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Tablet $0.05, Vial $1.64

Cyclizine

Editor: Updated Class:

ADMINISTRATION ROUTES:

PO, IM, IV

ALTERNATIVE NAMES:

Valoid, Nausicalm

ICU INDICATIONS:

  1. 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:

  1. 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