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Published online by Cambridge University Press: 06 October 2020
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
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