THERAPEUTICS

Brands

• Antivert, Bonine

Generic?

• Yes

Class

• Antiemetic

Commonly Prescribed for

(FDA approved in bold)

• Motion sickness

• Vertigo

How the Drug Works

• Antihistamine and anticholinergic drug

How Long Until It Works

• 30 minutes

If It Works

• Continue to use as needed, especially in shortterm disorders, such as viral labyrinthitis

If It Doesn't Work

• Treat the underlying disorder with appropriate agents for that disorder

• Benzodiazepines (Valium) may be effective for vertigo; antiemetics, such as promethazine, help also treat motion sickness

Best Augmenting Combos for Partial Response or Treatment-Resistance

• Benzodiazepines (Valium) may be effective for vertigo

• Meniere's disease: diuretics, antiemetics, and low-salt diet

• Vestibular rehabilitation may be helpful

Tests

• None

ADVERSE EFFECTS (AEs)

How the Drug Causes AEs

• Antihistamine and anticholinergic actions

Notable AEs

• Dry mouth, sedation are most common

• Paradoxical excitation (nervousness, agitation), blurred vision, rash, tinnitus

• Hypotension, tachycardia

Life-Threatening or Dangerous AEs

• May precipitate narrow-angle glaucoma

• Risk of heat stroke, especially in elderly patients

• Can precipitate tachycardia, cardiac arrhythmias, and hypotension

• May cause urinary retention in patients with prostate hypertrophy

Weight Gain

• Common

Sedation

• Common

What to Do About AEs

• Sedation: give at night or lower dose

• Dry mouth: chewing gum or water

Best Augmenting Agents to Reduce AEs

• Most AEs cannot be reduced with the use of an augmenting agent

DOSING AND USE

Usual Dosage Range

• Vertigo: 25–100mg/day

Dosage Forms

• Tablets: 12.5, 25, 50mg

• Chewable: 25mg

• Capsules: 25mg

How to Dose

• Motion sickness: 25–50mg 1 hour before travel

• Vertigo: 25–50mg 2–3 times daily (maximum 100mg/day)

Dosing Tips

• Taking with meals may reduce AEs

Overdose

• Large overdoses may cause convulsions, hallucinations, or respiratory depression

Long-Term Use

• Unknown, usually a short-term medication

Habit Forming

• No

How to Stop

• No need to taper