Antivert
Prospective follow-up of adverse reactions in breast-fed infants exposed to maternal medication.

Ito S, Blajchman A, Stephenson M, Eliopoulos C, Koren G.

Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.

OBJECTIVE: Our objective was to characterize the short-term effects of maternal medications on breast-fed infants. STUDY DESIGN: A cohort of 838 infants breast-fed by women who were taking medications was prospectively studied, and the incidence of adverse reactions in the infants during maternal therapy was recorded by telephone interviews. RESULTS: No major adverse reactions necessitating medical attention were observed in 838 breast-fed infants. However, 94 women (11.2%) reported infants' minor adverse reactions that did not require medical attention to the following maternal medications: (1) Antibiotics 19.3% (32/166); (2) analgesics or narcotics 11.2% (22/196); (3) antihistamines 9.4% (8/85); (4) sedatives, antidepressants, or antiepileptics 7.1% (3/42); and (5) others 9.9% (43/435). The most common minor adverse effects varies among drug categories, as follows: Antibiotics caused diarrhea (21/32); (2) analgesics or narcotics caused drowsiness (11/22); (3) antihistamines caused irritability (6/8); and (4) sedatives, antidepressants, or antiepileptics caused drowsiness (2/3). By identifying the 31 most frequently used drugs in our cohort, we have provided the first information on safety of breast-feeding during maternal therapy with such drugs as terfenadine, diphenhydramine, astemizole, dimenhydrinate, chlorpheniramine, 5-aminosalicylic acid, and alprazolam. CONCLUSIONS: The short-term effects, if any, of most maternal medications on breast-fed infants are mild and pose little risk to the infants.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8498418&dopt=Abstract dimenhydrinate meclizine Antivert



Antivert
[Results of a survey of anesthetists on postoperative nausea and vomiting]

[Article in German]

Eberhart LH, Morin AM, Felbinger TW, Falkner Y, Georgieff M, Seeling W.

Universitatsklinik fur Anasthesiologie Ulm.

OBJECTIVE: Although an increasing number of studies concerning postoperative nausea and vomiting (PONV) have been performed, we do not know, what anaesthesiologists think about this problem and how they handle it in their daily routine. METHODS: A survey was performed involving anesthesiologists at 30 institutions of different size. 474 out of 1000 questionnaires were returned. RESULTS: When asked what kind of general anaesthesia they prefere in a woman at a very high risk to suffer PONV, the following answers were obtained: anaesthesia induction with propofol (78%), thiopentone (17%), etomidate (5%). Maintenance of anaesthesia with an inhalation anesthetic (44%) or with propofol (44%). The remaining 14% would use a combination of these techniques (6%) or neuroleptanaesthesia with droperidol (5%) or midazolam (1%). Only 10% of the respondants would omit nitrous oxide. There is no consensus about the optimal amount of intraoperative opioids. Fentanyl, alfentanil, and sufentanil are rated to contribute equally to the occurence of PONV, whereas opioids used for postoperative analgesia are thought to have substantial differences: piritramid is rated to be much less emetogenic than tramadol and morphine. 70% advocate routine antiemetic prophylaxis for high-risk patients (most often mentioned risk factors were: female sex: 85%, obesity: 81%, high doses of intraoperative opioids: 72%) and 23% administrate antiemetics even for all patients. Ondansetron and droperidol are suggested to be superior to metoclopramide, triflupromazine, dimenhydrinate, and transdermal scopolamine. However, metoclopramide is the drug of first choice for more than 50% of the respondants followed by droperidol, whereas only 29% use ondansetron as a first line drug. An unexpected high number of anaesthesiologists (13%) have experience with non-pharmacological methods for prophylaxis and treatment of PONV. Acupuncture/acupressure (10%) was most often mentioned. CONCLUSION: A great majority (93%) stated, that PONV is a relevant problem, that still remains unsolved. This proofs the need for further controlled studies.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9787862&dopt=Abstract dimenhydrinate meclizine Antivert



Antivert
Comparison of Seven Commonly Used Agents for Prophylaxis of Seasickness.

Schmid R, Schick T, Steffen R, Tschopp A, Wilk T.

Institute of Social and Preventive Medicine of the University of Zurich, Switzerland.

The objective of the study was to compare the efficacy and tolerability of seven drugs frequently used for the prevention of seasickness: the drugs were namely cinnarizine, cinnarizine with domperidone, cyclizine, dimenhydrinate with caffeine, ginger root, meclozine with caffeine, and scopolamine. The design was a randomized, double-blind study with two arms. On ethical grounds, a placebo group was not included as in a previous study, in the same setting, 80% of the passengers not receiving prophylactic drugs were seasick. The setting was in Andenes (Norway) during a time period from July to September 1992. Subjects were 1741 tourist volunteers who were joining a whale safari. The main outcome measures were vomiting, malaise (modified Graybiel criteria), and subjective reports of adverse events. Follow up was possible in 1489 volunteers (85.5%). In each active treatment group, 4.1-10.2% experienced vomiting and 16.4-23.5% experienced malaise (not significant). Equally, there was no significant difference in the incidence and characteristics of adverse events reported in the various medication groups. Scopolamine Transdermal Therapeutic System (TTS) users exhibited slightly more visual problems and the agent tended to be less effective. Six of the seven medications may be recommended for prevention of seasickness; scopolamine TTS seems the least attractive.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9815340&dopt=Abstract dimenhydrinate meclizine Antivert



Antivert
Peripheral nerve injection injury with antiemetic agents.

Strasberg JE, Atchabahian A, Strasberg SR, Watanabe O, Hunter DA, Mackinnon SE.

Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.

Antiemetics are widely used drugs, frequently administered to alleviate postoperative and postchemotherapeutic nausea and vomiting. While antiemetics do not induce peripheral neurotoxicity when administered systemically, it is not known whether peripheral nerve injury can occur as a result of inadvertent intraneural injection during intramuscular administration. The purpose of this study was to characterize the neurotoxic effect of three commonly used antiemetic agents (promethazine, dimenhydrinate, and prochlorperazine) as compared to saline in the rat sciatic nerve model. Intrafascicular and extrafascicular injection as well as direct application of the antiemetic drugs were performed. Nerves were harvested at 2 weeks postoperatively for histology and morphometry, with an additional sacrifice point at 8 weeks for the intrafascicular injection group. Injection injuries caused by antiemetic drugs differed depending on the agent injected and the location of injection. Extrafascicular injection and direct application caused no damage. Intrafascicular injection caused diffuse axonal injury in the promethazine and dimenhydrinate groups, while prochlorperazine caused only focal injury. Regeneration was prominent at 8 weeks in all intrafascicular injection groups in this rat model. Prochlorperazine thus appears to be less neurotoxic when injected intraneurally and should preferentially be used for intramuscular injections.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9989469&dopt=Abstract dimenhydrinate meclizine Antivert