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Central nervous system effects of meclizine and dimenhydrinate: evidence of acute tolerance to antihistamines.

Relative daytime drowsiness and performance impairment produced by meclizine and dimenhydrinate was assessed in 24 healthy male volunteers. Subjects received either dimenhydrinate, 100 mg, at 8:00 AM, 12:00 PM, and 4:00 PM; meclizine, 50 mg, at 8:00 AM, with placebo at 12:00 PM and 4:00 PM; or placebo at all three times in this randomized, double-blind, three-way crossover study. Impairment of mental performance was assessed by choice reaction time testing and digit symbol substitution scores. Drowsiness was self-assessed on the Stanford Sleepiness Scale and on a visual analog scale. Both antihistamines produced changes in digit symbol substitution, recognition time, and subjective assessments of sleepiness different from placebo. Expressed as change from baseline, the greatest reductions in digit symbol substitution scores after dimenhydrinate occurred 3 hours after the first dose (6.6 +/- 7) and were not different from the greatest measured change after meclizine (5.8 +/- 8), which occurred 9 hours after the dose was administered. Similar results were obtained with the other psychometric test scores. Self-rated sleepiness after dimenhydrinate was greatest 1 hour after the first dose, and was significantly greater than the largest degree of sleepiness after meclizine, which occurred at 7 hours after the dose. The effects of the first dose of dimenhydrinate on psychometric test scores were compared with the magnitude of the effects produced by subsequent doses. The magnitude of effect of the first dose of dimenhydrinate was significantly greater than the magnitude of effect produced by subsequent doses. The data suggest the possibility that acute tolerance to central nervous system impairment develops with multiple doses of dimenhydrinate.

Adolescent

Selected ion monitoring assay for meclizine in human plasma.

A method has been developed for the quantification of meclizine in human plasma using gas chromatography mass spectrometry. Pentadeuterated meclizine was synthesized and used as an internal standard. The method gave linear results over a concentration range of 5-200 ng ml-1 and was used to determine plasma levels of meclizine following administration to a male volunteer.

Chromatography, Gas

Determination of meclizine hydrochloride by ion-pair extraction with methyl orange.

A method, based on ion-pair extraction, is described for the quantification of meclizine hydrochloride in various pharmaceutical dosage forms, for content uniformity determination, and for concentration monitoring in dissolution and bioavailability studies. Methyl orange, dissolved in pH 2.8 MacIlvaine buffer, gave excellent recovery of meclizine after its isolation from aqueous solutions of gelatin, urine, and blood serum. The chloroform-extracted molecular species appeared to be a 1:1 ion-pair. Beer's law was obeyed for a wide concentration range. Because the extracted species seemed well defined and stable and since a surface or an interphase adsorption phenomenon was not a problem, the reported method is considered sensitive, accurate, precise, rapid, and simple.

Azo Compounds

Comparative investigation between thiethylperazine and meclizine in vertigo of different genesis.

Forty patients suffering from vertigo of different genesis received thiethylperazine 6.5 mg or meclizine 25 mg, 2 capsules a day for 5 days, according to double-blind, cross-over methodology in randomized order. It appeared that the effect on the symptoms vertigo, gait disturbance and nausea does not differ significantly for the two preparations. On the other hand, an almost significant effect on vertigo, and, to a smaller degree, on gait disturbances, was obtained during the second period of treatment, independent of administered preparation. Side-effects in the form of fatigue and headache occur to the same extent after both preparations. Meclizine should be an alternative to thiethylperazine in the treatment of vertigo, especially in patients who might risk chronic dyskinesia in long-term treatment.

Adult

Interference of antihistamines and anti-allergic drugs with antigen-induced paw edema in boosted and unboosted mice.

The protective effects of two antihistamines and two anti-allergic drugs against anaphylactic paw edema were studied in immunized animals that had or had not received a booster injection of antigen. The injection of 1 or 10 micrograms/paw ovalbumin induced acute paw edema of similar intensity in both groups. The antihistamine meclizine and the mixed anti histamine/anti-5-HT antagonist cyproheptadine reduced the anaphylactic reaction by 55 and 84% respectively, in non-boosted animals and were less effective against edema induced by 1 microgram antigen in boosted animals. The effectiveness of these drugs was also reduced when boosted mice were challenged with 10 micrograms antigen, where meclizine and cyproheptadine inhibited edema by 31 and 59%, respectively. The anti-allergic compounds ketotifen and azelastine, although effective against allergic inflammation in non-boosted mice, had a reduced or no effect in boosted mice. Our results suggest that allergic edema is less sensitive to antihistamine and anti-allergic drugs in boosted mice, which may be accounted for by an increased role of other mediators.

Analysis of Variance

Interference of azelastine with anaphylaxis induced by ovalbumin challenge in actively sensitized rats.

The inhibition of the haematological alterations and prevention of death due to systemic anaphylaxis after antigen challenge were investigated in rats after various drug treatments. The i.v. injection of ovalbumin (250 micrograms/kg) into actively sensitized rats induced marked thrombocytopenia and haemoconcentration within 5 min and significant leukocytosis within 30 min, lasting for 2 h after the challenge. Pretreatment with meclizine or terfenadine (15-30 mg/kg i.p.) inhibited antigen-induced haemoconcentration, whereas WEB 2086 (2-10 mg/kg i.p.) and PCA 4248 (5-10 mg/kg p.o.), two platelet-activating factor (PAF) antagonists, interfered with thrombocytopenia only. Azelastine (1-20 mg/kg p.o.) dose dependently inhibited antigen-induced haemoconcentration and thrombocytopenia but failed to block leukocytosis. Azelastine also inhibited the thrombocytopenia observed after the i.v. administration of PAF (4 micrograms/kg). Administration of ovalbumin at a dose of 1.5 mg/kg resulted in a lethal anaphylactic reaction in about 85% of the rats. Pretreatment with WEB 2086 (10 mg/kg i.p.), meclizine (30 mg/kg i.p.) or both increased the survival rate from 15 to 57, 68 and 87%, respectively. Azelastine alone (20 mg/kg p.o.) completely blocked the lethal reaction. It was concluded that the ability of azelastine to antagonize histamine and PAF is important for its effectiveness against anaphylactic shock.

Anaphylaxis

Suppression by cetirizine of pleurisy triggered by antigen in actively sensitized rats.

The efficacy of cetirizine in comparison with meclizine, another piperazine H1 receptor antagonist, in rat pleurisy caused by allergen or autacoid was investigated. Sensitization was achieved by subcutaneous injection of a mixture of ovalbumin and aluminium hydroxide. Fourteen days later, the animals were challenged with an intrathoracic injection of ovalbumin (12 micrograms/cavity), which caused drastic mast cell degranulation, followed by pleural oedema and leucocyte influx. Cetirizine and meclizine (2.5-30 mg/kg i.p.), 1 h before challenge, inhibited the exudatory response evoked by antigen, under conditions where neutrophil and eosinophil accumulation was affected only by the former. When administered intrathoracically 22 h after allergen, i.e. using a curative approach, cetirizine (15 micrograms/cavity) drastically reduced the pleural eosinophilia noted 24 h post-challenge, indicating that this drug can reverse an already established eosinophilia. Cetirizine (15 mg/kg i.p.) also restored, to about 39% (P < 0.001), the number of uninjured mast cells recovered from the pleural cavity following allergen stimulation. In normal rats, cetirizine (5-15 micrograms/cavity) completely inhibited the pleural exudation elicited by histamine and only partially the exudation caused by 5-hydroxytryptamine or bradykinin, but was quite inactive against platelet-activating factor. We conclude that the pleural exudation triggered by allergen, vasoactive amines or bradykinin is clearly sensitive to cetirizine. In addition, the ability of the drug to interfere with pleural neutrophil or eosinophil mobilization and mast cell degranulation seems not to be associated with its ability to block the histamine H1 receptor.

Animals

An evaluation of the teratogenicity of certain antinauseant drugs.

In a large, prospective, observational study of pregnancy and child development, the antinauseant drugs prescribed to gravides for nausea and vomiting in the first 84 days of pregnancy were evaluated for their teratogenic potential. The severe congenital anomaly rates per 100 liveborn children and ther perinatal death rates of this group did not differ from the rates of the group with untreated nausea and vomiting. There was no indication that the phenothiazine derivatives, specifically the prochlorperazine derivative, as well as meclizine, cylizine, and Bendectin were associated with teratogenicity. The trimethobenzamide drug gave a slight suggestion of an excess of severe congenital anomalies.

Abnormalities, Drug-Induced

Neutralization of the oedematogenic activity of Bothrops jararaca venom on the mouse paw by an antibothropic fraction isolated from opossum (Didelphis marsupialis) serum.

The pharmacological modulation of mice paw oedema produced by Bothrops jararaca venom (BJV) has been studied. Intraplantar injection of BJV (1-30 micrograms/paw) produced a dose- and time-related oedema, which was maximal 30 min after injection, reduced gradually thereafter and disappeared over 48 h. BJV heated at 100 degrees C for 5 or 15 min blocked local hemorrhage and caused partial inhibition of its oedematogenic activity. The BJV oedema was not inhibited by the anti-histamine meclizine, the inhibitor of histamine and serotonin, cyproheptadine, PAF-acether antagonist WEB 2170 or by the anti-leukotrienes C4/D4, LY 171883. Dexamethasone, aspirin, indomethacin, and the dual cyclooxygenase and lipoxygenase inhibitor BW 755C inhibited BJV-induced oedema indicating that arachidonic acid metabolism products via the cyclooxygenase pathway participate in its genesis and/or maintenance. The antibothropic fraction (ABF) (25-200 micrograms/paw) isolated from Didelphis marsupialis serum neutralized the oedema induced by the venom with and without heating, the hemorrhage induced by BJV and partially blocked the oedema induced by bradykinin and by cellulose sulphate. The oedema produced by histamine, serotonin, PAF-acether or leukotriene C4 was not inhibited.

Animals

Interference of cetirizine with the late eosinophil accumulation induced by either PAF or compound 48/80.

1. The effect of topical or systemic treatment with the histamine H1-receptor antagonist, cetirizine, on the rat pleural eosinophil accumulation induced by PAF or compound 48/80 was investigated. The number of pleural resident eosinophils increased 6 h after the intrathoracic (i.t.) injection of PAF (1 microgram/cavity), peaked within 24 h and persisted significantly augmented for at least 96 h. Compound 48/80 (25 micrograms/cavity) also produced a long lasting pleural eosinophilia but this was first noted only 24 h after stimulation. 2. Intraperitoneal pretreatment with cetirizine inhibited eosinophilia induced by either PAF (ED50 = 19 mg kg-1) or compound 48/80 (ED50 = 14 mg kg-1) whereas meclizine, another histamine H1-receptor antagonist, was inactive. 3. Administered locally, cetirizine (5 and 15 micrograms/cavity) also dose-dependently inhibited both PAF- and compound 48/80-induced eosinophilia, providing evidence that its inhibitory effect is not due to any action upon circulating eosinophils. Consistent with this result, incubation of isolated peritoneal eosinophils with cetirizine failed to modify in vitro eosinophil migration caused by PAF. 4. Since the late eosinophilia induced by PAF may depend on the synthesis of a transferable protein mediator, cetirizine was administered to donor or recipient rats in order to determine whether it interferes with the generation or with the expression of this protein. We showed that only the treatment of recipient rats abolished the transfer of the eosinophilotactic activity, indicating that cetirizine does not modify the generation but inhibits the expression of this activity. 5. Our findings indicate that cetirizine is able to inhibit eosinophil accumulation by acting locally. The mechanism is neither related to its recognized ability to antagonize histamine H,-receptors nor to a direct action upon circulating eosinophils.

Administration, Topical

Nedocromil sodium prevents in vivo generation of the eosinophilotactic substance induced by PAF but fails to antagonize its effects.

1 The intrathoracic injection of platelet activating factor (PAF) into rats induced a decrease in the pleural leucocyte numbers within 15 min, accompanied by a marked exudation, maximal 1 h later. After 6 h, concomitantly with the reduction of exudation, a marked increase in the number of mononuclear cells, neutrophils and eosinophils was observed. Within 24 h, the pleural eosinophil accumulation peaked and persisted up to 96 h. 2 Topical treatment with nedocromil sodium affected pleural exudation by PAF under conditions where systemic meclizine was ineffective. Nedocromil sodium blocked, dose-dependently, the increase in the pleural content of mononuclear cells, neutrophils and eosinophils, observed 6 h after PAF administration, as well as the eosinophilia 24 h later. Moreover, the co-incubation of peritoneal eosinophils with nedocromil sodium did not interfere with the migration triggered by PAF. 3 The transfer of the 6 h-PAF pleural washings from donor to recipient rats caused a selective pleural eosinophilia, which was clearly inhibited when nedocromil sodium was administered to donor, but not to recipient animals, showing that this drug interferes with the generation rather than with the expression of the eosinophilotactic activity(ies). 4 These findings indicate that the nedocromil sodium interferes with PAF-induced exudation and leucocyte accumulation, by a mechanism other than its ability to reduce the local effects of histamine and which may relate to suppression of the eosinophilotactic principle generation.

Animals

Interaction between polyethylene films and bromhexine HCl in solid dosage form. V. Effect of packaging materials on the sorption of bromhexine HCl.

A prevention method of the sorption of bromhexine HCl to plastic materials used in packaging was investigated. Four kinds of plastic packaging materials were used: Polyethylene (PE), polyethylene terephthalate (PET), polypropylene (PP) and polyacrylonitrile (PAN). Three polyethylenes having different densities were used. No effect of PE density on the sorption of bromhexine HCl from granules was observed. The effects of different kinds of plastics on the sorption of bromhexine HCl from solution and granules were studied. The sorption of bromhexine HCl to PAN, which had a high relative dielectric constant, was the most depressed among the four plastics. The sorption of meclizine HCl to PAN from the solution was also lowest, the same as bromhexine HCl.

Acrylic Resins

The application of quadrupole mass filters in field desorption mass spectrometry.

The advantages and limitations which quadrupole mass filters afford to the field desorption technique with respect to use for routine work are discussed and experimentally confirmed by the analyses of some drugs using a field desorption quadrupole mass spectrometer. The possibility of fast identification of drug intoxication is demonstrated by the analysis of the chloroform extract of urine in a case of overdose of hypnotics.

Adsorption

Ultrastructures of glosso-palatal fusion after treatment of meclozine-hydrochloride.

The behavior of the epithelial cells on the tongue and palatal processes during glosso-palatal fusion induced by Meclozine-hydrochloride was investigated with light and electron microscopes. Microscopical observations revealed that; at two or three days after the administration, the palatal processes were approximating to the tongue, and the superficial cells on the lateral sides of tongue became swollen and to have inclusion bodies, and in the epithelium on the medial sides of palatal processes, some inclusion bodies appeared too. At the time of contact, the superficial epithelial cells of tongue tended to degenerate markedly, and these degenerating cells were dissociated from the epithelium, and concurrently, superficial layer of the palatal epithelium became to have a lot of inclusion bodies. Between the two tissues, attachment devices developed just after the contact, and then, the cells in the intervening epithelial lining fell into a degeneration gradually. As well known, Meclozine-hydrochloride is one of important miner tranquilizers. From the findings mentioned above, it seemed to be possible that a heterotopic fusion caused with this drug is a result of a destruction of embryonic epithelium on tongue and palatal processes at a certain stage of development.

Animals