What are the indications for cinnarizine?/nAre there controlled clinical trials showing it to be of

Fråga: What are the indications for cinnarizine?

Are there controlled clinical trials showing it to be of any value in any particular illness?

Sammanfattning: Cinnarizine is effective in the prophylactic treatment of sea sickness and in treating vertigo of vestibular origin.

There are no conclusive data in favour of its effectiveness on peripheral vascular diseases or allergic urticarias.

Svar: Cinnarizine is a piperazine derivative which antagonizes the stimulated influx of calcium ions to the cell. In addition this agent has receptor blocking properties on histamine (H1) and serotonin receptors.

There are several controlled clinical trials of cinnarizine regarding the treatment of peripheral vascular disease (1,2), based on the finding that this agent attenuates the vasoconstrictor actions of many endogenous substances probably by its action on calcium and also decreases blood viscosity. In those studies, the patients were treated with cinnarizine for 3 months (75 mg three times daily) and the mean walking distance increased compared to the placebo group, but other clinical symptoms (cold feet, popliteal pulse) were not different in the two groups (2).

The use of this drug in vertigo and other peripheral labyrinthine disorders (Menieres disease) has been studied in a large number of patients. Most of the controlled clinical trials show that vestibular vertigo decreases during treatment with cinnarizine (30-100 mg/day) compared to placebo, but all these trials are of short duration (max 4 weeks). It has not been found any difference in the symptomatic relief of peripheral vertigo obtained with either cinnarizine or prochlorperazine. The possible mechanism responsible for this action is the blockade of calcium ions influx from the endolymph into the vestibular sensory cells (review in 3,4). The most commonly reported side-effects were drowsiness and gastrointestinal disturbances.

Its efficacy in sea sickness has also been investigated in placebo-controlled double-blind trials and large number of patients (5,6), showing good effects in preventing sea sickness with low incidence of drowsiness. In an open study (7) the prophylactic effect of this agent was tested in car sickness in 79 children. Based on the antihistaminic properties of this drug, it has also been used in the treatment of chronic and cold urticaria and the results were not better than the ones obtained with other conventional antihistaminic agents (8,9). 1 Barber JH, Reuter CA, Jageneau AHM, Loots W: Intermittent claudication: a controlled study in parallel time of the short-term and long-term effects of cinnarizine. Pharmatherapeutica 1980; 2: 401-407 2 Donald JF: A multicentre general practice study of cinnarizine in the treatment of peripheral vascular disease. J Int Med Res 1979; 7: 502-506 3 Towse G: Cinnarizine - a labyrinthine sedative. J Laryngol Otol 1980; 94: 1009-1015 4 Brookes GB: Meniere´s disease. A practical approach to management. Drugs 1983; 25: 77-89 5 Hargreaves J: A double-blind placebo controlled study of cinnarizine in the prophylaxis of seasickness. Practitioner 1980; 224: 547-550 6 Driessche R van: A combination of cinnarizine and domperidone for the prevention of motion sickness: a double blind comparative study versus cinnarizine against seasickness. Curr Therap Res 1985; 38: 61-67 7 Macnair AL: Cinnarizine in the prophylaxis of car sickness in children. Curr Med Res Opin 1983; 8: 451-455 8 Kalimo K, Jansen CT: Treatment of chronic urticaria with an inhibitor of complement activation (cinnarizine). Ann Allergy 1980; 44: 34-37 9 Neittaanmäki H, Myöhänen T, Fräki JE: Comparison of cinnarizine, cyproheptadine, doxepin, and hydroxyzine in treatment of idiopathic cold urticaria: usefulness of doxepin. J Am Acad Dermatol 1984; 11: 483-489