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European Journal of Hospital Pharmacy :... Mar 2023Patients in the acute phase of agitation can require the administration of multiple drugs by intramuscular injection in order to temporarily stabilise their condition....
BACKGROUND
Patients in the acute phase of agitation can require the administration of multiple drugs by intramuscular injection in order to temporarily stabilise their condition. Administration of multiple psychotropic medications in a single syringe can be beneficial to both the patient and healthcare professionals. However, there are very little data in the literature regarding psychotropic drug compatibility in syringes for acute agitation.
OBJECTIVE
The aim of this study was to assess the visual compatibility of various combinations of 12 intramuscular psychotropic medications in syringes, and to validate compatibility with the use of a particle counter. The medications evaluated were benztropine mesylate, diazepam, dimenhydrinate, diphenhydramine hydrochloride, haloperidol lactate, hydroxyzine, lorazepam, loxapine, methotrimeprazine, midazolam, olanzapine and zuclopenthixol acetate.
METHODS
Compounded solutions of medication combinations underwent visual inspection initially and after 0.25, 0.5, 1, 2 and 4 hours using a white background and a black background. In order to validate the compatibility results, the presence of particulate matter was determined by light obscuration.
RESULTS
This study identified 35 combinations that were visually compatible and 35 that were visually incompatible. We chose eight highly clinically relevant combinations to test using the requirements of the United States Pharmacopoeia (USP) chapter 788 (Particulate Matter in Injections). Of those eight, six were physically compatible, including the triple combinations of lorazepam and haloperidol with either benztropine or diphenhydramine.
CONCLUSION
These physical compatibility results will give healthcare professionals an idea of the possible compatible combinations of psychotropic drugs in syringes, and thus complete some of the missing data in the literature.
Topics: Humans; Haloperidol; Lorazepam; Syringes; Psychotropic Drugs; Diphenhydramine
PubMed: 36002244
DOI: 10.1136/ejhpharm-2022-003378 -
BMJ Quality & Safety Dec 2019Benzodiazepines and sedative hypnotics (BSH) have numerous adverse effects that can lead to negative outcomes, particularly in vulnerable hospitalised older adults. At... (Comparative Study)
Comparative Study
BACKGROUND
Benzodiazepines and sedative hypnotics (BSH) have numerous adverse effects that can lead to negative outcomes, particularly in vulnerable hospitalised older adults. At our institution, over 15% of hospitalised older adults are prescribed sedative-hypnotics inappropriately. Of these prescriptions, 87% occurred at night to treat insomnia and almost 20% came from standard admission order sets.
METHODS
We conducted a time-series study from January 2015 to August 2016 among medical and cardiology inpatients following the implementation in August 2015 of a sedative reduction bundle (education, removal of BSH from available admission order sets and non-pharmacological strategies to improve sleep). Preintervention period was January-July 2015 and postintervention period was August 2015-August 2016. A surgical ward served as control. Primary outcome was the proportion of BSH-naive (not on BSH prior to admission) patients 65 years or older discharged from medical and cardiology wards who were prescribed any new BSH for sleep in hospital. Data were analysed on statistical process control (SPC) p-charts with upper and lower limits set at 3δ using standard rules. Secondary measures included Patient-reported Median Sleep Quality scores and rates of fall and sedating drug prescriptions that may be used for sleep (dimenhydrinate).
RESULTS
During the study period, there were 5805 and 1115 discharges from the intervention and control units, respectively. From the mean baseline BSH prescription rate of 15.8%, the postintervention period saw an absolute reduction of 8.0% (95% CI 5.6% to 10.3%; p<0.001). Adjusted for temporal trends, the intervention produced a 5.3% absolute reduction in the proportion of patients newly prescribed BSH (95% CI 5.6% to 10.3%; p=0.002). BSH prescription rates remained stable on the control ward. Patient-reported measure of sleep quality, falls and use of other sedating medications remained unchanged throughout the study duration.
CONCLUSION
A comprehensive intervention bundle was associated with a reduction in inappropriate BSH prescriptions among older inpatients.
Topics: Aged; Aged, 80 and over; Drug Utilization; Female; Health Education; Health Personnel; Hospitalization; Hospitals, University; Humans; Hypnotics and Sedatives; Inpatients; Male; Ontario; Prescription Drug Misuse; Sleep Initiation and Maintenance Disorders
PubMed: 31270252
DOI: 10.1136/bmjqs-2018-009241 -
Drug Development and Industrial Pharmacy 2016Dimenhydrinate (DMH)-loaded buccal bioadhesive films for the prevention and treatment of motion sickness were prepared and optimized. This study examines the rate of...
Dimenhydrinate (DMH)-loaded buccal bioadhesive films for the prevention and treatment of motion sickness were prepared and optimized. This study examines the rate of drug release from the films for prolonged periods of time to reduce or limit the frequency of DMH administration. Based on preliminary studies using various polymers and concentrations, hydroxyethylcellulose (2.5, 3.0, and 3.2%), and xanthan gum (2.8%) were chosen as matrix polymers. The films were analyzed with respect to their mechanical, physicochemical, bioadhesive, swelling, and in-vitro release properties. In in-vivo pharmacokinetic studies, xanthan gum-based DMH buccal film was associated with significantly increased DMH plasma levels between 1 h and 5 h after DMH dosing when compared with an oral drug solution. The area under the curve AUC0-7 h value of the mucoadhesive buccal film was two-fold higher than the oral DMH solution. Histological analysis revealed that DMH films cause mild morphological and inflammatory changes in rabbit buccal mucosa. The DMH buccal film is effective for approximately 7 h, thus representing an option for single-dose antiemetic therapy. This dosage regimen could be particularly beneficial for chain travelers who travel for long periods of time.
Topics: Adhesives; Administration, Buccal; Animals; Area Under Curve; Biological Availability; Cellulose; Chemistry, Pharmaceutical; Dimenhydrinate; Male; Mouth Mucosa; Polysaccharides, Bacterial; Rabbits; Surface Properties
PubMed: 26460061
DOI: 10.3109/03639045.2015.1091470 -
International Journal of Environmental... Feb 2020Medication use during pregnancy is a common practice that has been increasing in recent years. The aim of this study is to describe medication use among pregnant women...
Medication use during pregnancy is a common practice that has been increasing in recent years. The aim of this study is to describe medication use among pregnant women from the 2015 Pelotas (Brazil) Birth Cohort Study. This paper relies on a population-based cohort study including 4270 women. Participants completed a questionnaire about the antenatal period, including information about medication use. We performed descriptive analyses of the sample and the medications used and adjusted analyses for the use of medications and self-medication. The prevalence of medication use was 92.5% (95% CI 91.7-93.3), excluding iron salts, folic acid, vitamins, and other minerals. The prevalence of self-medication was 27.7% (95% CI 26.3-29.1). In the adjusted analysis, women who had three or more health problems during pregnancy demonstrated higher use of medicines. Self-medication was higher in lower income groups and among smokers and multiparous women (three pregnancies or more). Acetaminophen, scopolamine, and dimenhydrinate were the medications most commonly used. This study describes the pattern of drug use among pregnant women in a population-based cohort study, with a high prevalence of self-medication. Greater awareness of the risks of self-medication during pregnancy is required, focusing on groups more prone to this practice, as well as ensuring qualified multidisciplinary prenatal care.
Topics: Acetaminophen; Adult; Brazil; Cohort Studies; Dietary Supplements; Female; Folic Acid; Humans; Interviews as Topic; Pharmacoepidemiology; Pregnancy; Prenatal Care; Prevalence; Qualitative Research; Self Medication; Surveys and Questionnaires; Vitamins; Young Adult
PubMed: 32033282
DOI: 10.3390/ijerph17030989 -
Turkish Archives of Otorhinolaryngology Dec 2019Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular system disease causing dizziness. It occurs more in the 5th decade of life and...
OBJECTIVE
Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular system disease causing dizziness. It occurs more in the 5th decade of life and affects the posterior canal in 90% of the patients. The most effective treatment method is canalith repositioning (CRP) maneuver. The aim of this study is to evaluate the effects of betahistine and dimenhydrinate therapies in addition to CRP maneuver on BPPV patients.
METHODS
The study included 64 patients who had complaints of dizziness and were diagnosed with BPPV by their history and provocation maneuvers. The patients were divided into two groups. In Group 1, only repositioning maneuver was performed. Group 2 was divided into two subgroups. In Group 2a, repositioning maneuver was performed and betahistine 24 mg twice daily was given for 10 days. In Group 2b, repositioning maneuver was performed and dimenhydrinate 50 mg once daily was given for five days. On the 10 day, all patients were reexamined, and provocation maneuver was performed. Dizziness handicap inventory (DHI) was completed and outcomes were reviewed for therapeutic efficacy.
RESULTS
Mean DHI scores in all patient groups statistically significantly decreased from a pre-treatment level of 52.16 (range, 20-100) to a post-treatment level of 17.84 (range, 0-78) (p<0.001). No statistically significant differences were found in terms of DHI scores between Group 1 (repositioning maneuver only) and Group 2 (repositioning maneuver plus betahistine or dimenhydrinate).
CONCLUSION
The most effective treatment method of BPPV is repositioning maneuver. Addition of betahistine or dimenhydrinate pharmacotherapy to repositioning maneuver did not show superiority to treatment with repositioning maneuvers alone.
PubMed: 32128517
DOI: 10.5152/tao.2019.4185 -
Frontiers in Pharmacology 2023Acquired QT interval prolongations due to drug side effects can result in detrimental arrhythmia. Maternal use of placenta-permeable drugs may lead to fetal exposure,...
Acquired QT interval prolongations due to drug side effects can result in detrimental arrhythmia. Maternal use of placenta-permeable drugs may lead to fetal exposure, thus leading to an increased risk of neonatal QT prolongation and arrhythmia. This study aimed to evaluate the influence of maternal QT-prolonging medication on the neonatal QT interval. In the prospective KUNO-Kids health study, an ongoing population-based birth cohort, we classified maternal medications according to the known risk of QT interval prolongation. Effects on the neonatal QT interval were tested by linear regression analyses, correcting for perinatal confounders (birth weight, gestational age, birth mode, and age at ECG recording). Subgroup analyses were performed for selective serotonin reuptake inhibitors, proton pump inhibitors, and antihistamine dimenhydrinate. Logistic regression analysis was performed using a QTc of 450 ms as the cut-off value. A total of 2,550 pregnant women received a total of 3,990 medications, of which 315 were known to increase the risk of QT prolongation, resulting in 105 (4.1%) neonates exposed in the last month of pregnancy. Overall, the mean age of the neonates at ECG was 1.9 days and the mean QTc (Bazett) was 414 ms. Univariate (regression coefficient -2.62, = 0.288) and multivariate (regression coefficient -3.55, = 0.146) regression analyses showed no significant effect of fetal medication exposure on the neonatal QT interval, neither in the overall nor in the subgroup analysis. Logistic regression analysis showed no association of exposure to maternal medication with an increased risk of neonatal QT interval prolongation (OR (odds ratio) 0.34, = 0.14). The currently used maternal medication results in a relevant number of fetuses exposed to QT interval-prolonging drugs. In our cohort, exposure was found to have no effect on the neonatal QT interval.
PubMed: 37608894
DOI: 10.3389/fphar.2023.1193317 -
Journal of Addiction Medicine 2019: Reporting of intoxication and withdrawal from aberrant use of over-the-counter medication has been sparse and inconsistent in literature. Attributed to their...
: Reporting of intoxication and withdrawal from aberrant use of over-the-counter medication has been sparse and inconsistent in literature. Attributed to their anticholinergic properties, medications such as dimenhydrinate (Gravol) taken in supratherapeutic doses have been associated with euphoria, anxiolysis, and hallucinations. We present a case of a woman in her forties, with a psychiatric history of bipolar disorder, and complex concurrent medical history including familial Mediterranean fever (FMF), and fibromyalgia, admitted for withdrawal management of her intravenous dimenhydrinate use. As a result of her FMF, there were numerous hospital admissions and treatment which required intravenous access. Hence, a physician-inserted intravenous access port was placed on her chest. The port was maintained monthly with the help of a community agency. In this port, she was injecting 100 to 200 mg of dimenhydrinate hourly for its euphoric and calming effects, consuming upwards of 2400 mg/d. Comprehensive laboratory work-up and urine drug screening were unremarkable. Vital signs were stable. Her mental status at time of admission was lethargic, unfocused, but calm. Her withdrawal symptoms included severe nausea, vomiting, sedation, headaches, dizziness, anxiety, and muscle stiffness. Her detoxification was managed with benztropine and lorazepam, and was well tolerated. The patient was discharged to a community inpatient rehabilitation center. Urine drug testing before discharge was negative. This case draws attention to the addictive potential of dimenhydrinate and offers a regime for its medical withdrawal management. Additionally, this case highlights that screening and management of over-the-counter medications warrants further clinical consideration and investigation.
Topics: Benztropine; Bipolar Disorder; Dimenhydrinate; Female; Humans; Infusions, Intravenous; Lorazepam; Middle Aged; Poisoning; Psychotropic Drugs
PubMed: 30844875
DOI: 10.1097/ADM.0000000000000511 -
Clinical Drug Investigation Jan 2020
Topics: Betahistine; Cinnarizine; Dimenhydrinate; Double-Blind Method; Humans; Prospective Studies; Vertigo
PubMed: 31676932
DOI: 10.1007/s40261-019-00871-9 -
Journal of Family Medicine and Primary... Mar 2023The antihistamine dimenhydrinate as the trigger of acute urinary retention has not been reported. A 35-year-old female with a long-term history of depression treated...
The antihistamine dimenhydrinate as the trigger of acute urinary retention has not been reported. A 35-year-old female with a long-term history of depression treated with sertraline (150 mg/d) since years developed acute urinary retention after having received 100 mg dimenhydrinate intravenously for excessive, postural vertigo. Urinary retention required placement of a disposable catheter, which halted 1.6 liter of urine. Since urinary retention persisted, she received a permanent catheter, which initially halted another 1.2 liter of urine. Urinary retention resolved spontaneously within 48 hours, and the patient was discharged with her previous medication. This case shows that intravenous dimenhydrinate can trigger the development of acute urinary retention in patients under long-term treatment with sertraline, which is why it should be given with caution in this group of patients.
PubMed: 37122660
DOI: 10.4103/jfmpc.jfmpc_1338_22