| Drug |
Dosage |
Remarks |
Acetyl-dl-leucine
(Acetylleucine) |
1.5-2 g PO 8-12 hourly x 10 days up to 5-6 weeks
Max dose: 3-4 g/day |
Adverse Reactions
Special Instructions
- Taken preferably with meals
- Avoid in pregnant and lactating patients and those with hypersensitivity to its components
|
| Betahistine |
6-12 mg PO 8 hourly or
16 mg PO 8 hourly or
24 mg PO 12 hourly
Maintenance dose: 24-48 mg/day
Max dose: 48 mg/day |
Adverse Reactions
- GI effects (dyspepsia, nausea); Dermatologic effects (rashes, pruritus); CNS effect (headache)
Special Instructions
- Should be taken after meals
- Avoid in patients with pheochromocytoma
- Use with caution in patients with asthma and peptic ulcer disease
|
| Cinnarizine |
25-50 mg PO 8 hourly or
75-150 mg PO 24 hourly |
Adverse Reactions
- CNS effects (extrapyramidal symptoms, slight drowsiness to deep sleep, headache, psychomotor impairment); Antimuscarinic effects (dry mouth, thickened respiratory tract secretions, blurred vision, urinary difficulty or retention, constipation, increased gastric reflux)
Special Instructions
- Use with caution in patients with hypotension, angle-closure glaucoma, urinary retention, prostatic hyperplasia or pyloroduodenal obstruction
|
Difenidol
(Diphenidol) |
25-50 mg PO 8 hourly |
Adverse Reactions
- Antimuscarinic effects (dry mouth, mydriasis); Dermatologic effects (rashes, hives); Other effects (heartburn, palpitations)
Special Instructions
- Contraindicated in patients with renal failure
- Use with caution in patients with angle-closure glaucoma, GIT obstructive lesions, sinus tachycardia
|
| Dimenhydrinate |
50-100 mg PO 6-8 hourly
Max dose: 300 mg/day |
Adverse Reactions
- CNS effect (sedation); GI effects (dry mouth, constipation, GI disturbance); Respiratory effect (thickened respiratory tract secretions); CV effects (chest tightness, bradycardia, tachycardia, arrhythmias, blood dyscrasias); Ophthalmologic effect (blurred vision); GU effect (urinary retention)
Special Instructions
- Use with caution in patients with angle-closure glaucoma, urinary retention, prostatic hyperplasia and epilepsy
|
| Diphenhydramine |
25-50 mg PO 4-6 hourly as needed or 25-50 mg deep IM/IV injection 6 hourly as needed
Max dose:
300 mg/day PO or
400 mg/day IM/IV |
Adverse Reactions
- CNS effects (slight drowsiness to deep sleep, lassitude, dizziness, incoordination, headache, psychomotor impairment); Antimuscarinic effects (dry mouth, constipation, increased gastric reflux, thickened respiratory tract secretions, blurred vision, urinary retention); Dermatologic effects (hypersensitivity reactions, rashes); GI effects (nausea/vomiting, diarrhea); CV effects (palpitations, tachycardia, extrasystoles)
Special Instructions
- Contraindicated in porphyric patients and pregnancy, respiratory diseases (asthmatic attack, pulmonary emphysema), glaucoma
- Avoid use of drugs interfering with hepatic metabolism or increase the risk of arrhythmias and in patients with cardiac disease, known or suspected prolongation of QT interval, hypokalemia or other electrolyte imbalance
- Use with caution in patients with epilepsy and hepatic impairment
- Avoid driving or operating machinery
|
| Flunarizine |
<65 years old: 5 mg PO 24 hourly
>65 years old: 10 mg PO 24 hourly |
Adverse Reactions
- CNS effects (slight drowsiness to deep sleep, headache, psychomotor impairment, extrapyramidal symptoms); Antimuscarinic effects (dry mouth, thickened respiratory tract secretions, blurred vision, urinary difficulty or retention, constipation, increased gastric reflux); Other effect (weight gain)
Special Instructions
- Should not be given to patients for >2 months old
- Use with caution in patients with angle-closure glaucoma, urinary retention, prostatic hyperplasia or pyloroduodenal obstruction, Parkinson’s disease
|
Meclozine1
(Meclizine) |
25-100 mg PO daily in divided doses |
Adverse Reactions
- CNS effects (drowsiness, headache, dizziness, nervousness, fatigue); Respiratory effects (thickening of the bronchial secretions, pharyngitis); GI effects (increased appetite, nausea, diarrhea, abdominal pain, xerostomia); Other effect (weight gain)
Special Instructions
- If vertigo does not respond after 2 weeks, discontinue use
- Use with caution in patients with difficulty breathing, prostate gland enlargement, glaucoma, hepatic or renal impairment
|
| Prochlorperazine |
5-10 mg PO 6-8 hourly
Max dose: 30 mg/day |
Adverse Reactions
- CNS effects (extrapyramidal effect, severe dystonia in children and adolescents); GI effects (nausea/vomiting, mouth and lip soreness and ulceration); CV effects (hypotension, hypertension, arrhythmias); Cholinergic effects (constipation, xerostomia, blurred vision, urinary retention)
Special Instructions
- Use with caution in patients with GI motility problems, urinary retention, benign prostatic hyperplasia, cerebrovascular and CV diseases, Parkinson’s disease, pheochromocytoma, myasthenia gravis, history of seizures
|
| Promethazine |
20 mg PO 24 hourly at night
May be increased to 50 mg or 75 mg PO 24 hourly at night
Max dose: 100 mg/day |
Adverse Reactions
- CNS effects (slight drowsiness to deep sleep, headache, psychomotor impairment); Antimuscarinic effects (dry mouth, thickened respiratory tract secretions, blurred vision, urinary difficulty or retention, constipation, increased gastric reflux)
Special Instructions
- Patient should not drive or operate machinery
- Should not be used in neonates and young children
- Use with caution in patients with angle-closure glaucoma, urinary retention, prostatic hyperplasia or pyloroduodenal obstruction
- Contraindicated in patients with CNS depression, coma, and taking MAOI therapy within 14 days
|
| Trimetazidine |
Adjuvant symptomatic treatment:
35 mg PO 12 hourly or
40-60 mg/day PO in divided doses |
Adverse Reactions
- GI effects (gastralgia, dyspepsia, diarrhea, constipation, nausea/vomiting); CNS effects (parkinsonian symptoms eg tremor, akinesia, hypertonia; asthenia, headache, insomnia, drowsiness, somnolence, gait instability, restless leg syndrome, other related movement disorders); Dermatologic effects (rash, pruritus, urticaria, angioedema, Quincke’s edema, acute generalized exanthematous pustulosis; thrombocytopenic purpura); CV effects (palpitations, extrasystoles, tachycardia, arterial hypotension, orthostatic hypotension that may be associated with malaise, dizziness or fall particularly in patients taking antihypertensives, flushing); Hematologic effects (agranulocytosis, thrombocytopenia); Other effects (vertigo, hepatitis)
Special Instructions
- Should be taken after meals
- Assess benefit of treatment after 3 months and discontinue if there is no treatment response
- Contraindicated in patients with Parkinson’s disease, parkinsonian symptoms, tremors, restless leg syndrome, other related movement disorders, severe renal impairment
- Use with caution in patients with moderate renal impairment and elderly patients >75 years old
|
| Combination Product |
Cinnarizine/
Dimenhydrinate |
Cinnarizine 20 mg/
Dimenhydrinate 40 mg tab:
1 tab PO 8 hourly |
Adverse Reactions
- CNS effects (somnolence, headache, drowsiness, tiredness, fatigue, daze); GI effects (dry mouth, abdominal pain)
Special Instructions
- Use with caution in patients with hypotension, Parkinson’s disease and conditions that may be aggravated by anticholinergic therapy
|
| 1Combination with Pyridoxine is available. Please see the latest MIMS for specific formulations and prescribing information. |
