UK Clinical Pharmacy Association

Cinnarizine

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 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.

Sedating antihistamines have 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.

Sedating antihistamines have 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

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]

Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 15th March 2021]