Medical Indications for Dimenhydrinate (Gravol)
Dimenhydrinate is primarily indicated for the prevention and treatment of nausea, vomiting, or vertigo associated with motion sickness. 1
Primary Indications
Dimenhydrinate is an H1-receptor antagonist with antiemetic properties that has several established medical uses:
Motion Sickness
Nausea and Vomiting in Various Contexts
Vertigo
- Management of vertigo symptoms in conditions like Ménière's disease 4
Dosing and Administration
- Adults: 25-50 mg orally, 3-4 times daily
- Children: Dosing based on weight and age (pediatric use should be carefully considered) 5
- Available forms: Oral tablets, liquid, injectable formulations, and suppositories
Clinical Applications in Specific Conditions
Pregnancy-Related Nausea and Vomiting
Dimenhydrinate is considered a safe first-line pharmacologic antiemetic therapy for persistent nausea and vomiting of pregnancy (NVP) that is refractory to non-pharmacologic therapy such as ginger and vitamin B6 (pyridoxine) 4. The American College of Obstetricians and Gynecologists (ACOG) recognizes it as an appropriate option when non-pharmacologic approaches fail.
Gastroparesis
In refractory gastroparesis, dimenhydrinate (25-50 mg three times daily) may be used as an antiemetic option for symptom management 4. However, it is not a first-line therapy for this condition.
Infectious Diarrhea
For patients with infectious diarrhea accompanied by nausea and vomiting, antiemetic agents including dimenhydrinate may be considered once the patient is adequately hydrated 4. However, fluid and electrolyte therapy should remain the primary treatment.
Ménière's Disease
Dimenhydrinate may be used to reduce symptoms of vertigo in patients with Ménière's disease 4.
Important Precautions and Limitations
Not for primary antiemetic use: Dimenhydrinate is not recommended as a primary antiemetic agent in chemotherapy-induced nausea and vomiting, where 5-HT3 antagonists are preferred 6
Side effects: Common side effects include drowsiness, dry mouth, blurred vision, and potential for anticholinergic effects, particularly in elderly patients 6
Risk of abuse: There is potential for abuse due to anticholinergic properties that can produce euphoria, anxiolysis, and hallucinations at supratherapeutic doses 7
Contraindications: Use with caution in patients with glaucoma, prostatic hypertrophy, asthma, or bladder neck obstruction
Conclusion
Dimenhydrinate is a versatile antiemetic medication primarily indicated for motion sickness but with applications in various other conditions causing nausea, vomiting, or vertigo. While effective for these indications, it should be used judiciously, especially in pediatric and elderly populations, and with awareness of its potential side effects and abuse potential.