1. Introduction
Cinnarizine is an antihistamine and calcium channel blocker primarily used to treat balance disorders and motion sickness. It works by reducing abnormal vestibular activity in the inner ear and improving blood flow, making it effective in conditions such as vertigo, tinnitus, Ménière’s disease, and nausea associated with motion sickness.
2. Indications
- Approved Indications:
- Motion sickness.
- Vertigo and dizziness associated with vestibular disorders.
- Ménière’s disease.
- Nausea and vomiting due to balance disorders.
- Tinnitus associated with inner ear conditions.
- Off-Label Uses:
- Peripheral vascular disorders (e.g., Raynaud’s phenomenon, intermittent claudication).
3. Dosage
- For Motion Sickness:
- Adults: 30 mg taken 2 hours before travel, then 15 mg every 8 hours as needed.
- Children (5–12 years): 15 mg taken 2 hours before travel, then 7.5 mg every 8 hours as needed.
- For Vertigo and Balance Disorders:
- Adults: 30 mg 3 times daily.
- Children (5–12 years): 15 mg 3 times daily.
- Maximum Dose:
- Adults: 90 mg/day.
- Children: 45 mg/day.
4. Administration
- Take orally after meals to minimise gastrointestinal discomfort.
- Swallow tablets whole with water.
5. Forms Available
- Tablets: 15 mg, 25 mg.
6. Side Effects
6.1. Common Side Effects
- Drowsiness or sedation.
- Dry mouth.
- Gastrointestinal discomfort (nausea or stomach pain).
6.2. Less Common Side Effects
- Weight gain (with long-term use).
- Headache.
6.3. Rare but Serious Side Effects
- Extrapyramidal symptoms (e.g., tremors, muscle stiffness).
- Jaundice (indicating potential liver toxicity).
7. Warnings
- May cause sedation; avoid driving or operating heavy machinery until the effect is known.
- Avoid in patients with a history of Parkinson’s disease due to the risk of worsening symptoms.
8. Precautions
- Use cautiously in elderly patients, as they may be more prone to sedation and extrapyramidal side effects.
- Avoid alcohol and other sedatives, as they may enhance drowsiness.
- Long-term use may lead to weight gain or extrapyramidal symptoms; monitor accordingly.
9. Interactions
- Drug-Drug Interactions:
- CNS depressants (e.g., benzodiazepines, opioids): Increased risk of sedation.
- Alcohol: Enhances sedative effects.
- Anticholinergic drugs: May increase the risk of dry mouth and drowsiness.
- Drug-Food Interactions:
- No significant interactions, but taking after food reduces stomach upset.
10. Monitoring Parameters
- Symptom relief in vertigo, motion sickness, or balance disorders.
- Signs of sedation or excessive drowsiness.
- Watch for signs of extrapyramidal symptoms, particularly in long-term use.
11. Use in Children
- Approved for use in children over 5 years for motion sickness and balance disorders.
- Dosage should be adjusted based on age and weight.
12. Use in Pregnancy
- Category C: Not enough data available; use only if the potential benefit outweighs the risks.
- Avoid use in the first trimester unless absolutely necessary.
13. Use in Elderly
- Use with caution, as elderly patients may be more prone to sedation, extrapyramidal symptoms, and other side effects.
- Consider starting with the lowest effective dose.
14. Use in Kidney Disease
- No specific dose adjustments required, as cinnarizine is metabolised by the liver.
15. Use in Liver Disease
- Use cautiously in severe liver disease, as the drug is extensively metabolised by the liver.
16. Patient Counselling Points
- Inform patients that drowsiness is a common side effect; avoid driving or operating machinery if affected.
- Take cinnarizine after meals to reduce stomach discomfort.
- Avoid alcohol and sedative medications while on cinnarizine to minimise sedation.
- Advise patients to seek medical advice if they experience unusual symptoms like tremors, jaundice, or severe drowsiness.
- For motion sickness, take the initial dose 2 hours before travel for maximum efficacy.
17. Table of Brand Names, Manufacturers, and Prices
Brand Name | Manufacturer | Price (USD) |
---|---|---|
Stugeron | Johnson & Johnson | $5–10 (30 tablets, 25 mg) |
Cinnarizine | Various Generic Options | $3–8 (30 tablets, 25 mg) |
18. FAQs (15 Questions)
- What is cinnarizine used for?
It is used to treat motion sickness, vertigo, Ménière’s disease, and other balance disorders. - How does cinnarizine work?
It blocks histamine and calcium channels, reducing abnormal inner ear activity and improving blood flow. - Can cinnarizine cause drowsiness?
Yes, drowsiness is a common side effect. - Is cinnarizine safe for children?
Yes, it is safe for children over 5 years when used at appropriate doses. - Can cinnarizine be used during pregnancy?
It should only be used if the potential benefits outweigh the risks, especially in the first trimester. - What are the common side effects of cinnarizine?
Drowsiness, dry mouth, and nausea. - How should cinnarizine be taken?
It should be taken orally after meals to minimise stomach upset. - Can cinnarizine cause weight gain?
Long-term use may lead to weight gain in some individuals. - What should I do if I miss a dose?
Take it as soon as you remember, but skip it if it’s close to the next dose. Do not double up. - Does cinnarizine interact with other medications?
Yes, it interacts with sedatives, alcohol, and anticholinergic drugs. - How long does cinnarizine take to work?
It usually takes effect within 1–2 hours. - Can cinnarizine worsen Parkinson’s disease?
Yes, it can worsen symptoms and should be avoided in such patients. - How should cinnarizine be stored?
Store at room temperature, away from light and moisture. - Is cinnarizine available over the counter?
In some countries, cinnarizine can be purchased without a prescription for motion sickness. - Can cinnarizine treat nausea from causes other than motion sickness?
Yes, it can help with nausea caused by inner ear disorders or vertigo.