HRIDAYAMRITH Price

Overview

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This medicine contains an important and useful components, as it consists of
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Name

Cinnarizine + Dimenhydrinate

Precaution

Cinnarizine and Dimenhydrinate are both first-generation antihistamines, and when used together, they can enhance the sedative and anticholinergic effects of each other. Patients should be advised to avoid activities that require full mental alertness, such as driving or operating machinery, while taking this combination. Both medications can cause drowsiness, dizziness, and blurred vision, which can impair motor coordination. Special caution should be exercised in elderly patients, as they may be more prone to side effects like confusion, urinary retention, or falls due to the anticholinergic effects. These drugs should be used with caution in patients with a history of asthma, chronic obstructive pulmonary disease (COPD), or glaucoma, as they may exacerbate symptoms due to their drying effects on mucous membranes and potential to increase intraocular pressure. In pregnant women, both drugs fall under category C, meaning they should only be used if the benefits outweigh the risks, as there is limited safety data. Cinnarizine and Dimenhydrinate can also pass into breast milk, so breastfeeding mothers should be cautious when using this combination. Regular monitoring for side effects such as excessive sedation, confusion, or difficulty urinating is recommended during prolonged therapy.

Indication

Cinnarizine + Dimenhydrinate combination is used primarily for the treatment of motion sickness, vertigo, and nausea associated with vestibular disorders. Cinnarizine helps with symptoms related to balance and dizziness, while Dimenhydrinate is effective at controlling nausea and vomiting. This combination is particularly useful for individuals who experience severe motion sickness during travel or as a result of inner ear issues, such as benign paroxysmal positional vertigo (BPPV). The two drugs work together to reduce nausea, vomiting, and dizziness by blocking histamine receptors in the central nervous system and suppressing the vestibular system's excessive signals. Dimenhydrinate is also used to treat nausea and vomiting in certain medical conditions such as post-operative nausea, though this indication is more common for Dimenhydrinate alone. The combination may also be used off-label in the management of other conditions related to nausea, vertigo, or allergic rhinitis, though the primary use remains focused on motion sickness and vestibular disorders.

Contra indication

The combination of Cinnarizine and Dimenhydrinate should be avoided in patients who have a known hypersensitivity or allergy to either of the drugs or any of their components. It is contraindicated in individuals with a history of glaucoma, particularly narrow-angle glaucoma, as both drugs can increase intraocular pressure. Cinnarizine and Dimenhydrinate should not be used in patients with severe liver or kidney dysfunction, as impaired organ function can lead to the accumulation of these drugs, increasing the risk of side effects. The combination is also contraindicated in individuals with a history of urinary retention, prostate enlargement, or gastrointestinal obstruction due to the anticholinergic effects of both drugs. In addition, the combination should be avoided during the first trimester of pregnancy unless absolutely necessary, as there is limited safety data. Both drugs can pass into breast milk, so breastfeeding mothers should use this combination with caution. It is also contraindicated in children under the age of 2 due to the risk of severe sedative effects and respiratory depression.

Side Effect

The side effects of Cinnarizine + Dimenhydrinate are often related to their sedative and anticholinergic properties. Common side effects include drowsiness, dizziness, dry mouth, blurred vision, and constipation. These effects are particularly pronounced when the combination is taken at higher doses or for prolonged periods. Other less common side effects may include headache, fatigue, or gastrointestinal disturbances such as nausea and stomach discomfort. In some cases, the anticholinergic effects may lead to urinary retention, particularly in elderly men with prostate enlargement. Rare but serious side effects include confusion, memory problems, and difficulty urinating, which can occur with prolonged use or in older adults. In very rare cases, an allergic reaction may occur, leading to symptoms like rash, itching, and difficulty breathing. If any severe reactions occur, such as difficulty breathing or swelling of the face or throat, medical attention should be sought immediately. To minimize side effects, the combination should be used at the lowest effective dose for the shortest duration necessary, and patients should be monitored regularly, especially if they are elderly or have pre-existing health conditions that may be exacerbated by the drug's anticholinergic effects.

Pregnancy Category ID

3

Mode of Action

Cinnarizine and Dimenhydrinate both work by blocking histamine receptors, specifically H1 receptors, in the central nervous system. Histamine is a neurotransmitter involved in regulating various functions such as wakefulness, balance, and motion, and its inhibition helps alleviate symptoms of nausea, vomiting, and dizziness associated with motion sickness and vertigo. Cinnarizine also has mild anticholinergic properties, which help reduce the overactivity of the vestibular system, thus preventing vertigo and balance disturbances. Dimenhydrinate is structurally related to diphenhydramine and has strong antihistamine and anticholinergic effects, contributing to its anti-nausea and anti-emetic properties. The combination of these two drugs provides a synergistic effect, with Cinnarizine primarily addressing vertigo and Dimenhydrinate targeting nausea and vomiting. Both drugs cross the blood-brain barrier and exert their effects centrally, leading to the suppression of the symptoms caused by motion sickness and vestibular disorders. The pharmacokinetics of both drugs involve rapid absorption after oral administration, with effects typically occurring within 30 minutes and lasting for several hours.

Interaction

Cinnarizine and Dimenhydrinate may interact with other medications that have sedative effects, such as alcohol, benzodiazepines, or opioids, leading to an enhanced sedative response. This can increase the risk of excessive drowsiness, dizziness, and impaired motor function. When used with other CNS depressants, such as barbiturates or other antihistamines, the sedative effects of Cinnarizine and Dimenhydrinate can be intensified, which may lead to an increased risk of adverse outcomes, including respiratory depression or coma in extreme cases. The combination should be used with caution when taken with other anticholinergic drugs (e.g., atropine, tricyclic antidepressants), as this can increase the risk of anticholinergic side effects, including dry mouth, urinary retention, constipation, and blurred vision. Additionally, both Cinnarizine and Dimenhydrinate may interact with certain medications metabolized by the liver's cytochrome P450 system, such as certain antidepressants, antipsychotics, and anticonvulsants. This could potentially increase or decrease the levels of these medications in the bloodstream. Patients should be monitored carefully if they are taking other drugs metabolized by the liver to avoid interactions.

Pregnancy Category Note

Information not available

Adult Dose

For motion sickness, the typical adult dose of Cinnarizine + Dimenhydrinate is 25-50 mg of each drug, taken 30 minutes to an hour before travel. This can be repeated every 4-6 hours if needed, but the maximum daily dose should not exceed 200 mg of Cinnarizine and 200 mg of Dimenhydrinate combined. For vertigo or nausea related to vestibular disorders, the usual dosage is 25-50 mg of each drug taken 2 to 3 times per day. It is important to start with the lowest possible dose and adjust based on the patient's response and tolerance. The combination should be taken with food to minimize gastrointestinal irritation. In severe cases, the dose may be adjusted, but care should be taken not to exceed the maximum recommended dose to avoid the risk of excessive sedation, dry mouth, or anticholinergic side effects.

Child Dose

The combination of Cinnarizine + Dimenhydrinate is typically not recommended for children under the age of 2 due to the risk of severe sedative effects and potential respiratory depression. In children aged 2-12 years, the dose should be adjusted based on the child's age and weight. The usual dose is 12.5-25 mg of each drug, given every 6-8 hours as needed. For children over 12 years of age, the adult dose may be appropriate. However, the total daily dose should not exceed 100 mg of each drug. As children may be more sensitive to the sedative effects, starting with the lower end of the dosing range is recommended, and parents should monitor for any adverse reactions such as excessive drowsiness or irritability. As always, pediatric dosing should be closely supervised by a healthcare provider, and the combination should not be used for prolonged periods in children.

Renal Dose

In patients with renal impairment, the dosing of Cinnarizine + Dimenhydrinate should be approached with caution. Both medications are excreted in the urine, and in individuals with reduced kidney function, the drugs may accumulate in the body, potentially leading to an increased risk of side effects such as sedation, confusion, and anticholinergic symptoms. The dose should be reduced in patients with moderate to severe renal impairment, and the interval between doses may need to be extended. Monitoring of renal function is recommended during therapy, especially in elderly patients who are more likely to have compromised renal function. In cases of severe renal failure, alternative treatments should be considered, and the use of Cinnarizine + Dimenhydrinate should be avoided unless absolutely necessary.

Administration

Information not available