharmaceutics, Modern College of Pharmacy, Sector 21, Yamunanagar, Nigdi, Pune 411 044, Maharashtra, India
| | - Upendra Chandrakant Galgatte
- Department of Pharmaceutics, Modern College of Pharmacy, Sector 21, Yamunanagar, Nigdi, Pune 411 044, Maharashtra, India
| | - Pravin Digambar Chaudhari
- Department of Pharmaceutics, Modern College of Pharmacy, Sector 21, Yamunanagar, Nigdi, Pune 411 044, Maharashtra, India
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Aslani A, Ghasemi A, Karbasizadeh Esfahani S. Design, Formulation and Physicochemical Evaluation of Dimenhydrinate Orally Disintegrating Tablets. Galen Med J 2018; 7:e936. [PMID: 34466419 PMCID: PMC8343990 DOI: 10.22086/gmj.v0i0.936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/08/2017] [Accepted: 08/12/2017] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Design, formulation and physicochemical evaluation of dimenhydrinate 25 mg oral tablets that disintegrate in oral cavity in a proper time. This product is easy to use for babies, geriatrics and people who have difficulty in swallowing. MATERIALS AND METHODS 31 formulations were designed in 3 categories via Design-Expert software version 7. Group 1 consist of super-disintegrating bases, group 2 consist of effervescent bases and group 3 consist of super-disintegrating and effervescent bases together. Proposed by DesignExpert software, the optimum formulations were selected in each category and the tablets were produced by direct compression method. Tablets evaluated by friability, thickness, hardness, weight variation, drug content, content uniformity, disintegration time, wetting time, dissolution and moisture uptake tests. RESULTS The angle of repose and compressibility index of formulations were in the range of 24.65-29.08 and 5.02-9.01 % respectively. Thickness, hardness, wetting time, friability and content uniformity of formulations were in the range of 3.36-3.84 mm, 33.25-38.03 N, 19-37 seconds, 0.31-0.42 % and 96.44-99.02 % respectively. Disintegration time of the groups 1, 2 and 3 were in the range of 16-70, 47-72 and 12-35 seconds respectively. CONCLUSION Mixture of powders and orally dispersible tablets passed all tests. The results showed that formulations containing both of super-disintegrants and effervescent bases had better disintegration time compare to other formulations.
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Affiliation(s)
- Abolfazl Aslani
- 1Department of Pharmaceutics, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
,Correspondence to: Abolfazl Aslani, Department of Pharmaceutics, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran Telephone Number: +989132679663 Email Address:
| | - Alireza Ghasemi
- 1Department of Pharmaceutics, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shekofeh Karbasizadeh Esfahani
- 1Department of Pharmaceutics, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
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Kirtane MV, Bhandari A, Narang P, Santani R. Cinnarizine: A Contemporary Review. Indian J Otolaryngol Head Neck Surg 2019; 71:1060-8. [PMID: 31750127 DOI: 10.1007/s12070-017-1120-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 04/04/2017] [Indexed: 10/19/2022] Open
Abstract
Cinnarizine, is approved for nausea, vomiting, motion sickness, inner ear disorders and is considered as first-line pharmacotherapy for management of vertigo. It acts by anti-vasoconstrictor activity, reducing blood viscosity and reducing nystagmus in labyrinth. Lack of adequate literature on clinical evidence of cinnarizine and its combination (dimenhydrinate) in vertigo management prompted this review. A specific MEDLINE literature search strategy was designed combining Medical Subject Headings, free-text keywords (like cinnarizine and vertigo) using Boolean operators (1970-2016) for clinical studies, clinical reviews and meta-analyses of cinnarizine. Analyses of studies validated cinnarizine's efficacy in peripheral and central vertigo versus placebo or other therapies, and was well-tolerated by the patients recruited across different studies. Cinnarizine and/ or its combinations are favorable in management of vestibular disorders wherein cinnarizine acts predominantly peripherally on labyrinth and dimenhydrinate acts centrally on vestibular nuclei and associated centers in brainstem. Combination therapy of cinnarizine and/ or its combinations demonstrated a better safety profile than either of the mono-components, offering a viable therapeutic option in vertigo management.
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Tawakkol SM, El-Zeiny MB, Hemdan A. Full spectrum and selected spectrum based chemometric methods for the simultaneous determination of Cinnarizine and Dimenhydrinate in laboratory prepared mixtures and pharmaceutical dosage form. Spectrochim Acta A Mol Biomol Spectrosc 2017; 173:892-896. [PMID: 27837737 DOI: 10.1016/j.saa.2016.10.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 10/25/2016] [Accepted: 10/26/2016] [Indexed: 06/06/2023]
Abstract
Three chemometric methods namely, concentration residual augmented classical least squares (CRACLS), spectral residual augmented classical least squares (SRACLS) and partial least squares (PLS) were applied for the simultaneous quantitative determination of Cinnarizine and Dimenhydrinate in their binary mixtures. All techniques were applied with and without variable selection using genetic algorithm (GA) resulting in six models (CRACLS, GA-CRACLS, SRACLS, GA-SRACLS, PLS, GA-PLS). These models were applied for the simultaneous determination of the drugs in their laboratory prepared mixtures and pharmaceutical dosage form via handling their UV spectral data. It was found that GA based models are simpler and more robust than those built with the full spectral data. The proposed models were found to be simple, fast and require no preliminary separation steps; so they can be used for the routine analysis of this binary mixture in quality control laboratories.
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Affiliation(s)
- Shereen M Tawakkol
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Helwan University, Cairo, Egypt
| | - Mohamed B El-Zeiny
- Analytical Chemistry Department, Faculty of Pharmacy, Modern University for Technology and Information (MTI), 12582 Al Hadaba Al Wosta, Cairo, Egypt.
| | - A Hemdan
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Ahram Canadian University, 6th of October, Egypt
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Scholtz AW, Ilgner J, Loader B, Pritschow BW, Weisshaar G. Cinnarizine and dimenhydrinate in the treatment of vertigo in medical practice. Wien Klin Wochenschr 2016; 128:341-7. [PMID: 26659910 PMCID: PMC4875047 DOI: 10.1007/s00508-015-0905-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 11/18/2015] [Indexed: 11/06/2022]
Abstract
The efficacy and safety of the fixed combination of cinnarizine 20 mg and dimenhydrinate 40 mg in the treatment of vertigo of various origins have been investigated in a prospective, noninterventional study involving private practices throughout Germany. A total of 1275 patients with an average age of 61.2 years participated in the study. The vertigo symptoms, measured by a validated mean vertigo score (primary efficacy endpoint) improved by 61 % in the course of the observational period (median: 6 weeks). Concomitant symptoms frequently associated with vertigo such as nausea, vomiting and tinnitus were also markedly reduced by 84, 85 and 51 %, respectively. Overall efficacy has been rated by the physicians as 'very much improved' or 'much improved' in 95 % of the patients. A total of 47 patients (3.7 %) reported 51 adverse drug reactions (all nonserious). The results indicate a good tolerability and efficacy of the fixed combination of cinnarizine and dimenhydrinate in the treatment of vertigo in daily medical practice, which is in line with previous findings of numerous interventional, randomised, double-blind, controlled clinical trials.
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Affiliation(s)
- Arne-Wulf Scholtz
- Department of Otorhinolaryngology, Division of Neurotology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Justus Ilgner
- Department of Oto-Laryngology and Plastic Head and Neck Surgery, University Hospital Aachen, Aachen, Germany
| | - Benjamin Loader
- Department of Otorhinolaryngology, Head and Neck Surgery, Rudolfstiftung Tertiary Teaching Hospital, Vienna, Austria
| | - Bernd W Pritschow
- Medical Department, Hennig Arzneimittel, Floersheim am Main, Germany
| | - Gerhard Weisshaar
- Medical Department, Hennig Arzneimittel, Floersheim am Main, Germany
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Tal D, Shemy S, Kaminski-Graif G, Wiener G, Hershkovitz D. Vestibular evoked myogenic potentials and motion sickness medications. Clin Neurophysiol 2016; 127:2350-4. [PMID: 27178852 DOI: 10.1016/j.clinph.2016.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 03/03/2016] [Accepted: 03/07/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Seasickness is a widespread problem among naval crew, and has a major impact on their performance at sea. The three pharmacological agents most commonly employed in the treatment of seasickness are dimenhydrinate, cinnarizine, and scopolamine. At present, the effectiveness of anti-seasickness drugs is tested by a process of "trial and error", while sailing and exposed to sea conditions. A physiological test to evaluate the action of a drug might save crew members long periods of suffering, as well as simplifying the procedure of selecting the appropriate treatment for each individual. The cervical vestibular evoked myogenic potentials (cVEMP) test has come to be recognized as a reliable procedure for the objective evaluation of saccular function. It was the hypothesis of the present study that cVEMP otolith responses may be affected by anti-motion sickness drugs, which might thus make cVEMP a useful clinical neurophysiological tool for the assessment of drug absorption and efficacy. METHODS Thirty male sailors who regularly took medication for the treatment of seasickness participated in the study. Participants underwent the cVEMP test pre- and 1h post-drug administration. RESULTS A statistically significant decrease in p13 latency was found after administration of scopolamine compared with baseline (14.46ms vs. 15.09ms, p=0.0049), with significant prolongation of the binaural average inter-latency in this group. No differences were found in the dimenhydrinate and cinnarizine study groups. CONCLUSIONS This study demonstrated that scopolamine absorption can be verified by changes in cVEMP latencies. SIGNIFICANCE The potential of the cVEMP test for predicting action of scopolamine on the vestibular system.
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Affiliation(s)
- Dror Tal
- Motion Sickness and Human Performance Laboratory, Israel Naval Medical Institute, Israel Defense Forces Medical Corps, Haifa, Israel.
| | - Shir Shemy
- Motion Sickness and Human Performance Laboratory, Israel Naval Medical Institute, Israel Defense Forces Medical Corps, Haifa, Israel
| | - Gil Kaminski-Graif
- Motion Sickness and Human Performance Laboratory, Israel Naval Medical Institute, Israel Defense Forces Medical Corps, Haifa, Israel
| | - Guy Wiener
- Motion Sickness and Human Performance Laboratory, Israel Naval Medical Institute, Israel Defense Forces Medical Corps, Haifa, Israel
| | - Dov Hershkovitz
- Motion Sickness and Human Performance Laboratory, Israel Naval Medical Institute, Israel Defense Forces Medical Corps, Haifa, Israel
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Belal TS, Abdel-Hay KM, Clark CR. Selective determination of dimenhydrinate in presence of six of its related substances and potential impurities using a direct GC/MS method. J Adv Res 2016; 7:53-8. [PMID: 26843970 PMCID: PMC4703418 DOI: 10.1016/j.jare.2015.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 01/28/2015] [Accepted: 01/29/2015] [Indexed: 11/19/2022] Open
Abstract
A novel simple, direct and selective gas chromatography–mass spectrometry (GC/MS) procedure was developed for the determination of the antihistamine drug dimenhydrinate (DMH) in presence of six of its related substances and potential impurities, namely, diphenylmethane, diphenylmethanol, benzophenone, orphenadrine, caffeine and 8-chlorocaffeine. The method involved resolution of the underivatized compounds using a trifluoropropylmethyl polysiloxane (Rtx-200) capillary column and the mass spectrometric detection was carried out in the electron-impact (EI) mode. Excellent baseline separation of DMH and the cited related substances was achieved in less than 15 min. Quantification of the parent drug DMH was based on measuring its peak area. The reliability and analytical performance of the proposed method were validated with respect to linearity, range, precision, accuracy, specificity, robustness, detection and quantification limits. Calibration curve of DMH was linear over the range 50–500 μg/mL with determination coefficient (R2) = 0.9982. The proposed method was successfully applied for the assay of DMH in tablets dosage form with recoveries >96.80%.
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Affiliation(s)
- Tarek S. Belal
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, University of Alexandria, Alexandria 21521, Egypt
- Corresponding author. Tel.: +20 3 4871351; fax: +20 3 4873273, +20 3 4871668.
| | - Karim M. Abdel-Hay
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, University of Alexandria, Alexandria 21521, Egypt
- Department of Drug Discovery and Development, Harrison School of Pharmacy, Auburn University, Auburn, AL 36849, USA
| | - C. Randall Clark
- Department of Drug Discovery and Development, Harrison School of Pharmacy, Auburn University, Auburn, AL 36849, USA
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Abstract
OBJECTIVES One of the major causes of mortality in children is acute gastroenteritis. Vomiting is common in early stages of the disease. The aim of this study was to determine the effect of oral dimenhydrinate (DH) in the control of vomiting in cases of acute gastroenteritis in children. METHODS This double-blind, randomized, clinical trial was conducted in a university-affiliated hospital in a western province of Iran. Two hundred children aged one to 12 years old were randomly assigned to either drug or placebo groups. Children in the drug group received oral DH as four doses of 1 mg/kg every six hours (maximum 200 mg), and children in the placebo group received a placebo drug. The patients variables were compared 24 hours after receiving the first dose and at seven and 14 days after discharge. RESULTS The mean number of episodes of vomiting was 4.4±2.5 in the drug group versus 4.4±2.1 in the placebo group, which was not statistically significant (p<0.050). The mean number of episodes of diarrhea was 7.4±3.2 and 10.1±2.8 in the drug and placebo groups, respectively, (p<0.050). The duration of diarrhea, side effects, need to revisit, and parent's satisfaction in both groups were also significantly different (p>0.050). CONCLUSIONS Oral DH in children with acute gastroenteritis does not reduce the number and duration of vomiting. However, our results showed that consumption of DH in acute gastroenteritis patients was effective in reducing the frequency and duration of diarrhea and further investigation into this is warranted.
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Affiliation(s)
- Simin Gheini
- Department of Pediatrics, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Somaieh Ameli
- Department of Pediatrics, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Jamal Hoseini
- Department of Biostatistics and Epidemiology, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Lamie NT, Yehia AM. Development of normalized spectra manipulating spectrophotometric methods for simultaneous determination of Dimenhydrinate and Cinnarizine binary mixture. Spectrochim Acta A Mol Biomol Spectrosc 2015; 150:142-150. [PMID: 26037499 DOI: 10.1016/j.saa.2015.05.048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/18/2015] [Accepted: 05/19/2015] [Indexed: 06/04/2023]
Abstract
Simultaneous determination of Dimenhydrinate (DIM) and Cinnarizine (CIN) binary mixture with simple procedures were applied. Three ratio manipulating spectrophotometric methods were proposed. Normalized spectrum was utilized as a divisor for simultaneous determination of both drugs with minimum manipulation steps. The proposed methods were simultaneous constant center (SCC), simultaneous derivative ratio spectrophotometry (S(1)DD) and ratio H-point standard addition method (RHPSAM). Peak amplitudes at isoabsorptive point in ratio spectra were measured for determination of total concentrations of DIM and CIN. For subsequent determination of DIM concentration, difference between peak amplitudes at 250 nm and 267 nm were used in SCC. While the peak amplitude at 275 nm of the first derivative ratio spectra were used in S(1)DD; then subtraction of DIM concentration from the total one provided the CIN concentration. The last RHPSAM was a dual wavelength method in which two calibrations were plotted at 220 nm and 230 nm. The coordinates of intersection point between the two calibration lines were corresponding to DIM and CIN concentrations. The proposed methods were successfully applied for combined dosage form analysis, Moreover statistical comparison between the proposed and reported spectrophotometric methods was applied.
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Affiliation(s)
- Nesrine T Lamie
- Analytical Chemistry Department, Faculty of Pharmacy, Cairo University, El-Kasr El-Aini Street, 11562 Cairo, Egypt
| | - Ali M Yehia
- Analytical Chemistry Department, Faculty of Pharmacy, Cairo University, El-Kasr El-Aini Street, 11562 Cairo, Egypt.
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Hüseyinoğlu Ü, Ülker K. Preoperative Use of 10-mg Metoclopramide and 50-mg Dimenhydrinate in the Prophylaxis of Postoperative Nausea and Vomiting in Elective Caesarean Births: A Prospective Randomized Clinical Study. J Obstet Gynaecol India 2015; 66:252-8. [PMID: 27382219 DOI: 10.1007/s13224-015-0679-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 02/16/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess the efficacy and outcomes of preoperative prophylactic metoclopramide and dimenhydrinate use in elective cesarean births. METHODS Participants (n = 84) scheduled for elective cesarean births were randomized equally into placebo (10 cc 0.9 % NaCl), 10-mg metoclopramide or 50-mg dimenhydrinate groups. Oral alimentation was prohibited 8 h before the surgery; however, patients continued drinking water until 4 h before surgery. Placebo and antiemetics were administered 1 h before the anticipated procedure in a 5-ml syringe. In metoclopramide and dimenhydrinate group, an ampoule of the agents was completed to 5 ml by adding 0.9 % NaCl. In the control group 5 ml of 0.9 % NaCl was used. All prophylactic agents were administered intramuscularly. All patients received a general anesthesia. The placebo group (control group) was compared with the metoclopramide and dimenhydrinate groups. RESULTS Demographic data including maternal age, height, weight, body mass index, gravidity, parity, miscarriage, induced abortion, the number of offspring, and the medical history did not show significant differences among the three groups. Postoperative nausea, vomiting, and the use of rescue medication ratios were significantly lower in metoclopramide and dimenhydrinate groups compared with the placebo group (p < 0.05); however, the difference between the metoclopramide and dimenhydrinate groups was not significant (p > 0.05). CONCLUSION Dimenhydrinate and metoclopramide significantly decrease postoperative nausea, vomiting, and the need for rescue antiemetic medication. Both agents have similar efficacy and may be used as an alternative to each other.
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Affiliation(s)
- Ürfettin Hüseyinoğlu
- Department of Anesthesia and Reanimation, Kafkas University School of Medicine, 36200 Kars, Turkey
| | - Kahraman Ülker
- Istanbul Memorial Hospital, Okmeydanı, Şişli, 3483 Istanbul, Turkey
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Lamie NT. Comparative study of spectrophotometric methods manipulating ratio spectra: an application on pharmaceutical binary mixture of cinnarizine and dimenhydrinate. Spectrochim Acta A Mol Biomol Spectrosc 2015; 141:193-201. [PMID: 25677532 DOI: 10.1016/j.saa.2015.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 01/11/2015] [Accepted: 01/18/2015] [Indexed: 06/04/2023]
Abstract
Four simple, specific, accurate and precise spectrophotometric methods are developed and validated for simultaneous determination of cinnarizine (CIN) and dimenhydrinate (DIM) in a binary mixture with overlapping spectra, without preliminary separation. The first method is dual wavelength spectrophotometry (DW), the second is a ratio difference spectrophotometric one (RD) which measures the difference in amplitudes between 250 and 270 nm of ratio spectrum, the third one is novel constant center spectrophotometric method (CC) and the fourth method is mean centering of ratio spectra (MCR). The calibration curve is linear over the concentration range of 4-20 and 10-45 μg/ml for CIN and DIM, respectively. These methods are tested by analyzing synthetic mixtures of the above drugs and they are applied to commercial pharmaceutical preparation of the subjected drugs. The validity of results was assessed by applying standard addition technique. The results obtained were found to agree statistically with those obtained by a reported method, showing no significant difference with respect to accuracy and precision.
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Affiliation(s)
- Nesrine T Lamie
- Cairo University, Faculty of Pharmacy, Department of Analytical Chemistry, Kasr El-Aini Street, ET 11562 Cairo, Egypt.
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Babaei AH, Foghaha MH. A randomized comparison of vitamin B6 and dimenhydrinate in the treatment of nausea and vomiting in early pregnancy. Iran J Nurs Midwifery Res 2014; 19:199-202. [PMID: 24834091 PMCID: PMC4020031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Nausea and vomiting are the common symptoms of early pregnancy. Without treatment, vomiting can complicate the pregnancy, so it must be reduced. Wide varieties of treatment have been used for nausea and vomiting in pregnancy. This study compared the effectiveness of vitamin B6 and dimenhydrinate for gestational nausea and vomiting. MATERIALS AND METHODS One hundred and forty pregnant women with a gestational age of <16 weeks who had symptoms of nausea and vomiting were selected. They were randomly allocated into group A (n = 70) and group B (n = 70). The patients in group A received a vitamin B6 tablet, while the patients in group B received a dimenhydrinate tablet daily; the tablets were identical in appearance. The degree of nausea and vomiting was assessed by physical symptoms of Rhodes score. RESULTS One hundred and thirty-five women returned to follow-up. Dimenhydrinate and vitamin B6 significantly reduced nausea and vomiting scores from 8.3 (7.4) to 2.8 (2.0) and from 8.6 (2.9) to 3.8 (2.3), respectively. The mean score change after treatment with dimenhydrinate was greater than with vitamin B6. CONCLUSION Both dimenhydrinate and vitamin B6 were effective in the treatment of nausea and vomiting in early pregnancy. Dimenhydrinate was more effective than vitamin B6.
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Affiliation(s)
- Amir Hossein Babaei
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahboube Haji Foghaha
- Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran,Address for correspondence: Ms. Mahboube Haji Foghaha, Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran. E-mail:
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