cyclizine hydrochloride + dipipanone hydrochloride: clinical use

Prescribing considerations

• Agree treatment goals and a withdrawal strategy before initiation; regularly review analgesic need and function.
• Assess respiratory disease, frailty, mental health, substance-use history and concomitant medicines.
• Explain overdose, dependence, tolerance, hyperalgesia, secure storage and driving risks.
• Use particular caution in older people and in glaucoma, severe heart failure, phaeochromocytoma, urinary retention, and disorders affected by anticholinergic or opioid actions.
• Avoid abrupt cessation after ongoing exposure.

Contraindications and cautions

• Hypersensitivity to either active ingredient or an excipient.
• Respiratory depression, obstructive airway disease, acute asthma, or heart failure secondary to chronic lung disease.
• Head injury or raised intracranial pressure.
• Acute alcohol intoxication.
• Concurrent or recent monoamine oxidase inhibitor treatment.
• Ulcerative colitis, paralytic ileus, delayed gastric emptying, or biliary or renal tract spasm.
• The specified pre-operative and early postoperative periods.
• Severe hepatic or renal impairment.

Monitoring

• Respiratory rate, sedation, consciousness and blood pressure.
• Analgesic benefit, function, adverse effects and continuing clinical need.
• Constipation, urinary retention and symptoms of ileus.
• Tolerance, escalating use, misuse, addiction, withdrawal and possible opioid-induced hyperalgesia.
• Confusion in older people and intraocular-pressure-related symptoms in glaucoma.
• Hepatic or renal function where impaired; investigate jaundice or unexplained blood-count symptoms.

Clinical pharmacology

Dipipanone is absorbed from the gastrointestinal tract, metabolised in the liver and eliminated through urine and faeces. Cyclizine is a piperazine H1-receptor antagonist with anticholinergic and antiemetic properties; norcyclizine is an identified metabolite.

Formulation and product differences

• The product is an immediate-release oral tablet containing both active ingredients.
• The deep-pink tablet is scored and coded F3A.
• The scoreline helps swallowing but does not divide the tablet equally.
• It contains lactose and is unsuitable for certain rare hereditary disorders of galactose handling.

Tablet

Route: Oral

Strengths: 10 mg + 30 mg