Names and pronunciation
Increlex
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Drug reference
Increlex
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Func. class.: Biologic response modi- fier; insulin-like growth factor Func. class.: Antiemetic, antihista- mine, anticholinergic
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USES: Growth failure in children with severe primary insulin-like growth fac- tor-1 (IGF-1) deficiency (primary IGFD) or with growth hormone (GH) gene dele- tion who have developed neutralizing antibodies to GH USES: Vertigo, motion sickness
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Chem. class.: H1-receptor antagonist, piperazine derivative
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Do not confuse: Antivert/Axert
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ACTION: Suppresses vestibular end- M organ receptors and inhibits activation of cholinergic pathways
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CONTRAINDICATIONS: Hyper- sensitivity, benzyl alcohol, closed epiphyses, active/suspected neoplasia, IV use CONTRAINDICATIONS: Hyper- sensitivity to cyclizines Precautions: Pregnancy, breastfeeding, children, geriatric patients, closed-angle glaucoma, prostatic hypertrophy, hepatic/renal disease, urinary retention, GI obstruction, contact lenses
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SIDE EFFECTS CNS: Drowsiness, fatigue EENT: Blurred vision GI: Dry mouth
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INTERACTIONS Increase: sedation—CYP2D6, inhibitors Increase: anticholinergic effects—other antihistamines, atropine, antidepres- sants, phenothiazines Increase: effect of alcohol, opioids, other CNS depressants Drug/Lab Test False negative: allergy skin testing (allergen extracts)
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DOSAGE AND ROUTES • Child ≥2 yr: SUBCUT 0.04-0.08 mg/kg (40-80 mcg/kg) bid; if well tolerated for 1 wk, may increase by 0.04 mg/kg/dose, max 0.12 mg/kg bid (mek′li-zeen) Antivert, Bonamine , Dramamine Less Drowsy, Dramamine-N DOSAGE AND ROUTES Vertigo • Adult/adolescent: PO 25-100 mg/day in divided doses Motion sickness • Adult/adolescent: PO 25-50 mg 1 hr before traveling, repeat dose q24hr prn
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Available forms: Tablets 12.5, 25, 50 mg: chewable tablets 25 mg; ODT 25 mg
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Administer: PO route • May give without regard to food • Chew tab: give without regard to water or may be swallowed whole with water • Lowest possible dose for geriatric pa- tients; anticholinergic effects
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Assess: • Vertigo/motion sickness: nausea, vom- iting after 1 hr; assess vertigo periodically • Signs of toxicity: CNS depression, consti- pation; consider other causes of symptoms; may mask symptoms of other diseases, such as brain tumor, intestinal obstruction • For urinary disease obstruction, de- creased urinary output; may exacerbate symptoms; monitor urinary output • Observe for drowsiness, dizziness, level of consciousness • Pregnancy/breastfeeding: use only if needed; occasional doses should not pose a risk in breastfeeding • Beers: use caution in older adults; higher risk of anticholinergic effects
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Evaluate: • Therapeutic response: absence of diz- ziness, vomiting
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • That a false-negative result may occur with skin testing for allergies; that these procedures should not be scheduled for ≤4 days after discontinuing use • To avoid hazardous activities, activities requiring alertness because dizziness may occur; to request assistance with ambulation • To avoid alcohol, other depressants; not to breastfeed; to report severe side effects • To use sugarless gum, frequent sips of water for dry mouth • Motion sickness prophylaxis: to take ≥1 hr before event that may cause mo- tion sickness
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PHARMACOKINETICS PO: Onset 1 hr, duration 8-24 hr, half-life 6 hr
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• Child ≥2 yr: SUBCUT 0.04-0.08 mg/kg (40-80 mcg/kg) bid; if well tolerated for 1 wk, may increase by 0.04 mg/kg/dose, max 0.12 mg/kg bid (mek′li-zeen) Antivert, Bonamine , Dramamine Less Drowsy, Dramamine-N DOSAGE AND ROUTES Vertigo
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