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Dimenhydrinate (Monograph)

Brand names: DMH, Dramamine, TripTone
Drug class: Antihistamines
ATC class: A04AD
CAS number: 523-87-5

Medically reviewed by Drugs.com on Jun 12, 2023. Written by ASHP.

Introduction

Ethanolamine-derivative antihistamine containing a diphenhydramine moiety; antiemetic.

Uses for Dimenhydrinate

Motion Sickness

Used principally in the prevention and treatment of nausea, vomiting, and/or vertigo associated with motion sickness, although scopolamine, promethazine, or meclizine may be more effective.

Most effective when given prophylactically.

Ménière’s Disease and Other Vestibular Disturbances

Has been used for symptomatic treatment (e.g., nausea, vomiting, vertigo) of Ménière’s disease [off-label] and other vestibular disturbances [off-label].

Nausea and Vomiting

May be less effective than phenothiazines in controlling nausea and vomiting not related to vestibular stimulation.

Allergic Conditions

Although a histamine antagonist, use in allergic conditions [off-label] has not been evaluated.

Dimenhydrinate Dosage and Administration

Administration

Administer orally or by IM or IV injection.

IV Injection

For solution and drug compatibility information, see Compatibility under Stability.

Dilution

Each 50 mg must be diluted with 10 mL of 0.9% sodium chloride injection.

Rate of Administration

Inject IV slowly over a period of 2 minutes.

Dosage

Pediatric Patients

Motion Sickness
Oral

For prevention, take 30 minutes before exposure to motion.

Children <2 Years of Age: Give only under the direction of a clinician.

Children 2 to <6 Years of Age: 12.5–25 mg every 6–8 hours, not to exceed 75 mg in 24 hours, or as directed by a clinician.

Children 6 to <12 Years of Age: 25–50 mg every 6–8 hours, not to exceed 150 mg in 24 hours, or as directed by a clinician.

Children ≥12 Years of Age: Usually, 50–100 mg every 4–6 hours, not to exceed 400 mg in 24 hours, or as directed by a clinician.

Children: Alternatively, 1.25 mg/kg or 37.5 mg/m2 4 times daily, up to a maximum of 300 mg daily.

IM

Children: 1.25 mg/kg or 37.5 mg/m2 4 times daily, up to a maximum of 300 mg daily.

IV

Not established for children.

Adults

Motion Sickness
Oral

For prevention, take 30 minutes before exposure to motion.

Usually 50–100 mg every 4–6 hours, not to exceed 400 mg in 24 hours, or as directed by a clinician.

IM

50–100 mg every 4–6 hours, not to exceed 400 mg in 24 hours, or as directed by a clinician.

IV

50–100 mg every 4–6 hours, not to exceed 400 mg in 24 hours, or as directed by a clinician.

Ménière’s Disease and Other Vestibular Disturbances
Maintenance of Symptomatic Relief
Oral

25–50 mg has been given 3 times daily.

Acute Attacks
IM

50 mg.

Prescribing Limits

Pediatric Patients

Motion Sickness
Oral

Children 2 to <6 Years of Age: Maximum 75 mg in 24 hours, or as directed by a clinician.

Children 6 to <12 Years of Age: Maximum 150 mg in 24 hours, or as directed by a clinician.

Children ≥12 Years of Age: Maximum 400 mg in 24 hours, or as directed by a clinician.

Children: Alternatively, maximum 300 mg daily when given as 1.25 mg/kg or 37.5 mg/m2.

IM

300 mg daily.

Adults

Motion Sickness
Oral

Maximum 400 mg in 24 hours, or as directed by a clinician.

IM

Maximum 400 mg in 24 hours, or as directed by a clinician.

IV

Maximum 400 mg in 24 hours, or as directed by a clinician.

Special Populations

Hepatic Impairment

No specific dosage recommendations for hepatic impairment.

Renal Impairment

No specific dosage recommendations for renal impairment.

Geriatric Patients

No specific geriatric dosage recommendations.

Cautions for Dimenhydrinate

Contraindications

Warnings/Precautions

Warnings

Concomitant Diseases

Patients with glaucoma, respiratory conditions (e.g., emphysema, chronic bronchitis), or difficulty urinating due to prostatic hypertrophy should consult a clinician before initiating therapy with dimenhydrinate.

Use with caution in patients with increased IOP, narrow-angle glaucoma, stenosing peptic ulcer, pyloroduodenal obstruction, bladder-neck obstruction, symptomatic prostatic hypertrophy, active or a history of lower respiratory disease (e.g., bronchial asthma), hyperthyroidism, or cardiovascular disease (e.g., hypertension).

CNS Effects

Risk of marked drowsiness. Among first generation antihistamines, ethanolamines (e.g., dimenhydrinate) considered the most sedating.

Performance of activities requiring mental alertness or physical coordination may be impaired.

Concurrent use of other CNS depressants may cause additive or potentiated CNS depression.

Diphenhydramine Toxicity

Dimenhydrinate contains 53–55.5% diphenhydramine. Risk of diphenhydramine toxicity. (See Pediatric Use under Cautions.) Do not use more often than directed for any condition or use concomitantly with other diphenhydramine-containing preparations, including oral and topical preparations.

Sensitivity Reactions

Tartrazine Sensitivity

Dramamine chewable tablets contain tartrazine (FD&C yellow No. 5), which may cause allergic reactions including bronchial asthma in susceptible individuals. Incidence of tartrazine sensitivity is low, but it frequently occurs in patients who are sensitive to aspirin.

General Precautions

Anticholinergic Effects

Consider anticholinergic effects in patients with conditions aggravated by anticholinergic therapy (e.g., angle-closure glaucoma, enlargement of the prostate gland). (See Concomitant Diseases under Cautions.)

Ototoxic Drugs

Symptoms of ototoxicity may be masked by dimenhydrinate; administer with caution in patients receiving known ototoxic drugs and closely monitor.

Seizure Disorders

Use with caution in seizure disorders.

Specific Populations

Pregnancy

Category C.

Lactation

Distributed into milk. Discontinue nursing or the drug.

Pediatric Use

Do not use in children <2 years of age unless directed by a clinician.

Risk of diminished mental alertness. Risk of excitation in young pediatric patients.

Risk of diphenhydramine toxicity (e.g., dilated pupils, flushed face, hallucinations, ataxic gait, urinary retention) when used concomitantly with other diphenhydramine-containing preparations, including oral and topical preparations. (See Diphenhydramine Toxicity under Cautions.)

Common Adverse Effects

Drowsiness, headache, blurred vision, tinnitus, dryness of the mouth and respiratory passages, incoordination, palpitation, dizziness, hypotension.

Paradoxical CNS stimulation in pediatric patients and occasionally in adults.

With IM injection: Pain at the injection site.

Because dimenhydrinate contains diphenhydramine, the possibility of other diphenhydramine-related adverse effects should also be considered.

Drug Interactions

Drugs Metabolized by Hepatic Microsomal Enzymes

Although dimenhydrinate has been reported to induce hepatic microsomal enzymes in animals, there is no clinical evidence that it influences the metabolism of other drugs in humans.

Specific Drugs

Drug

Interaction

Comments

Anticholinergic drugs

Anticholinergic effects may be potentiated

Antidepressants, tricyclic

Anticholinergic effects may be potentiated

CNS depressants

May enhance the effects of other CNS depressants, including alcohol

Use concomitantly with caution

Ototoxic drugs

May mask the early manifestations of ototoxicity

Use concomitantly with caution and closely monitor

Dimenhydrinate Pharmacokinetics

Absorption

Bioavailability

Well absorbed after oral or parenteral administration.

Onset

IV injection: Antiemetic effects occur almost immediately.

Oral administration: Antiemetic effects within 15–30 minutes.

IM injection: Antiemetic effects within 20–30 minutes.

Duration

3–6 hours.

Distribution

Extent

Probably widely distributed into body tissues.

Crosses the placenta.

Small amounts are distributed into milk.

Elimination

Metabolism

Metabolized by the liver.

Elimination Route

Excreted in urine.

Stability

Storage

Well-closed containers at room temperature.

Oral

Solution

Tight containers. Avoid freezing.

Tablets

Well-closed containers at room temperature.

Parenteral

Injection

Avoid freezing.

Compatibility

Parenteral

Solution CompatibilityHID

Compatible

Dextrose–Ringer’s injection combinations

Dextrose–Ringer’s injection, lactated, combinations

Dextrose–saline combinations

Dextrose 5% in sodium chloride 0.9%

Dextrose 2.5, 5, or 10% in water

Ionosol products

Ringer’s injection

Ringer’s injection, lactated

Sodium chloride 0.45 or 0.9%

Sodium lactate (1/6) M

Drug Compatibility
Admixture CompatibilityHID

Compatible

Amikacin sulfate

Ammonium chloride

Chloramphenicol sodium succinate

Heparin sodium

Hydroxyzine HCl

Norepinephrine bitartrate

Penicillin G potassium

Pentobarbital sodium

Phenobarbital sodium

Potassium chloride

Prochlorperazine edisylate

Vancomycin HCl

Variable

Aminophylline

Hydrocortisone sodium succinate

Y-site CompatibilityHID

Compatible

Acyclovir sodium

Ciprofloxacin

Fluconazole

Metronidazole

Pantoprazole sodium

Actions

Advice to Patients

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

dimenhyDRINATE

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Solution

12.5 mg/5 mL*

DMH Syrup

Alra

Dramamine Children’s

Pfizer

Tablets

50 mg*

Dramamine (scored)

Pfizer

Tablets, chewable

50 mg

Dramamine Children’s (scored)

Pfizer

Tablets, film-coated

50 mg

TripTone Caplets (scored)

Del

Parenteral

Injection

50 mg/mL*

dimenhyDRINATE Injection

AHFS DI Essentials™. © Copyright 2024, Selected Revisions June 20, 2013. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.

† Off-label: Use is not currently included in the labeling approved by the US Food and Drug Administration.

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