ADMINISTRATION ROUTES:
PO, IM, IV
ALTERNATIVE NAMES:
Valoid, Nausicalm
ICU INDICATIONS:
- Treatment of nausea and vomiting
PRESENTATION AND ADMINISTRATION:
PO:
Nausicalm 50 mg tablets (white)
IV:
50 mg per mL solution
Store at room temperature. Protect from light.
Cyclizine may be mixed with morphine in a syringe immediately before use.
If cyclizine must be diluted in a syringe, either water for injection or 5% dextrose is recommended as the diluent rather than Normal saline. This reduces the risk of crystallisation.
IM:
Inject undiluted solution
DOSAGE:
IV:
25-50 mg TDS
PO:
25-50 mg TDS
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
Dose as in normal renal function
DOSAGE IN PAEDIATRICS:
IV / PO:
1 mg/kg TDS
CLINICAL PHARMACOLOGY:
The active ingredient cyclizine is a piperazine derivative with the general properties of H1-blocking drugs but is used as an anti-emetic in a variety of clinical situations including drug-induced and motion sickness, vertigo, post-operative vomiting and radiation sickness. Cyclizine also possesses anticholinergic activity.
CONTRAINDICATIONS:
- Hypersensitivity to cyclizine.
WARNINGS:
In the critically ill, cyclizine often causes significant sedation
PRECAUTIONS:
General:
As with other anticholinergic agents, cyclizine should be used with caution and appropriate monitoring in patients with glaucoma, obstructive disease of the gastrointestinal tract and in males with possible prostatic hypertrophy.
Cyclizine should be used with caution in patients with severe heart failure. In such patients, cyclizine may cause a fall in cardiac output associated with increases in heart rate, mean arterial pressure and pulmonary wedge pressure.
Laboratory Tests:
No tests in addition to routine ICU tests are indicated
Drug/Laboratory Test Interactions:
None of note
IMPORTANT DRUG INTERACTIONS IN ICU:
Cyclizine may have additive effects with alcohol and other central nervous system depressants e.g. hypnotics, tranquillisers. Because of its anticholinergic activity cyclizine may enhance the side-effects of other anticholinergic drugs
ADVERSE REACTIONS:
Central Nervous System:
Restlessness, nervousness, insomnia and auditory and visual hallucinations, drowsiness, blurred vision, dystonia, dyskinesia, extrapyramidal motor disturbances, tremor, twitching, muscle spasms, convulsions, disorientation, dizziness, decreased consciousness and transient speech disorders
Respiratory System:
Dryness of the mouth, nose and throat
Cardiovascular System:
Tachycardia
Gastrointestinal System:
Cholestatic jaundice, constipation, hypersensitivity hepatitis
Haematological System:
Agranulocytosis
Urogenital System:
Urinary retention
Skin:
Urticaria, drug rash