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 that serves as a first-line pharmacologic antiemetic therapy for nausea and vomiting 2
- It is specifically FDA-approved for the prevention and treatment of nausea, vomiting, and vertigo associated with motion sickness 1
- Dimenhydrinate at doses of 25-50 mg three times daily is recommended for treating nausea and vomiting in refractory gastroparesis 2
Use in Pregnancy
- Dimenhydrinate is considered safe as a first-line pharmacologic antiemetic therapy for persistent nausea and vomiting during pregnancy (NVP) when non-pharmacologic approaches are ineffective 2
- It is used when symptoms persist despite lifestyle modifications and non-pharmacologic interventions such as ginger and vitamin B6 (pyridoxine) 2
- The American College of Obstetricians and Gynecologists (ACOG) recommends dimenhydrinate among other H1-receptor antagonists for persistent NVP 2
Use in Vestibular Disorders
- Dimenhydrinate is used in the treatment of Ménière's disease to manage vertigo symptoms 2
- It has demonstrated efficacy in reducing vertigo in experimental studies, comparable to transdermally administered scopolamine 3
Pediatric Use
- Dimenhydrinate appears to be safe for use in the pediatric population for treating vomiting, though the underlying cause of vomiting should be identified first 4
- For children with acute gastroenteritis, antiemetics including dimenhydrinate may be considered, but are not a substitute for fluid and electrolyte therapy 2
Dosing Considerations
- Adults: Typical dosing is 25-50 mg three times daily 2
- Children: Dosing should be adjusted based on age and weight, with careful attention to potential adverse effects 4
Important Cautions and Contraindications
- Dimenhydrinate should not be given to children under 18 years with acute diarrhea 2
- Due to its anticholinergic properties, dimenhydrinate taken in supratherapeutic doses has been associated with euphoria, anxiolysis, and hallucinations 5
- There is documented potential for abuse and dependence, particularly due to its interactions with multiple neurotransmitter systems 6
- Toxicity can occur with overdose, with children under 6 years ingesting at least 7.5 mg/kg requiring emergency department evaluation 7
- Patients 6 years and older who ingest at least 7.5 mg/kg or 300 mg (whichever is less) should be referred for emergency evaluation 7
Side Effects
- Common side effects include drowsiness, dizziness, and anticholinergic effects such as dry mouth 7
- More severe adverse effects can include confusion, hallucinations, and paradoxical excitation, particularly at higher doses 5
- In cases of overdose, symptoms may progress to agitation, hallucinations, seizures, and respiratory depression 7
When prescribing dimenhydrinate, clinicians should carefully consider the indication, appropriate dosing, and potential for side effects or abuse, especially when used for extended periods or in vulnerable populations.