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Nutritional and Dietary Supplementation during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Piperazine derivatives (cyclizine, buclizine, meclizine) are used for their antiemetic and antihistamine properties. The frequency of congenital anomalies was not increased with exposure to cyclizine or meclizine during the first trimester in the Collaborative Perinatal Project in more than 1,000 infants (Heinonen et al., 1977). Among 111 infants whose mothers took cyclizine in the first trimester, no increase in congenital anomalies was found (Milkovich and van den Berg, 1977). More detailed discussion of these agents is given in Chapter 11. No studies have been published on buclizine during pregnancy. The Swedish Birth Defects Registry reported no increased frequency of birth defects among 1,408 and 62 infants born to women who used meclizine and cyclizine, respectively, during organogenesis (Kallen, 2019).
Emesis
Published in Michael JG Farthing, Anne B Ballinger, Drug Therapy for Gastrointestinal and Liver Diseases, 2019
Gareth J Sanger, Paul LR Andrews
Histamine H1 receptor antagonists are used to treat nausea and vomiting using established, proven doses mostly by antagonism at histamine H1 receptors in vestibular and brainstem nuclei. Other non-selective activities exert additional anti-emetic, therapeutic, side-effect activities. Can cause drowsiness (affects performance of skilled tasks such as driving; enhances effects of alcohol) and antimuscarinic side-effects (dry mouth, blurred vision); cyclizine or cinnarizine are associated with slightly less sedation.
Drug Therapy in Otology
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
The antihistamines are competitive antagonists of histamine at H1-receptors, and their main action is on the vomiting centre rather than on the chemoreceptor trigger zone. They have weak anticholinergic effects and may occasionally produce a dry mouth and blurred vision. Drowsiness, occasional insomnia and euphoria are side effects that have been reported. These central effects are accentuated with alcohol. Cinnarazine (Stugeron®) and cyclizine (Valoid®) are less sedating than promethazine teoclate (Avomine®). Cinnarizine has been used in the prophylaxis and treatment of Menière’s at a dosage of 30 mg three times a day. Cyclizine may be given in the acute attack orally or parentally at a dosage of 50 mg three times a day.
Repeated poisonings in Denmark – a nationwide study
Published in Clinical Toxicology, 2023
Thomas Leth Jensen, Matilde Tejlbo Frost, Kim Dalhoff, Tonny Studsgaard Petersen
In 2010, the Global Allergy and Asthma European Network (GA2LEN) assessed the use of first generation antihistamines, including cyclizine. They did not support the status of first generation antihistamines as over the counter medications, especially since safer alternatives, non-sedating antihistamines, are available [19]. Since 2012, there has been an increased awareness of the use of the first generation antihistamine promethazine in Denmark, and data from the Danish Poison Information Centre showed an increase in the numbers of enquiries regarding promethazine. Therefore, the legal status of promethazine was changed from an over the counter medication to a prescription only medication during the study period in 2014 [20]. Even though promethazine is now classified as a prescription only medication in Denmark, the analogue first generation antihistamine cyclizine is still available in Denmark as an over the counter medication. In January 2018, the Danish Medicines Agency imposed new rules to regulate sales of cyclizine over the counter, and in April of 2022 they reduced the allowed number of doses in packages sold over the counter to 10 [21,22]. The indications for which first generation antihistamines can be used (e.g., insomnia, motion sickness), are rarely acute problems. Patients needing first generation antihistamines for these indications can obtain a prescription from their doctor, and safer alternatives for treating allergic reactions are widely available. Thereby, a doctor can evaluate if the patient is at risk of poisoning themselves (e.g., has risk factors shown in our study such as being a young female and having psychiatric comorbidities). Based on our findings, it would be advisable to change the status of cyclizine from an over the counter medication to a prescription only medication like the analogue first generation antihistamine promethazine.
Otosclerosis and stapedotomy: hearing improvement, complications, and analysis of potential prognostic factors in a series of 93 cases
Published in Acta Oto-Laryngologica, 2023
Charlotte Wedel, Niels H. Holm, Frank Mirz, Therese Ovesen
Vertigo/dizziness was the most common symptom after stapedotomy. However, this group compiles both patients with actual objective vertigo and those with subjective symptoms of dizziness or unsteadiness. In 23 out of 33 primary surgery patients, a pattern was observed with vague and uncharacteristic subjective symptoms, accompanied by the absence of objective findings. As a result, a predominantly conservative approach was pursued. The objective examination primarily involved assessing for nystagmus. Nystagmus was identified in only one case. Consequently, this patient was administered oral steroids. Additionally, three patients were prescribed cyclizine on an as-needed basis for a period of two to three days following their surgery. Generally, vertigo/dizziness was common during the first two weeks after surgery and then subsided. On two occasions, patients described symptoms at early follow-up that strongly indicated benign paroxysmal positional vertigo (BPPV). However, the symptoms were transient, and no objective symptoms were found during the follow-up assessment. Magliulo et al. found BPPV to be present in 8.5% of cases after stapedotomy [17]. Their study, though, was prospective and searched specifically for cases of BPPV after stapedotomy. It is likely that more of our patients could have suffered from BPPV. An assumption could be, that if symptoms are insignificant and self-limiting patients might have more vague descriptions of the symptoms months after surgery. To properly evaluate for vestibular pathology, a more comprehensive objective examination of the vestibular system ought to have been conducted. Nevertheless, in a clinical setting, the cost and benefits of additional examinations should also be considered in relation to the extent and severity of the patient’s symptoms. Therefore, we contend that a conservative approach is justifiable in cases where symptoms are mild and atypical for vestibular system pathology.