Asunto(s)
Antieméticos/efectos adversos , Ciclizina/efectos adversos , Complicaciones Intraoperatorias/inducido químicamente , Parálisis Respiratoria/inducido químicamente , Antieméticos/uso terapéutico , Apendicectomía , Ciclizina/uso terapéutico , Femenino , Humanos , Laparoscopía , Náusea y Vómito Posoperatorios/complicaciones , Náusea y Vómito Posoperatorios/tratamiento farmacológico , Adulto JovenAsunto(s)
Ciclizina/efectos adversos , Cuidados Paliativos/métodos , Cuadriplejía/inducido químicamente , Cuadriplejía/diagnóstico , Cuidado Terminal/métodos , Ciclizina/uso terapéutico , Diagnóstico Diferencial , Femenino , Humanos , Cuadriplejía/prevención & control , Resultado del Tratamiento , Vómitos/complicaciones , Vómitos/tratamiento farmacológico , Adulto JovenRESUMEN
This brief report describes the cautious but successful use of cyclizine, an anticholinergic agent, for the relief of intractable nausea in a patient with myasthenia gravis, followed by a review of the available literature.
Asunto(s)
Antieméticos/uso terapéutico , Ciclizina/uso terapéutico , Miastenia Gravis/tratamiento farmacológico , Náusea/tratamiento farmacológico , Vómitos/tratamiento farmacológico , Anciano , Humanos , Masculino , Miastenia Gravis/complicaciones , Náusea/etiología , Insuficiencia del Tratamiento , Vómitos/etiologíaRESUMEN
Cyclizine is an antihistamine, which is frequently used to manage nausea and vomiting in cancer patients. Antihistamines can be drugs of misuse/abuse, and the article describes four cancer patients who developed such problems after receiving parenteral cyclizine within the inpatient unit of a cancer centre. The article also briefly reviews the literature on the misuse/abuse of cyclizine and other antihistamines.
Asunto(s)
Antieméticos/uso terapéutico , Ciclizina/uso terapéutico , Náusea/inducido químicamente , Neoplasias/tratamiento farmacológico , Trastornos Relacionados con Sustancias , Vómitos/inducido químicamente , Adolescente , Adulto , Femenino , Antagonistas de los Receptores Histamínicos/uso terapéutico , Humanos , Masculino , Persona de Mediana EdadRESUMEN
INTRODUCTION: Dizziness is a common presenting complaint in primary healthcare. One differential diagnosis is Ménière's disease. The UK National Health Service 'Prodigy' guidelines have been produced to help healthcare professionals to diagnose and manage Ménière's disease. The aim of this audit was to consider how Ménière's disease is managed in general practice, and to assess how well general practitioners adhere to the Prodigy guidelines. MATERIALS AND METHODS: We identified general practices near the Torbay region of south Devon which had a 'TQ' postcode. There were 41 practices, staffed by a total of 203 general practitioners. We wrote to each general practitioner, asking them to fill in a questionnaire regarding Ménière's disease. Our practice response rate was 68 per cent and our individual rate 43 per cent. RESULTS: The mean correct answer rate was >50 per cent. The respondents achieved this despite few being aware of any formal guidelines, and none being aware of the Prodigy guidelines. CONCLUSION: Detailed knowledge of Ménière's disease was uncommon, and formal guidelines were not frequently consulted.
Asunto(s)
Medicina Familiar y Comunitaria , Adhesión a Directriz , Enfermedad de Meniere/tratamiento farmacológico , Adulto , Betahistina/uso terapéutico , Ciclizina/uso terapéutico , Inglaterra , Femenino , Encuestas de Atención de la Salud , Antagonistas de los Receptores Histamínicos H1/uso terapéutico , Humanos , Masculino , Enfermedad de Meniere/diagnóstico , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Proclorperazina/uso terapéutico , Derivación y ConsultaRESUMEN
We conducted a randomised double-blinded study of 960 women undergoing day-case surgery to determine whether combination anti-emetic therapy of granisetron and cyclizine was more effective at decreasing the incidence of postoperative nausea and vomiting than these agents used alone. The women were randomly allocated to three groups to receive intravenous granisetron 1 mg, cyclizine 50 mg or both before induction of general anaesthesia. The incidence of postoperative nausea and vomiting was 77/322 (24%) in the granisetron group, 73/316 (23%) in the cyclizine group and 53/322 (17%) in those women given both drugs (p = 0.04). There was no difference in the requirement for rescue anti-emetic drugs. There were no differences in the anaesthetic techniques used in the three groups. We conclude that the risk of postoperative nausea and vomiting is less with cyclizine and granisetron given together than with either given alone.
Asunto(s)
Antieméticos/uso terapéutico , Ciclizina/uso terapéutico , Granisetrón/uso terapéutico , Náusea y Vómito Posoperatorios/prevención & control , Adulto , Procedimientos Quirúrgicos Ambulatorios , Antieméticos/efectos adversos , Ciclizina/efectos adversos , Método Doble Ciego , Quimioterapia Combinada , Femenino , Granisetrón/efectos adversos , Humanos , Estudios Prospectivos , Factores de RiesgoRESUMEN
Nausea and vomiting is a relevant and common problem with unfavourable sequelae in children undergoing some plastic surgery procedures. There is a lack of anti-emetic trials performed in children, with only a few investigating the roles of the older anti-emetic agents such as cyclizine compared with newer ones such as ondansetron. This randomised, controlled, double-blind study examined the effectiveness of a single dose of ondansetron (0.1 mg x kg-1), cyclizine (20 mg) and placebo (normal saline) in the prevention of postoperative nausea and vomiting in 150 children (mean age 3.6 years) undergoing plastic genitourinary procedures. Rates of previous postoperative nausea and vomiting and motion sickness were comparable across the groups. Postoperative vomiting was significantly reduced with ondansetron prophylaxis (p = 0.006) but there was no detectable anti-emetic effect with cyclizine. Furthermore, cyclizine caused pain on injection (p < 0.001).
Asunto(s)
Antieméticos/uso terapéutico , Ciclizina/uso terapéutico , Ondansetrón/uso terapéutico , Náusea y Vómito Posoperatorios/prevención & control , Analgésicos Opioides/administración & dosificación , Antieméticos/efectos adversos , Preescolar , Ciclizina/efectos adversos , Método Doble Ciego , Esquema de Medicación , Humanos , Morfina/administración & dosificación , Ondansetrón/efectos adversos , Estudios ProspectivosRESUMEN
BACKGROUND: Low-dose intrathecal (spinal) morphine (0.1-0.2 mg) for Caesarean section delivers excellent postoperative analgesia but is associated with significant nausea and vomiting. We compared the antiemetic efficacy of cyclizine, dexamethasone, and placebo in this clinical setting. METHODS: Ninety-nine women undergoing elective Caesarean section under spinal anaesthesia were allocated randomly, in a double-blind study design, to receive either cyclizine 50 mg, dexamethasone 8 mg, or placebo as a single-dose infusion in saline 0.9%, 100 ml on completion of surgery. Spinal anaesthesia consisted of: hyperbaric bupivacaine 0.5%, 2.0 ml; fentanyl 10 micro g; and spinal morphine 0.2 mg. The primary outcome measure was the incidence of nausea. RESULTS: The incidence of nausea was significantly less in patients receiving cyclizine compared with dexamethasone and placebo (33 vs 60 and 67%, respectively, P<0.05). Severity of nausea and number of vomiting episodes were also less at 3-6 h in cyclizine patients. Overall satisfaction with postoperative care at 24 h, expressed on a 100 mm visual analogue scale, was greater in cyclizine [78 (28)] than either dexamethasone [58 (31), P=0.03] or placebo [51 (28), P=0.008]. CONCLUSION: We conclude that following spinal morphine 0.2 mg and fentanyl 10 micro g analgesia for Caesarean section, cyclizine 50 mg i.v. reduces the incidence of nausea compared with dexamethasone 8 mg i.v. or placebo. It also lessens the severity of nausea and vomiting, and increases maternal satisfaction in the early postoperative period.
Asunto(s)
Antieméticos/uso terapéutico , Cesárea , Ciclizina/uso terapéutico , Dexametasona/uso terapéutico , Náusea y Vómito Posoperatorios/prevención & control , Adulto , Analgesia Obstétrica/efectos adversos , Analgésicos Opioides/efectos adversos , Anestesia Obstétrica , Anestesia Raquidea , Método Doble Ciego , Femenino , Humanos , Morfina/efectos adversos , Satisfacción del Paciente , Náusea y Vómito Posoperatorios/inducido químicamente , Embarazo , Índice de Severidad de la EnfermedadRESUMEN
Seventy-four patients undergoing laparoscopic gynaecological surgery were randomly allocated to two groups receiving cyclizine 50 mg or ondansetron 4 mg at induction of anaesthesia. Anaesthetic and postoperative analgesia regimens were standardised. Approximately half of the patients in each group experienced some degree of postoperative nausea and vomiting (cyclizine, 56%; ondansetron, 54%). There was no difference between groups in respect of pre- and postdischarge incidence. Mean (SD) time to eye opening was significantly prolonged in the cyclizine group [10 (4) min vs. 8 (2) min; p < 0.001], but this had no influence on discharge times. Cyclizine and ondansetron appear equally effective in preventing postoperative nausea and vomiting but the 10-fold price differential favours cyclizine.
Asunto(s)
Antieméticos/uso terapéutico , Ciclizina/uso terapéutico , Laparoscopía , Ondansetrón/uso terapéutico , Náusea y Vómito Posoperatorios/prevención & control , Adulto , Procedimientos Quirúrgicos Ambulatorios , Periodo de Recuperación de la Anestesia , Método Doble Ciego , Femenino , Antagonistas de los Receptores Histamínicos H1/uso terapéutico , Humanos , Antagonistas de la Serotonina/uso terapéuticoRESUMEN
The objective of this study was to assess usage patterns of ergotamine and sumatriptan over a period of 6 years, primarily to evaluate the impact that sumatriptan has had on the prescription of ergotamine. This study used ergotamine and sumatriptan prescription data representing inhabitants of eight cities in the Netherlands and covering the period of 1991-1997. The yearly incidence of new users between 1991 and 1997 was estimated for both drugs as well as for the drug of first choice to be prescribed to patients initiating specific abortive migraine treatment with either ergotamine or sumatriptan. Intra-individual ergotamine and sumatriptan usage patterns, characterized by single (incidental), continuous (rate of retention) or switch use, were examined for five patient cohorts, each for a follow-up period of 1 year. During the year of sumatriptan introduction (1991-1992), the overall incidence of new use for both drugs was highest (5.4 per 1000 inhabitants). Hereafter, a substantial reduction of more than 50% was observed. From 1992 to 1996, the yearly incidence of ergotamine first-time use was significantly higher than that of sumatriptan and up to 1996 ergotamine was more than twice as likely than sumatriptan to be prescribed to patients initiating specific abortive treatment. Hereafter, sumatriptan was as likely as ergotamine to be prescribed as the drug of first choice, which coincided with the full reimbursement of sumatriptan tablets. Overall, neurologists were more likely than general practitioners (GPs), to prescribe sumatriptan as the drug of first choice. Approximately half of the total study population were identified as single-time users. This phenomonen occurred more frequently in the ergotamine cohorts. The sumatriptan cohorts displayed a slight yet significant stronger retention rate compared with the ergotamine cohorts. The overall impact of sumatriptan on ergotamine use in The Netherlands was marginal, predominantly due to GP's adherence to migraine treatment guidelines and reimbursement policies concerning sumatriptan tablets. Overall, incidental use was relatively high and may reflect the reported difficulties in diagnosing migraine, lack of patient-doctor consultation, or that anticipated benefits of the drug were not achieved. Further study is required to clarify these issues.
Asunto(s)
Analgésicos no Narcóticos/uso terapéutico , Ergotamina/uso terapéutico , Trastornos Migrañosos/tratamiento farmacológico , Agonistas de Receptores de Serotonina/uso terapéutico , Sumatriptán/uso terapéutico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Cafeína/administración & dosificación , Cafeína/uso terapéutico , Estudios de Cohortes , Ciclizina/administración & dosificación , Ciclizina/uso terapéutico , Combinación de Medicamentos , Prescripciones de Medicamentos/estadística & datos numéricos , Quimioterapia Combinada , Utilización de Medicamentos/estadística & datos numéricos , Utilización de Medicamentos/tendencias , Ergotamina/administración & dosificación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Países Bajos , Pautas de la Práctica en Medicina/estadística & datos numéricosRESUMEN
Histamine-1 (H1) antihistamines are the first-line drug for the treatment of urticaria. Major progress has been achieved in recent years both in the understanding of their ligands, the H1-histamine receptors, and therefore in the mechanisms of their pharmacologic effects, as well as in the development of safer antihistamines with low or no sedating effects and no interactions on the level of potassium channels leading to QT-prolongations and interactions on the level of cytochrome P450 isoenzymes. This development has brought antihistamines very close to the ideal antihistamines that are desired by clinicians to treat most types of urticaria in patients who have to take these drugs for a long time.
Asunto(s)
Antagonistas de los Receptores Histamínicos H1/uso terapéutico , Urticaria/tratamiento farmacológico , Ciclizina/uso terapéutico , Sistema Enzimático del Citocromo P-450/biosíntesis , Difenhidramina/uso terapéutico , Electrocardiografía/efectos adversos , Humanos , Prometazina/uso terapéutico , Pirilamina/uso terapéuticoRESUMEN
Following the establishment of an acute pain service in one UK acute NHS trust, including the introduction of patient-controlled analgesia (PCA), pain scoring, and a rationalization of the use of simple analgesics, attention was drawn to an apparent increase in postoperative nausea and vomiting (PONV) among women given PCA following abdominal hysterectomy. Audits were conducted into clinical practice and patient satisfaction and it was agreed that an evaluation of the evidence should be conducted to ensure that the correct direction for development in the management of PONV could be established. This article discusses the evidence surrounding the issues regarding the management of PONV in patients who have been given PCA. The possibility of adding antiemetics to the analgesic solution, and the choice of antiemetic drugs, are investigated. Other factors that can affect the incidence of PONV in patients with PCA are also discussed, and an auditable framework for the evaluation of clinically effective practice is suggested.
Asunto(s)
Analgesia Controlada por el Paciente/efectos adversos , Analgesia Controlada por el Paciente/métodos , Antieméticos/uso terapéutico , Histerectomía/efectos adversos , Náusea y Vómito Posoperatorios/etiología , Náusea y Vómito Posoperatorios/prevención & control , Protocolos Clínicos , Ciclizina/uso terapéutico , Medicina Basada en la Evidencia , Humanos , Incidencia , Auditoría de Enfermería , Ondansetrón/uso terapéutico , Náusea y Vómito Posoperatorios/epidemiología , Factores de RiesgoRESUMEN
In a randomized, double-blind trial, we compared i.v. ondansetron 4 mg (control), i.v. ondansetron 4 mg and cyclizine 50 mg (combination) and i.v. saline 0.9% (placebo), given after induction of standardized anaesthesia, for the prevention of nausea and vomiting (PONV) after day-case gynaecological laparoscopic surgery. Compared with placebo, fewer patients in the control group vomited (9/20 versus 11/59, P = 0.02) or needed rescue antiemetic (7/20 versus 9/59, P = 0.06) before discharge. Compared with the control, fewer patients in the combination group (n = 60) vomited (11/59 versus 2/60, P = 0.01) or needed rescue antiemetic (29/59 versus 2/60, P = 0.03) before discharge. The incidence of vomiting in the combination group was less than 5% overall. Compared with the control, the combination group had a significantly lower incidence (P = 0.001) and severity (P < 0.001) of nausea after discharge and more patients with no PONV at any time during the study (15/59 versus 27/60, P = 0.03). Unlike the placebo and control groups, no patient receiving combination prophylaxis was admitted overnight for PONV management.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios , Antieméticos/uso terapéutico , Laparoscopía , Náusea y Vómito Posoperatorios/prevención & control , Adulto , Ciclizina/uso terapéutico , Método Doble Ciego , Quimioterapia Combinada , Femenino , Antagonistas de los Receptores Histamínicos H1/uso terapéutico , Humanos , Ondansetrón/uso terapéutico , Antagonistas de la Serotonina/uso terapéutico , Resultado del TratamientoRESUMEN
Objective. To test the validity of an animal model in selecting anti-motion sickness drugs, and compare the effects of two drugs. Method. Anti-motion sickness effects of two drugs (Cyclizine and Scopolamin-d-amphetamin compound) were observed in rats with motion sickness (MS) induced by rotatory stimulation and the amount of Kaolin ate by rats was taken as an evaluation criterion. Result. The consumption of Kaolin by the rats decreased significantly after administration of both drugs, and the effect of Scopolamin-d-amphetamin compound was better than those of Cyclizine under the same condition. Conclusion. It suggests that the rat model of motion sickness is practical and useful in studying anti-motion sickness drugs.
Asunto(s)
Antieméticos/uso terapéutico , Estimulantes del Sistema Nervioso Central/uso terapéutico , Ciclizina/uso terapéutico , Dextroanfetamina/uso terapéutico , Mareo por Movimiento/tratamiento farmacológico , Escopolamina/uso terapéutico , Animales , Modelos Animales de Enfermedad , Relación Dosis-Respuesta a Droga , Combinación de Medicamentos , Caolín , Mareo por Movimiento/prevención & control , Pica/tratamiento farmacológico , Pica/prevención & control , RatasRESUMEN
We have compared ondansetron 4 mg i.v. and cyclizine 50 mg i.v., in a double-blind, randomized, placebo-controlled study for the prevention of postoperative nausea and vomiting (PONV) for 24 h after day-case gynaecological laparoscopy. Compared with placebo (n = 58), ondansetron (n = 60) and cyclizine (n = 57) reduced significantly the incidence of moderate or severe nausea (30% and 23% vs 52%; P = 0.02 and P = 0.001, respectively) and requirement for escape antiemetic (28% and 16% vs 47%; P = 0.04 and P < 0.001, respectively) before discharge from hospital. There were no significant differences in PONV after discharge. Significantly more patients suffered no PONV before and after discharge after ondansetron and cyclizine compared with placebo (31% and 33% vs 12%; P = 0.02 and P < 0.01, respectively). For diagnostic laparoscopy (n = 74), fewer patients received escape antiemetic after cyclizine than after ondansetron (4% vs 37%; P < 0.01); for laparoscopic sterilization (n = 101), both antiemetics were equally effective. Ondansetron and cyclizine both reduced severe and moderate nausea and the need for antiemetic therapy after day-case gynaecological laparoscopy.
Asunto(s)
Antieméticos/uso terapéutico , Ciclizina/uso terapéutico , Laparoscopía , Ondansetrón/uso terapéutico , Náusea y Vómito Posoperatorios/prevención & control , Adulto , Procedimientos Quirúrgicos Ambulatorios , Análisis de Varianza , Método Doble Ciego , Femenino , Antagonistas de los Receptores Histamínicos H1/uso terapéutico , Humanos , Persona de Mediana Edad , Antagonistas de la Serotonina/uso terapéuticoRESUMEN
An audit of post-operative nausea and vomiting (PONV) was undertaken in 935 female patients who used morphine patient-controlled analgesia (PCA) for pain relief after major gynaecological operations in a district general hospital. We investigated retrospectively five different antiemetic policies and a reference group without policy from January 1993 to July 1995. The department's computerized audit system was used to analyse the observations. At the beginning of the audit, the incidence of nausea and vomiting was as high as 71.5%. But as a consequence of this audit, a departmental policy was adopted 3 years later, which had an incidence of PONV of only 51.7%. During this time the compliance with antiemetic protocols increased from 41% to 76%. There was significantly less PONV if an antiemetic protocol was followed (P = 0.002). This emphasizes the importance of corporate involvement in the development, formulation and evaluation of departmental protocols if compliance is to be high. We conclude that audit as a corporate effort improves the acceptance of departmental protocols. This reduces PONV significantly irrespective of the type of antiemetic drug used.
Asunto(s)
Servicio de Anestesia en Hospital/organización & administración , Genitales Femeninos/cirugía , Auditoría Médica , Náusea y Vómito Posoperatorios/prevención & control , Analgesia Controlada por el Paciente/efectos adversos , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/efectos adversos , Antieméticos/administración & dosificación , Antieméticos/uso terapéutico , Actitud del Personal de Salud , Cinarizina/uso terapéutico , Protocolos Clínicos , Ciclizina/uso terapéutico , Droperidol/uso terapéutico , Inglaterra , Femenino , Hospitales de Distrito/organización & administración , Hospitales Generales/organización & administración , Humanos , Incidencia , Modelos Logísticos , Morfina/administración & dosificación , Morfina/efectos adversos , Ondansetrón/uso terapéutico , Política Organizacional , Dolor Postoperatorio/prevención & control , Proclorperazina/uso terapéutico , Estudios RetrospectivosRESUMEN
BACKGROUND: The most common pharmacological agents for alleviating symptoms of motion sickness in the U.S. are over-the-counter antihistamines. Two example are dimenhydrinate (Dramamine) and cyclizine (Marezine). HYPOTHESIS: Dramamine and Marezine suppress overall motion sickness symptoms with equal effectiveness, but Dramamine affects the central nervous system (CNS), while Marezine affects the stomach directly. METHODS: This study employed a double-blind, within-subject design to compare the effectiveness of Marezine (50 mg) and Dramamine (50 mg), in preventing subjective symptoms and gastric dysrhythmias associated with motion sickness. The sedative effects of the two drugs were also compared. Electrogastrograms (EGGs) were recorded from 23 subjects during 2 counterbalanced sessions for 3 trial periods: an 8-min pre-drug baseline, an 8-min pre-rotation baseline, which began 30 min after drug ingestion, and a 16-min period of exposure to a rotating optokinetic drum. Subjects reported any subjective symptoms of motion sickness (SSMS) and drowsiness before and during induction of motion sickness. RESULTS: There were no statistically significant differences between the two drug conditions for the overall mean SSMS scores. However, when the scores were divided into symptom groups, Marezine was associated with significantly lower scores than Dramamine for gastrointestinal (GI) symptoms. Also, Marezine was associated with significantly less drowsiness than Dramamine 30 min after ingestion. Power in both the normal (3 cpm) and tachyarrhythmia (4-9 cpm) ranges of the EGG increased significantly more during rotation compared to baseline in the Dramamine condition than in the Marezine condition. CONCLUSIONS: Marezine and Dramamine are similarly effective in preventing the overall subjective symptoms of motion sickness. While Dramamine's effectiveness may be related to its sedative properties, Marezine may work more directly on the stomach and thus be more effective in preventing gastric dysrhythmias and reports of GI symptoms.
Asunto(s)
Antieméticos/uso terapéutico , Ciclizina/uso terapéutico , Dimenhidrinato/uso terapéutico , Mareo por Movimiento/tratamiento farmacológico , Adolescente , Adulto , Estudios Cruzados , Método Doble Ciego , Femenino , Motilidad Gastrointestinal/efectos de los fármacos , Humanos , Masculino , Fases del Sueño/efectos de los fármacos , Factores de TiempoRESUMEN
This study determined the overall incidence of postoperative nausea and vomiting (PONV) in 38 patients undergoing laparoscopic gynaecological procedures who received a standardized propofol/isoflurane anaesthetic but no preoperative antiemetic. A further 166 patients similarly anaesthetized were then randomly allocated to receive either metoclopramide 10 mg. ondansetron 4 mg, or cyclizine 50 mg as an intravenous antiemetic immediately preinduction. Overall incidence of PONV was determined for all groups and the relative efficacy of the three antiemetic agents assessed. Fifty per cent of patients in the initial group (no antiemetic) reported significant nausea and/or vomiting up to 24 hours postoperatively. The incidence of PONV in the metoclopramide group was 24%, in the ondansetron group 20%, and in the cyclizine group 51%. There was no detectable difference in relative efficacy between ondansetron 4 mg and metoclopramide 10 mg. The incidence of PONV in the group who received cyclizine was similar to that found in the pilot group who received no PONV prophylaxis. Both metoclopramide and ondansetron may potentially decrease the incidence of PONV following gynaecologic laparoscopy by up to 50% when administered intravenously prior to a propofol/isoflurane anaesthetic.