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arznei-telegramm 2008; 39: 62

 


Seizures with parenteral dimenhydrinate (VOMEX A)? An emergency physician was called to a 70-year old woman with a femoral neck fracture. Before the patient was transferred to the emergency room, she was given the antiemetic dimenhydrinate (VOMEX A) slowly i.v. During the subsequent administration of an opioid, she suffered a tonic-clonic seizure with gaze deviation, stood up apparently without feeling pain, and was then unconscious until she arrived in the hospital (NETZWERK report 14.923). The doctor reported on another patient who was given half an ampoule of dimenhydrinate i.v. twice during the journey while being transferred for bypass surgery. Immediately after the second injection he had a tonic-clonic seizure with tachycardia and respiratory arrest for 20 to 30 seconds (14.924). Dimenhydrinate dissociates in the blood to the xanthine derivative 8-chlorotheophylline and the antihistamine diphenhydramine (EMESAN, generics). Seizures have been reported with theophyllines and also after overdose of diphenhydramine and dimenhydrinate. In an analysis of nearly 400 toxicity reports from California, diphenhydramine overdoses were the second most common cause of convulsions in this group of patients after bupropion (ELONTRIL, ZYBAN) (THUNDIYIL, J. G. et al.: J. Med. Toxicol. 2007; 3: 15-9). In the reports referred to above, however, the dosages were in the therapeutic range. The first patient was given an injection of 0.15 mg fentanyl (FENTANYL, generics), which can also provoke seizures, following the dimenhydrinate. In the second patient, the concomitant circumstances including any comedication are unknown. Dimenhydrinate, which has been available since the 1950s, continues to be used frequently. If seizures due to dimenhydrinate or diphenhydramine are suspected, please notify our MUTUAL INFORMATION NETWORK.



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