Issues for surgery
For vestibular disorders – exacerbation of symptoms (e.g. vertigo, tinnitus, nausea and vomiting in Ménière’s disease) if omitted.
Advice in the perioperative period
Elective and emergency surgery
Continue, including the combination product
Combination product: cinnarizine and dimenhydrinate
Post-operative advice
If taken regularly, restart post-operatively as soon as next dose is due, otherwise restart when required.
Interactions with common anaesthetic agents
CNS depression
See also Interactions with other common medicines used in the perioperative period.
Cinnarizine has CNS depressant effects which may be additive with other medicines that also have CNS depressant effects such as:
- benzodiazepines
- inhalational anaesthetics and intravenous anaesthetics
- local anaesthetics
- opioids
Consult British National Formulary for available drugs in each class.
For combination product containing dimenhydrinate
The antimuscarinic action of dimenhydrinate may be additive with agents that also have antimuscarinic effects such as atropine and glycopyrronium.
Interactions with other common medicines used in the perioperative period
CNS depression
See also Interactions with common anaesthetic agents.
Cinnarizine has CNS depressant effects which may be additive with other medicines that also have CNS depressant effects such as:
- antiemetics (e.g. cyclizine, prochlorperazine)
- opioids
Consult British National Formulary for available drugs in each class.
Seizure threshold
Cinnarizine may lower the seizure threshold; concurrent use with other drugs that lower the seizure threshold (e.g. tramadol) might result in additive effects.
For combination product containing dimenhydrinate
Antiemetics
The antimuscarinic action of dimenhydrinate may be additive with antiemetics that also have antimuscarinic effects such as cyclizine, haloperidol, levomepromazine or prochlorperazine.
Nefopam
The antimuscarinic action of dimenhydrinate may be additive with nefopam which also has antimuscarinic effects.
Further information
None relevant.
References
Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 15th March 2021]
Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 15th March 2021]
Summary of Product Characteristics – Cinnarizine 15mg Tablets. Mylan. Accessed via www.medicines.org.uk15/03/2021 [date of revision of the text January 2021]