Dimenhydrinate Age of Use
Dimenhydrinate can be used in adults and has been documented as beneficial for managing nausea and vomiting in this population, but there is no established safe age threshold for pediatric use, and it should be avoided in young children due to safety concerns. 1
Age-Specific Recommendations
Adults
- Dimenhydrinate has been shown to be beneficial in adults for managing nausea and vomiting associated with acute gastroenteritis 1
- The medication is commonly used as an over-the-counter antiemetic in the adult population 1
Pediatric Population - Critical Safety Concerns
The evidence does not support routine use of dimenhydrinate in children, particularly those under 6 years of age:
- Children less than 6 years of age who ingest at least 7.5 mg/kg of dimenhydrinate should be referred to an emergency department due to toxicity risk 2
- Patients 6 years of age and older who ingest at least 7.5 mg/kg or 300 mg of dimenhydrinate (whichever is less) should be referred to an emergency department 2
Specific Pediatric Risks
Seizure Risk in Infants and Young Children:
- A documented case of a 13-month-old infant who received 23 mg/kg dimenhydrinate over 2 days developed three generalized tonic-clonic seizures 3
- Infants have particular risk for dimenhydrinate intoxication, especially when suppositories are given repeatedly 3
Diagnostic Delay:
- Use of dimenhydrinate in children with vomiting is associated with significant delay in diagnosis of treatable medical conditions 4
- Children who received dimenhydrinate were more likely to present more than 12 hours after onset of vomiting (67% vs 34%, p<0.01), delaying diagnosis of conditions including asthma, pelvic inflammatory disease, and urinary tract infection 4
Clinical Approach
Before considering dimenhydrinate in any pediatric patient:
- Identify the underlying cause of vomiting first 5
- Ensure no contraindications or potential drug interactions exist 5
- Consider alternative antiemetics with better pediatric safety profiles, such as ondansetron for children >4 years of age with acute gastroenteritis 1
Key Pitfalls to Avoid
- Do not use dimenhydrinate as first-line therapy in children with vomiting - it may mask serious underlying conditions requiring prompt diagnosis 4
- Avoid repeated dosing in infants - accumulation can occur, particularly with suppository formulations, leading to toxicity 3
- Do not assume over-the-counter availability equals pediatric safety - the lack of established safe dosing in young children is a significant concern 5