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Published on: November 9, 2016
[How safe are dimenhydrinate suppositories?]
M K Bernhard1, U Mütze, S Syrbe
1Universitätsklinik und Poliklinik für Kinder und Jugendliche, Leipzig.
Insights
Infants may experience dimenhydrinate intoxication, leading to seizures, particularly with repeated suppository use. Prompt medical evaluation is crucial for diagnosis and management of adverse drug reactions.
Area of Science:
- Pediatric Pharmacology
- Clinical Toxicology
- Neuroscience
Background:
- Dimenhydrinate, an antihistamine, is commonly used for nausea and vomiting.
- Overdosing in infants can lead to serious adverse effects.
- Understanding the pharmacokinetic profile in infants is crucial for safe dosing.
Observation:
- A 13-month-old infant presented with generalized tonic-clonic seizures after receiving multiple dimenhydrinate suppositories.
- The infant's total dosage was 23 mg/kg over two days.
- Seizures began approximately 10 hours after the last dose.
Findings:
- Elevated plasma diphenhydramine levels (230 µg/l) were detected post-seizure.
- Electroencephalography (EEG) and MRI brain scans were largely unremarkable, showing only minor gliotic spots.
- Seizures were successfully managed with diazepam, and no further seizures occurred in the subsequent four years.
Implications:
- Repeated administration of dimenhydrinate, especially via suppositories, poses a risk of intoxication in infants.
- Healthcare providers should exercise caution when prescribing dimenhydrinate to young children, considering alternative treatments.
- This case highlights the importance of monitoring drug levels and potential toxicity in pediatric patients.
History:
A 13-month-old girl suffered from 3 generalized tonic-clonic seizures for several minutes within a total period of 9 hours. History revealed that the child received a total of 5 dimenhydrinate containing suppositories à 40 mg during the previous 2 days (i. e. 23 mg dimenhydrinate per kg body weight) due to enteritis with vomiting. The first seizure occurred 10 hours after the last administration.
Investigations:
The plasma level of diphenhydramin was 230 µg/l approximately one hour after the first seizure. Electroencephalography showed no pathological signs, an MRI scan of the brain was normal except of several small gliotic spots and body temperature was regularly.
Treatment And Course:
Two stationary occurring seizures were stopped with 5 mg diazepam rectally. Continued surveillance and an EEG two days later showed age-appropriate normal findings. There were no further seizures in the next 4 years.
Conclusion:
Infants have the risk to develop dimenhydrinate intoxication, especially in cases where suppositories were given repeatedly because of intermittent defecation.
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