Table 5

Cyclizine sublingual or rectal

Cyclizine sublingual or rectal
What is it?Antiemetic
Mechanism of actionAntihistaminic antimuscarinic antiemetic
Starting dose50 mg two times to three times a day
Time to onset of effect30–60 min17
FormulationInjection given as a sublingual solution
Rectal suppository (must be kept in fridge)
IndicationNausea related to raised intracranial pressure
Nausea-related gastrointestinal obstruction
Nausea related to vestibular disorders
Common adverse effectsAnticholinergic adverse effects; movement disorders, potential for misuse/abuse of injections
ContraindicationsEpilepsy; prostatic hypertrophy (in adults); pyloroduodenal obstruction; severe heart failure—may cause fall in cardiac output and associated increase in heart rate, mean arterial pressure and pulmonary wedge pressure; susceptibility to angle-closure glaucoma16
CautionRenal and hepatic impairment
LicenceUse of injection orally: ‘off label’
Use of suppositories: unlicensed product
BenefitsAlternative routes of administration
RisksDelay to manufacture of suppositories
CostOral solution:
50 mg/mL ampoules for injection—£18.58 for 5
Suppository—a special order. Price of application