When is Gravol (dimenhydrinate) indicated in patients with anorexia?

Dimenhydrinate (Gravol) in Anorexia Patients: Indications and Management

Dimenhydrinate (Gravol) is not specifically indicated for patients with anorexia nervosa and should be used with extreme caution due to potential for abuse and limited therapeutic benefit in this population. 1

Appropriate Indications for Dimenhydrinate in Anorexia Patients

• Dimenhydrinate may be considered only for short-term management of nausea and vomiting that interferes with nutritional intake in anorexia patients, when other reversible causes have been addressed 1
• Should be limited to specific clinical scenarios where the benefit of treating nausea/vomiting outweighs potential risks 1
• May be appropriate during refeeding when patients experience significant nausea that impedes nutritional rehabilitation 1

Contraindications and Concerns

• High potential for abuse due to anticholinergic properties that can produce euphoria, anxiolysis, and hallucinations at supratherapeutic doses 2, 3
• Risk of addiction and dependency, particularly concerning in vulnerable psychiatric populations 2
• May mask underlying medical complications of anorexia that require medical attention 1
• Can exacerbate cognitive impairment already present in severely malnourished patients 1
• May worsen gastrointestinal dysmotility already present in anorexia patients 1

Recommended Approach to Management

First-Line Interventions (Before Considering Dimenhydrinate)

• Address reversible causes of nausea/vomiting such as:

  • Oropharyngeal candidiasis 1
  • Depression 1
  • Constipation 1
  • Medication side effects 1
  • Anxiety 1

• Consider metoclopramide for early satiety or gastroparesis symptoms 1

When to Consider Dimenhydrinate

• Only after failing first-line interventions 1
• When nausea/vomiting is significantly impacting nutritional rehabilitation 1
• For short-term use only during acute phases of treatment 1
• At standard therapeutic doses (50-100mg every 4-6 hours, not exceeding 400mg/day) 4

Monitoring Requirements

• Regular assessment for signs of abuse or misuse 2
• Monitor for sedation, cognitive impairment, and anticholinergic side effects 4
• Evaluate effectiveness in improving nutritional intake 1
• Consider discontinuation if no clear benefit after 3-5 days 4

Special Considerations

• Patients with anorexia nervosa who have delayed gastric emptying may benefit more from prokinetic agents like metoclopramide rather than antihistamines like dimenhydrinate 1
• Patients with comorbid anxiety may experience paradoxical agitation with dimenhydrinate 1
• Risk of abuse is higher in patients with history of substance use disorders 2, 3
• Severely malnourished patients may have altered drug metabolism, potentially increasing risk of side effects 1

Alternatives to Consider

• Metoclopramide for gastroparesis and early satiety 1
• Olanzapine for both anxiety and nausea (may also stimulate appetite) 1
• Non-pharmacological interventions including cognitive behavioral therapy for anxiety-related nausea 1
• Nutritional rehabilitation itself may resolve gastrointestinal symptoms in many cases 1

Remember that the primary focus of treatment in anorexia nervosa should be nutritional rehabilitation and addressing the underlying psychological factors, with symptom management as a supportive measure only when necessary 1.