Making the most of OTC meds – meclizine

This article begins a series on making the most of over-the-counter drugs. Usually medical questions begin with, “I have such and such a problem – what can I do for...

This article begins a series on making the most of over-the-counter drugs.

Usually medical questions begin with, “I have such and such a problem – what can I do for it?” Today’s approach takes the opposite tack. With a limited supply of drugs on hand, how can you maximize their use? Employing a medication for its FDA-approved use will severely limit your treatment options.

Meclizine is a good place to start because this medication exists as both an OTC and prescription medication. The over-the-counter formulation comes as a 25 mg tablet (Bonine, Dramamine, several generics), whereas the prescription options (Antivert) are 12.5, 25, and 50 mg. Obviously, the OTC formulation could be halved or doubled to achieve the prescription dose.

Traditionally meclizine is used for motion sickness, nausea, vomiting, and vertigo-type dizziness. Motion sickness includes nausea or vomiting due to any sort of motion (cars, planes, boats, roller coasters, etc). Otherwise, the drug is mostly used for nausea associated with stomach viruses. It is considered generally safe for use during pregnancy (morning sickness), especially when vomiting may lead to dehydration.

Here is the first opportunity for inventiveness. There are many other causes of nausea, including bladder infection, sinus drainage, medication use, stomach irritation, acid reflux, and anxiety or nervousness. Meclizine is generally not a first-line drug for any of these problems, but is often effective at tempering symptoms, and if it’s what you have on hand, you may find it useful.

If a patient is in dire need of a medication that nauseates them (say iron, or an antibiotic, or perhaps a corticosteroid such as prednisone), administering meclizine before the nausea-producing drug may spell the difference between recovery and relapse.

Next, any situation where appetite and thirst are depressed (raising the possibility of dehydration) may be another situation to consider the use of meclizine. Patients do not always complain of nausea or vomiting, and in fact sometimes deny these symptoms, saying instead they’ve merely lost their appetite. But loss of appetite is often a sign of mild nausea, so when adequate oral intake is a concern, meclizine may be beneficial.

When the drug is used for dizziness it is important to note that it only helps vertigo (room-spinning, or vestibular) type of dizziness. Light-headedness caused by low blood pressure, dehydration, slow heart rate, anemia, or medication reaction (to name the most common) is unlikely to respond to meclizine. Of course, patients often aren’t sure if their dizziness is more like vertigo or more light-headedness, and sometimes it’s a mix of the two. A trial of meclizine may help clarify the situation.

Next, consider side-effects as potential benefits. Chemically, meclizine is an antihistamine and often exhibits antihistamine-like activity and side-effects. Although the drug is not usually considered a sleeping pill, it often induces drowsiness, and hence may help induce sleep. In many patients it causes dry mouth (or dry nose), and thus may be helpful for symptoms of runny nose (rhinitis). It is not traditionally used for itching, but may be effective for itchy rashes such as chicken pox or poison ivy.

Many drugs that induce drowsiness are also useful as mild sedatives. Anxiety is likely to run rampant at TEOTWAWKI, and many people will yearn for relief. Although 12.5 mg may be sufficient to relieve nausea, the drug may be dosed up to 100 mg if needed, which would at least allow the majority of patients to rest.

Other side-effects may appear, especially at higher doses, including constipation (common) and diarrhea (unusual). Again, this drug is not considered a first-line treatment for diarrhea, but meclizine may well reduce diarrhea caused by irritable bowel syndrome, viral illness, or certain medications.

I have never used meclizine as an anti-spasmodic, but it may be effective at reducing muscle cramps (especially those of the intestines and bladder).

Occasionally meclizine causes hypotension (low blood pressure) and related dizziness (light-headedness). Therefore, in certain patients it may be possible to treat high blood pressure using a small daily dose of the drug.

Side-effects that are unlikely to be useful included blurred vision and urinary retention. Patients with glaucoma, prostatic enlargement, urinary blockage, and possibly asthma or COPD may be more susceptible to these side-effects, and so should start with a low dose (6.25 or 12.5 mg) if they are to take meclizine at all. In the elderly the drug may cause confusion, so again should be used with caution and at low dose. The use of meclizine in children has not been well-studied, and officially its use is not recommended for patients under 12 years of age. However, low dosages would be a consideration at least for patients in the 6-12 year age group, especially if no other options are available.

Perhaps readers of this blog have additional ideas for off-label use of meclizine. Please submit your ideas in the block below to share with others.

(Note – off-label use of medications is up to the medical practitioner to decide. Please do not take this information as endorsement of off-label use under our current health care system.)

Copyright © 2011 Cynthia J. Koelker, MD

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