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Background: Remimazolam is a relatively new benzodiazepine with growing use in procedural sedation and general anaesthesia. Initiated by case reports, the physical incompatibility of remimazolam with ringer's acetated and ringer's lactated solution has been reported. More recently, remifentanil, fentanyl, rocuronium, vecuronium, dexmedetomidine, and midazolam, have been investigated and suggested safe for coadministration with remimazolam. Apart from case reports, incompatibility for other frequently used drugs remains unknown. Methods: Sixty-five drugs and intravenous fluids were tested for possible precipitation with remimazolam in a simulated y-site administration. Equal volumes of the test drug were injected into the remimazolam solution, examined and photo documented at 1, 15, 30 and 60 min after mixture. Examination was taken by two independent investigators. pH was measured before, and 60 min after mixing the drugs. Results: Seventeen (26.15%) drugs or fluids showed precipitation, 47 (72.31%) did not show any sign of interaction. Propofol could not be assessed, because of the turbidity of the substance itself. Precipitation occurred immediately and remained stable in all timestamps. The incompatible drug-remimazolam-mixtures had a median pH of 7.15 (6.67, 8.01), the non-precipitating mixtures a median pH of 4.75 (3.8, 5.6). The pH-values of both groups were significantly different (Mann-Whitney-U-test; p <.00001). There is an increasing risk for precipitation with more basic baseline pH-levels of the tested drug. No interaction was seen in baseline pH below 5. Conclusions: Remimazolam (Byfavo®) is incompatible with ampicillin/ sulbactam, calcium gluconate, clindamycin, dexamethasone, dimenhydrinate, an 148mval/l electrolyte - glucose 1% solution (E148G1®), furosemide, a 4% gelatine volume expander (gelafundin®), heparin sodium, insulin, meropenem, sodium bicarbonate 8.4%, prednisolone, the crystalloid infusions jonosteril® and sterofundin®, thiopental and tranexamic acid. The results strongly affirm remimazolam's safety requirements: A separate line for remimazolam and an approved compatible baseline infusion is mandatory and an alternative way to administer bolus medication is required. [ABSTRACT FROM AUTHOR]

Resumen: Introducción y objetivos: el mareo, abarcando el vértigo, el desequilibrio y el presíncope, afecta al 15–20% de los adultos, aumentando el riesgo de caídas, especialmente en ancianos. La interacción entre señales del sistema vestibular periférico, los núcleos vestibulares y el sistema nervioso central, modulada por neurotransmisores como glutamato, acetilcolina y glicina, junto con histamina, adrenalina y noradrenalina, es crucial para el equilibrio. El mareo surge cuando la información vestibular no coincide con otras fuentes y puede asociarse con diversas condiciones neurológicas, psiquiátricas, respiratorias o infecciosas. El tratamiento actual se basa en reposo, maniobras de reposición de partículas y medicamentos como betahistina y sedantes; pero la combinación fija de cinarizina y dimenhidrinato ha demostrado eficacia en ensayos clínicos, tratando eficazmente el vértigo de varios orígenes, actuando en sistemas vestibulares periféricos y centrales. Pacientes: presentamos 7 casos clínicos en los que hemos utilizado el mismo tratamiento con cinarizina y dimenhidrato a dosis de 20/40 mg. Resultados: la combinación de cinarizina y dimenhidrinato demostró ser efectiva en el manejo de una variedad de trastornos vestibulares, incluyendo vértigo posicional paroxístico benigno recurrente, migraña vestibular, síndrome de Ménière y presbivestibulopatía. Los pacientes experimentaron mejoría en los síntomas vestibulares como mareos, vértigo y desequilibrio, siendo un fármaco seguro y eficaz, demostrando en algunos casos la resolución de los síntomas en pacientes previamente tratados con otras terapias. Conclusión: la versatilidad de la combinación permite su uso en el tratamiento de vértigos de origen diverso, lo que lo convierte en una opción integral y valiosa para situaciones donde el diagnóstico preciso de las causas del vértigo no está claro. Abstract: Introduction and objectives: Dizziness, including vertigo, imbalance, and presyncope, affects 15–20% of adults, increasing the risk of falls, especially in the elderly. The interaction between signals from the peripheral vestibular system, vestibular nuclei, and the central nervous system, modulated by neurotransmitters such as glutamate, acetylcholine, and glycine, along with histamine, adrenaline, and noradrenaline, is crucial for balance. Dizziness arises when vestibular information does not match other sources and can be associated with various neurological, psychiatric, respiratory, or infectious conditions. Current treatment is based on rest, particle replacement maneuvers and medications such as betahistine and sedatives, but the fixed combination of cinnarizine and dimenhydrinate has proven effective in clinical trials, effectively treating vertigo of various origins by acting on peripheral and central vestibular systems. Patients: We present 7 clinical cases, in which we have used the same treatment with cinnarizine and dimenhydrate at fixed doses of 20/40 mg. Results: The combination of cinnarizine and dimenhydrinate proved effective in managing a variety of vestibular disorders, including recurrent benign paroxysmal positional vertigo, vestibular migraine, Meniere's syndrome, and presbivestibulopathy. Patients experienced improvement in vestibular symptoms, such as dizziness, vertigo, and imbalance, proving to be a safe and effective drug, demonstrating in some cases the resolution of symptoms in patients previously treated with other therapies. Conclusion: The versatility of the combination allows its use in the treatment of vertigo of various origins, making it a comprehensive and valuable option for situations where the precise diagnosis of the causes of vertigo is not clear.

Easy access to over-the-counter (OTC) drugs makes it possible to procure active substances that normally used in therapeutic doses do not raise health problems. The use of high doses of OTC drugs containing codeine, loperamide, pseudoephedrine, diphenhydramine or dimenhydrinate, as well as the use of benzidamine systemically raises concerns regarding the increase in units sold. These drugs are used for recreational or euphorizing purposes, including by young women of childbearing age, psychoactive substance users representing a risk group in terms of the possibility of an unplanned pregnancy. Abusive consumption of OTC products during pregnancy is harmful, with consequences for both fetal and late development that can occur in the infant. This literature review presents the risks (teratogenicity, fetal toxicity, neonatal abstinence syndrome, etc.) associated with the use of potentially psychoactive OTC drugs to emphasize the importance of re-evaluating OTC classification and dispensing. [ABSTRACT FROM AUTHOR]

Although the Epley maneuver is considered the primary treatment in BPPV, anti-vertigo medications are effective in residual symptoms. This study was designed to compare betahistine and dimenhydrinate plus the Epley maneuver and the Epley maneuver alone. This prospective cohort study was performed in Mashhad, Iran, from 2013 to 2015. 90 adult patients diagnosed with BPPV in hospitals and ENT clinics were selected through convenience sampling. Patients received betahistine 8 mg TDS or dimenhydrinate 50 mg once daily plus Epley or the Epley alone for four weeks. SF-36 and the DHI were used before and after the treatment. 49 were females (54.4%). The mean (SD) age was 47.9 (8.7) years. There was no significant difference between the groups in age (P = 0.753) and gender (P = 0.050).There were significant differences in all areas of SF-36 except for social activities in the dimenhydrinate group. There was a marginally significant difference between the betahistine and dimenhydrinate groups in role limitation due to physical health problems (P = 0.046). There were significant differences between the females and males in emotional well-being before and after treatment in the dimenhydrinate group (P = 0.014) and in terms of role limitation due to physical health problems in the Epley maneuver group (P = 0.022). Older patients in the betahistine group had better social activities after treatment (P = 0.048). In severe forms of BPPV, betahistine or dimenhydrinate might effectively reduce the symptoms. [ABSTRACT FROM AUTHOR]

Dimenhydrinate (DMH), used to alleviate motion sickness symptoms such as nausea, vomiting, dizziness, and vertigo, encounters limitations in oral pharmaceutical formulations due to its poor water solubility and bitter taste. Our research hypothesized that inclusion complexation with β-cyclodextrin (β-CD) might address these drawbacks while ensuring that the newly formed complexes exhibit no cytotoxic or genotoxic effects on peripheral blood mononuclear cells (PBMCs). Inclusion complexes were prepared using the kneading method and the solvent evaporation method. The phase solubility analysis, attenuated total reflectance-fourier transform infrared spectroscopy (ATR-FTIR), and differential scanning calorimetry (DSC) were conducted to evaluate the complexation efficacy and stability constant of the new binary systems. The results demonstrated that both methods provided complete and efficient complexation. Cytogenotoxic analysis, including the 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide (MTT) assay, alkaline comet assay, and cytokinesis-block micronucleus cytome (CBMN-cyt) assay, was conducted to assess the cytogenotoxic potential of DMH-β-CD inclusion complexes, a topic previously unexamined. No cytotoxic or genotoxic effects were observed within the concentration range of 36.36 to 109.09 ng/mL. Cell viability of treated PBMCs exceeded 85% for all tested concentrations. No significant increases in DNA strand breaks were observed at any dose, and tail intensity of all complexes remained lower or up to 2.2% higher than the negative control. Parameters indicating genotoxic effects, as well as cytotoxic and cytostatic potential in the CBMN-cyt assay, did not significantly differ from untreated controls. These results suggest that inclusion complexation with β-CD might be a safe and promising solution to overcome the limitations of poor solubility and unpleasant taste of DMH, potentially providing opportunities for new and improved oral pharmaceutical dosage forms.

Background: The treatment of benign paroxysmal positional vertigo (BPPV) has not been well studied. Many clinicians are indifferent about canalith reposition maneuvers and frequently prefer medical treatments. Objectives: We aimed to detect efficacy of Epley maneuver in relieving symptoms of benign paroxysmal positional vertigo patients diagnosed in emergency department and if medical treatments are useful in patients whose symptoms were not relieved. Methods: The study was conducted as a prospective cohort study in the emergency department of a tertiary hospital. Patients who were over 18 years of age and presented to emergency department with complaints of vertigo symptoms and nausea and had a positive Dix–Hallpike test were included in the study. Patients' demographic data, possible etiological factors, affected ear, and benign paroxysmal positional vertigo diagnosis in the history were recorded on the study data form. The European Evaluation of Vertigo scale and the Visual Analogue Scale (VAS) score of nausea and vertigo symptoms were graded and recorded for each patient before and after treatment. Results: Ninety patients were included in the study in total. Epley maneuver was carried out to all patients. Vertigo symptoms VAS (VASd) score (p < 0.001), nausea and vomiting VAS (VASnv) score (p < 0.001), and European Evaluation of Vertigo scale score (p < 0.001) of all patients showed a statistically significant decrease after Epley maneuver. A combination of dimenhydrinate and metoclopramide helped to reduce VASd (p = 0.048), VASnv (p = 0.031), and European Evaluation of Vertigo scale scores (p = 0.001) at a statistically significant level more than dimenhydrinate treatment alone. Conclusions: Epley maneuver may be applied to every patient with benign paroxysmal positional vertigo. Dimenhydrinate and/or metoclopramide helps to control patients' symptoms whose symptoms remain despite Epley maneuver. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to explore the differences in diagnosis (Dix-Hallpike test; the head impulse, nystagmus, and the test of skew [HINTS] procedures; imaging modalities; and audiological battery) and treatment (pharmacological treatments and the Epley maneuver) of acute vertigo (AV) by examining the perspectives of otolaryngologists, emergency physicians (EPs), and primary care physicians (PCPs). Method: A total of 123 physicians (otolaryngologists [n = 40], EPs [n = 41], PCPs [n = 42]) were included in this study. This study was conducted using an online questionnaire created in Google Forms. The questionnaire included five demographic questions and eight questions assessing the diagnosis and treatment of four case scenarios (benign paroxysmal positional vertigo [BPPV], vestibular neuronitis, Meniere's disease [MD], and vertebrobasilar insufficiency). Multiple-response and chi-square tests were used to analyze the data. Results: In the case of BPPV, 82.5% of otolaryngologists, 73.2% of EPs, and 59.6% of PCPs preferred the "Dix-Hallpike maneuver" (p = .067). In addition, 72.5% of otolaryngologists, 48.8% of EPs, and 47.6% of PCPs preferred the Epley maneuver for treatment in a case with BPPV (p = .032). It was found that physicians preferred the most (18.9%) "videonystagmography (VNG)-caloric" test for diagnosis in the MD case. There was a statistically significant difference in the intravenous serum therapy and rest, and Epley maneuver preferences of physicians for the treatment of cases with MD (p = .002 and p = .046). Conclusions: In this study, significant differences were found in the AV care provided by different specialties. Standardized education systems for AV (symposiums, congresses, scientific activities, etc., with multidisciplinary participation) may be beneficial for improving the diagnosis and treatment process of AV in our country. [ABSTRACT FROM AUTHOR]

Copyright of Monatsschrift Kinderheilkunde is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Easy access to over-the-counter (OTC) drugs makes it possible to procure active substances that normally used in therapeutic doses do not raise health problems. The use of high doses of OTC drugs containing codeine, loperamide, pseudoephedrine, diphenhydramine or dimenhydrinate, as well as the use of benzidamine systemically raises concerns regarding the increase in units sold. These drugs are used for recreational or euphorizing purposes, including by young women of childbearing age, psychoactive substance users representing a risk group in terms of the possibility of an unplanned pregnancy. Abusive consumption of OTC products during pregnancy is harmful, with consequences for both fetal and late development that can occur in the infant. This literature review presents the risks (teratogenicity, fetal toxicity, neonatal abstinence syndrome, etc.) associated with the use of potentially psychoactive OTC drugs to emphasize the importance of re-evaluating OTC classification and dispensing.

Cancer is one of the leading causes of death worldwide, and natural agents have shown some promise in fighting it. Thus, the present study tried to evaluate the healing potential of an equal combination of olive and sesame extract (MOS) against the colorectal cancerous lesions that were induced by dimethylhydrazine (DMH) in male rats and also compare the anticarcinogenic potential of the MOS and vitamin E with each other. Therefore, the mixture of equal olive and sesame extract (MOS) was used as the main treatment, alongside vitamin E as a parallel treatment. This study examined the red blood cell (RBC) and white blood cell (WBC) levels, biochemical indices, lactate dehydrogenase (LDH), C-reactive protein (CRP), total protein (TP), creatine kinase (CPK), albumin, and the colon tissue pathology, as well as the level of protein expression of the adenomatous polyposis coli (APC), proliferating cell nuclear antigen (PCNA), carcinoembryonic antigen (CEA), and platelet-derived growth factor (PDGF). Also, the tissue stress markers including total antioxidant capacity (TAC), malondialdehyde (MDA), and superoxide dismutase (SOD) were analyzed. Overall, the results represented a significant reduction in the congestion, mitotic index, inflammation, and cell destruction in the MOS group compared to the DMH group. In terms of the oxidative stress level, a significant increase was observed in the DMH group in comparison with the DMH-MOS group (P < 0.05), and the MOS significantly increased TAC level (P < 0.05). Furthermore, the DMH+MOS-exposed group exhibited a significantly lower expression of the PCNA, CEA, and PDGF proteins than those of the DMH group. Overall, the MOS showed that it can effectively prevent DMH-induced colon lesions. This mixture, as a strong antioxidant agent, can be clinically applied for preventing and treating colorectal cancer, the effectiveness of which is higher than that of vitamin E. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate the effects of dimenhydrinate on neural tube development in an early chick embryo model. Materials and Methods: 32 fertile, specific pathogen free eggs were used in the study. All eggs were divided into four groups with 8 eggs in each group. At the 28th hour of the incubation, three different doses of dimenhydrinate (0.7, 1.4, 2.1 mg/kg) were injected into the experimental groups and physiological saline was injected into the control group. At 48th hour of incubation, all embryos were dissected and evaluated histologically under the light microscope. Results: When the control, low, medium and high dose group embryos were evaluated morphologically, their mean craniocaudal lengths were 8493.73±1342.90 µm, 5743.61±770.3 µm, 5572.62±315.32 µm, 5306.55±1135.99 µm respectively, mean of somite numbers were 15.91±1.62, 15.38±1.19, 15.13±0.83, 10.63±5.15 respectively. Craniocaudal lengths and somite numbers decreased depending on the increase in the dimenhydrinate dose. The incidence of open neural tube increased due to the increase in dimenhydrinate dose. Conclusion: Neurogenesis and morphological development were negatively affected due to the increase in dose in the groups treated with dimenhydrinate in the early chick embryo model. [ABSTRACT FROM AUTHOR]

Copyright of International Journal of Clinical & Experimental Hypnosis is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Covered stent placement (CSP) is gaining popularity for the management of delayed massive hemorrhage (DMH) after pancreatic or biliary surgery. However, early studies have produced conflicting results regarding the potential advantages of the procedure. We aimed to compare the short- and medium-term outcomes of arterial embolization (AE) and CSP for DMH.Methods: We analyzed data for patients who underwent AE or CSP as an endovascular treatment (EVT) for DMH from the common hepatic artery (CHA) and its distal arteries between January 2009 and December 2019. We evaluated the major hepatic complications, in-hospital mortality, and 1-year mortality associated with the procedures, according to age, sex, reintervention, arterial variant, interval between surgery and EVT, and portal vein stenosis.Results: All hemorrhages were treated using AE (n = 50) or CSP (n = 20). CSP was associated with no in-hospital mortality (32% vs. 0%, p = 0.003), and lower incidences of major hepatic complications (44% vs. 10%, p = 0.011) and 1-year mortality (54% vs. 25%, p = 0.035) compared with AE, respectively. There was no significant difference in technical success and reintervention rates. Compared with AE, the risk-adjusted odds ratios for CSP (95% confidence intervals) for major hepatic complications and 1-year mortality were 0.06 (0.01-0.39) and 0.19 (0.05-0.71), respectively.Conclusions: CSP is superior to AE regarding major hepatic complications and in-hospital- and 1-year mortality in patients with DMH from hepatic arteries. [ABSTRACT FROM AUTHOR]

Dimenhydrinate (DMH) is a salt composed by the combination of two active pharmaceutical ingredients: diphenhydramine (DIP) and 8-chlorotheophylline (CTP). In this work, the glassy carbon electrode was electrochemically deposited in two steps. The electrode was first inserted in the Alizarin Yellow R (AYR) solution and it was placed on the surface of the electrode after 8 scans. In order to modify the electrode with copper nanoparticles, the prepared electrode was first inserted into the copper sulfate solution and coated with copper nanoparticles using cyclic voltammetry CuNps/PAYR/GCE was fabricated. SEM images showed that the copper nanoparticles were deposited on the electrode. The electrocatalytical effects of the electrochemical sensor were also studied by cyclic voltammetry (CV) and differential pulse voltammetry (DPV) techniques. This electrode was used for detection simultaneously of DIP (OX1) and CTP (OX2) in pharmaceutical samples. The results showed that the highest sensitivity for DMH was obtained at pH = 10. Finally, Also, the detection of limit, sensitivity and linear range were calculated as 0. 29 µM, 0.043 and 1–3000 µM respectively. CuNps/PAYR/GCE presented considerable advantages for instance high sensitivity, used for real samples, simple preparation, low detection of limit, and specially the simultaneous oxidation of CTP and DIP for detection of DMH. [ABSTRACT FROM AUTHOR]

Cuscuta reflexa has been traditionally used as an antiemetic. Additionally, it has been used in various herbal formulations for the treatment of emesis. So far, there is no scientific evidence of the plant extract as antiemetic. Therefore, this study was intended to assess the antiemetic activity of Juice (JCR), aqueous (CRAE) and methanolic extract (CRME) of C. reflexa in pigeons. Emesis was induced through GIT irritants like ampicillin (300 mg/kg, IM), copper sulphate (100 mg/kg, PO), conc. sodium chloride solution (1600 mg/kg, PO) and cisplatin (5-HT3 receptor stimulator) (6 mg/kg, IM). Dimenhydrinate acted as a positive control (2 mg/kg; IM). JCR [(1 ml/kg (1 %) and 1 ml/kg (2 %)], CRAE, and CRME were administered intramuscularly at different doses (50, 100 and 200 mg/kg) to each pigeon (n = 6). In each group, calculation of total number of jerks & vomiting episodes, and vomiting-weight was carried out to evaluate its antiemetic activity. The JCR exhibited a significant (p < 0.05) antiemetic impact on both the frequency and onset of emesis at 1 ml/kg (2 %) against various emesis mediator, except sodium chloride. Similarly, CRAE and CRME elicited marked dose dependent inhibition both on onset and frequency of emesis with highly significant (p < 0.001) effect at 200 mg/kg. The study reflects that juice, aqueous and methanolic extract of C. reflexa have significant antiemetic potential and possess pharmacological active constituent(s) that interfered with the emetic mediators by acting through GIT irritation and 5-HT3 receptor stimulations. Results of this study provide a scientific background to its traditional antiemetic uses.

Dimenhydrinate is a therapeutic agent used for the treatment of nausea and vomiting. A conventional dose of dimenhydrinate is 50 mg per 8 h. Once-daily controlled release tablets of dimenhydrinate were formulated intended to treat emesis. The tablets were formulated using hydrophilic polymers Methocel® and hydrophobic polymers Ethocel® and subsequently analyzed for pre-compression and post-compression characteristics, % moisture uptake, dissolution profiles and release behavior of the drug. Identification of active ingredient and compatibility of blends were analyzed through FT-IR. Drug release kinetics of dimenhydrinate was assessed at pH 1.2, 4.5 and 6.8. The results of release profiles were evaluated for different kinetic models including model dependent and model independent. The optimized formulation K100M 30% showed ideal pre-compression properties and in vitro characteristics. Tablets exhibited a controlled drug release pattern due to the formation of a viscous gel layer followed by erosion. Furthermore, zero-order best described the release pattern with the value of r2 ˃ 0.99. Once-daily tablets released 98–100% drug in 24 h. Significantly more concentration and higher viscosity grade of hydrophilic polymer ensured the required pattern of drug release. [ABSTRACT FROM AUTHOR]

Dimenhydrinate is an over-the-counter medication that is used to relieve nausea, vomiting, and vertigo caused by motion sickness. It has a short elimination half-life, possibly due to its first-pass metabolism. The current study aimed to prepare and evaluate new transdermal formulations of dimenhydrinate to prolong the drug's release and improve its cutaneous permeation. First, the patches were fabricated and evaluated to determine their properties. The results were statistically investigated and considered significant at the p < 0.05 level. Additionally, the quantitative analysis of the drug-release data and kinetic modeling was performed by using the DDSolver software to decide the candidate formula dependably. The effect of the penetration enhancers on the permeability of dimenhydrinate from the selected patch was then studied ex vivo compared to the control sample, and the patch's safety was evaluated in rabbits, using the skin-irritation test. [ABSTRACT FROM AUTHOR]