Dramina

Dramamine (dimenhydrinate) is a drug that is often used to prevent and treat motion sickness, dizziness, nausea, and vomiting caused by motion (as when traveling by car, boat, or plane). It may also be used to treat vertebrobasilar insufficiency.

Dimenhydrinate is a histamine H1 receptor antagonist and blocks the action of histamine in the central nervous system, which reduces nausea and vomiting associated with movement.

In addition, Dramamine may also be used as an adjunct in the treatment of motion sickness and other types of kinetosis (motion causing nausea) and in combination with other drugs to enhance its effect.

Indications Dramines

1. Prevention and treatment of motion sickness, dizziness, nausea and vomiting caused by movement (e.g. when travelling by car, ship or plane).
2. Treatment of vertebrobasilar insufficiency associated with dizziness and nausea.

Release form

• Tablets: This is the most common form of release. Tablets are intended for oral administration and have a standard dosage of the active substance.
• Children's tablets: This form contains a reduced dose of the active substance, suitable for children.

Pharmacodynamics

Mechanism of action:

• Dimenhydrinate blocks the action of histamine on peripheral H1 receptors, preventing or reducing the occurrence of allergic reaction symptoms.
• This leads to a reduction in various allergic manifestations, such as itching, runny nose, redness of the skin and others.
• In addition, Dramamine has anticholinergic properties, which contribute to its antiemetic and anti-nausea effects.

Pharmacokinetics

1. Absorption: Dimenhydrinate is usually rapidly and completely absorbed from the gastrointestinal tract after oral administration.
2. Bioavailability: The bioavailability of dimenhydrinate is about 50-60% due to the first-pass effect in the liver.
3. Distribution: Dimenhydrinate is distributed throughout the body and crosses the blood-brain barrier, which may cause sedation.
4. Metabolism: Dimenhydrinate is metabolized primarily in the liver to form active metabolites including 8-phenitrophenylethanol.
5. Elimination half-life: The elimination half-life of dimenhydrinate from the body has a significant range and can range from 3 to 6 hours.
6. Excretion: About 50-70% of dimenhydrinate is excreted from the body in the urine as metabolites.
7. Systemic concentration: The concentration of dimenhydrinate in the blood usually reaches its maximum within 1-3 hours after administration.
8. Interactions: Dimenhydrinate may interact with other drugs, especially other centrally acting agents such as hypnotics, sedatives or alcohol, which may increase the sedative effect.
9. Metabolism features: The metabolism of dimenhydrinate may be slower in the elderly or in people with impaired liver function, which may lead to an increase in its concentration in the blood and increased side effects.

Dosing and administration

Directions for use:

• The tablets are intended for oral administration.
• The tablet should be taken with a sufficient amount of water.

Dosage:

For adults and children over 12 years old:

• The recommended dose is 50-100 mg (1-2 tablets) 2-3 times a day.
• The maximum daily dose should not exceed 400 mg (8 tablets).

For children from 6 to 12 years old:

• The recommended dose is 25-50 mg (half to 1 tablet) 2-3 times a day.
• The maximum daily dose should not exceed 150 mg (3 tablets).

For children from 2 to 6 years old:

• The recommended dose is 12.5-25 mg (a quarter to half a tablet) 2-3 times a day.
• The maximum daily dose should not exceed 75 mg (1.5 tablets).

Motion sickness prevention:

• The drug should be taken 30-60 minutes before the start of the trip or journey.

Special instructions:

• It is not recommended to exceed the stated dosage.
• If a dose is missed, do not take a double dose to make up for the missed dose.
• The drug may cause drowsiness, so you should avoid driving vehicles and operating machinery that requires increased concentration.
• Before starting to use the drug, it is recommended to consult a doctor, especially if you have chronic diseases or are taking other medications.

Use Dramines during pregnancy

Using Dimenhydrinate (Dramamine) during pregnancy may be effective in treating morning sickness and vomiting, although it should be used with caution and under the supervision of a doctor. Here are some findings from research studies:

1. Effectiveness compared to other agents: Dimenhydrinate is effective in reducing symptoms of morning sickness and vomiting, and its effects are comparable to substances such as vitamin B6 and ginger, while it has fewer side effects such as drowsiness than other antiemetics such as ondansetron (Babaei & Foghaha, 2014).
2. Safety: Studies have shown no significant risk of teratogenicity in children born to mothers who used dimenhydrinate during the first trimester of pregnancy (Czeizel & Vargha, 2005).

Dimenhydrinate may be considered as an option for treating nausea and vomiting during pregnancy, but it should be used under strict medical supervision to avoid possible side effects and assess the risks.

Contraindications

1. Glaucoma: Dramamine may cause dilation of the pupils and increased intraocular pressure, which may worsen symptoms of glaucoma, so the drug is not recommended for use in the presence of glaucoma without consulting a doctor.
2. Asthma: Dimenhydrinate may cause worsening of asthma symptoms in some people, so its use may be contraindicated in patients with asthma.
3. Gastrointestinal disorders: Dramamine may cause irritation of the gastric mucosa, so its use may be contraindicated in patients with gastric or duodenal ulcers.
4. Urinary problems: Patients with renal or urinary tract problems may require a dose adjustment of dimenhydrinate or additional medical monitoring.
5. Hypersensitivity to the drug: People with a known allergy to dimenhydrinate or any other component of the drug should avoid its use.
6. Pregnancy and breastfeeding: The safety of Dramamine during pregnancy and breastfeeding has not been established, and its use in these cases should be discussed with a doctor.
7. Paediatrics: Dramamine is not recommended for use in children under 2 years of age without the advice of a doctor.

Side effects Dramines

1. Drowsiness or fatigue.
2. Dry mouth.
3. Rarely - irritability or anxiety.
4. Difficulty urinating.
5. Vision problems.
6. Increased heart rate.
7. Constipation.

Overdose

1. Drowsiness and general weakness: Overdose can cause significant depression of the central nervous system, resulting in severe drowsiness and general weakness.
2. Intestinal paralysis: This may manifest as constipation or urinary retention.
3. Dryness of mucous membranes: Including dry mouth and difficulty swallowing.
4. Heart rhythm disorders: Heart rhythm disorders such as tachycardia or arrhythmia may occur.
5. Loss of coordination and dizziness: This can lead to injuries and falls.
6. Visual disturbances: Including dilated pupils, changes in focus, or double vision.

Measures in case of overdose:

1. Immediate medical attention: If overdose is suspected, seek immediate medical attention. Call an ambulance or go to the nearest medical facility.
2. Stopping the Medication: If possible, stop taking Dramamine.
3. Symptomatic treatment: Treatment of overdose will be aimed at relieving symptoms and supporting vital functions. This may include the use of an antidote or symptomatic treatment.
4. Monitoring of condition: The patient may need to be observed and monitored for some time after measures have been taken to treat an overdose.
5. Individual measures: Depending on the symptoms and severity of the overdose, additional medical treatment and support measures may be needed.

Interactions with other drugs

1. Centrally acting agents: Dimenhydrinate has a sedative effect, so concomitant administration with other centrally acting drugs such as hypnotics, sedatives or alcohol may increase sedation and central nervous system depression.
2. Anticholinergic drugs: Dimenhydrinate is an anticholinergic drug, so concomitant use with other anticholinergic drugs such as antidepressants, antihistamines, antiparkinsonian drugs and some antihistamines may increase the effects of anticholinergic therapy such as dry mouth, constipation and urinary disturbances.
3. Drugs that enhance cardiotoxicity: Concomitant administration of dimenhydrinate with drugs that may also cause arrhythmias or enhance cardiotoxicity, such as certain antiarrhythmic drugs, anticonvulsants, or antidepressants, may increase the risk of cardiac side effects.
4. Drugs that enhance the hypotensive effect: Dimenhydrinate may cause hypotension. Therefore, concomitant administration with drugs such as antihypertensive drugs, alpha-blockers or other drugs that lower blood pressure may enhance this effect and lead to orthostatic hypotension.
5. Drugs that enhance the somnolent effect: Dimenhydrinate may cause drowsiness. Therefore, simultaneous administration with other hypnotics or sedatives may enhance this effect and increase the risk of respiratory depression or other undesirable somatic effects.

Storage conditions

Dramamine should be stored in a dry place at room temperature, usually not higher than 25°C. The drug should be kept away from direct sources of light and heat to avoid its decomposition. It is also important to ensure that the drug is inaccessible to children. It is generally recommended to store drugs in their original packaging until the time of use to protect them from moisture and other external factors that may affect their effectiveness.