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1 CYCLIZINE v01 1/7 CYCLIZINE PGD Details Version 1.0 Legal category Staff grades Approved by POM Paramedic (Non-ECP) Nurse (Non-ECP) Emergency Care Practitioner (Paramedic) Emergency Care Practitioner (Nurse) Medicines Management Group Date issued 01/02/2013 Review date 31/01/2015 Clinical Publication Category Mandatory (Red) - No deviation from document permissible Clinical Requirements Competencies Continuing education Successful completion of a competency assessment in the use of this medicine for the indications stated; Completion of education in both the legal and professional aspects of PGD administration and the supply of medicines; Registered paramedics must have successfully completed a recognised Emergency Care Practitioner course; Registered nurses must be employed as Nurse Practitioners or have successfully completed a recognised Emergency Care Practitioner course. The clinician is responsible for keeping him/herself aware of any changes to the recommendations for the medicine listed. These changes will usually be advised in a Clinical Notice to staff. It is the responsibility of the individual to keep up-to-date with continued professional development and to work within the limitations of their own individual scope of practice.

2 CYCLIZINE v01 2/7 Clinical Situation Clinical situation Inclusion criteria Exclusion criteria Cautions Prevention and treatment of nausea and vomiting including: Motion sickness; Nausea and vomiting caused by opiate analgesics; Vomiting associated with radiotherapy or chemotherapy; Nausea and vomiting in palliative care due to mechanical bowel obstruction or raised intracranial pressure; Relieving vomiting and attacks of vertigo associated with Meniere s disease and other forms of vestibular disturbance. Adults and children aged 16 years and over. Hypersensitivity to cyclizine; Pregnancy; Breastfeeding. Nausea and vomiting may be a symptom of a more serious underlying condition; Anti-emetic use in palliative care should be regularly reviewed as it may be necessary to substitute the antiemetic or to add another one. Seek the advice of a medical practitioner if necessary; Cyclizine should be used with caution in patients with severe heart failure. In these patients it may cause a fall in cardiac output associated with increases in heart rate, mean arterial pressure and pulmonary wedge pressure; Caution in elderly patients: Cyclizine is an anticholinergic agent and should be used with caution and appropriate monitoring in patients with glaucoma, dementia, obstructive diseases of the gastrointestinal tract, hepatic disease, epilepsy and in males with possible prostatic hypertrophy. Elderly patients may already be prescribed medicines with anticholinergic activity; Cyclizine may have a hypotensive effect in some patients;

3 CYCLIZINE v01 3/7 Practitioners should be aware that cyclizine may be abused IV for its euphoric or hallucinatory effects. A running balance must be maintained for all stock. This record must be audited against records of administration. Interactions: Cyclizine may have additive effects with alcohol or other central nervous system depressants e.g. hypnotics or tranquilisers; Cyclizine enhances the soporific effect of pethidine; Cyclizine may enhance the side-effects of other anticholinergic drugs (i.e. urinary retention, dry mouth, blurred vision, etc). Side effects Action if excluded Action if patient declines Hypersensitivity reactions: Bronchospasm, urticaria, rash, angioedema and rarely, anaphylaxis; Injection site reactions: Vein tracking, erythema, pain and thrombophlebitis; Anticholinergic effects: Dry mouth, nose and throat, blurred vision, urinary retention and tachycardia; CNS effects: Headache, restlessness, nervousness, insomnia, auditory and visual hallucinations, dystonia, dyskinesia, tremor, twitching, muscle spasm, convulsions, disorientation, dizziness, decreased consciousness, transient speech disorders, hypertension and paraesthesia; Rarely: fixed drug eruption, apnoea, generalised chorea, hypersensitivity hepatitis, hepatic dysfunction and agranulocytosis. If patient meets exclusion criteria refer to medical practitioner: Record in patient clinical record the reason for exclusion and any action taken. If patient declines treatment or advice, document on clinical record. Ensure the patient clinical record details: The advice given by the practitioner; Details of any referral made; The intended actions of the patient (including parent or guardian).

4 CYCLIZINE v01 4/7 Description of Treatment Generic name Presentation Route Cyclizine. 50mg/1ml ampoule. Intravenous Administer slowly into bloodstream, with only minimal drawback of blood into the syringe over one to two minutes. Dilute 1:1 with water for injections to reduce the risk of injection site reactions. DO NOT DILUTE WITH SODIUM CHLORIDE. Intramuscular Use of the IM route is restricted to adults aged 18 years and over. Avoid this route if the patient is likely to require thrombolysis. Method Administration Supply Dose Frequency Duration of treatment 50mg (1ml). Single dose. Single dose.

5 CYCLIZINE v01 5/7 Follow Up Referral arrangements and safety netting Advice to patients Records References If vomiting persists, the patient should be reassessed to exclude the possibility of an underlying disorder; If a patient is not admitted they must be told to seek further medical advice if they become generally unwell, if there is no improvement within 48 hours or if there is a deterioration in their condition; Ensure that there is a communication to the patient s registered GP to inform him/her about the consultation, the outcomes of that consultation and any treatment given using local mechanisms. This information must also be available to other healthcare professionals who may be required to administer care to the patient following the consultation. If an adult patient is not conveyed to hospital they must be warned that cyclizine can cause sedation of short duration which can affect their ability to perform skilled tasks including driving and operating machinery. Complete Patient Clinical Record. British National Formulary 64 March 2012; The Electronic Medicines compendium. Accessed at Injectable medicines guide. Accessed at

6 CYCLIZINE v01 6/7 Authorisation Chief Executive Officer Medical Director Pharmaceutical Advisor Name Ken Wenman Signature Date 01/02/2013 Name Dr Andy Smith Signature Date 01/02/2013 Name Sue Oakley Signature Date 01/02/2013 This must be signed by the Chief Executive Officer, Medical Director and Pharmaceutical Advisor to be legally valid.

7 CYCLIZINE v01 7/7 Individual Authorisation (Staff Copy) Individual Name Signature Date / / Authorising officer Name Signature Date / / I have read and understood the Patient Group Direction and agree to administer this medicine only in accordance with this document. PGDs do not remove inherent professional obligations or accountability. It is the responsibility of each professional to practice only within the bounds of their own competence and in accordance with their own Code of Professional Conduct. This signed page must be retained by the member of staff, together with the full PGD, which must be available in clinical practice.

8

9 CYCLIZINE v01 Individual Authorisation (Trust Copy) Individual Name Signature Date / / Authorising officer Name Signature Date / / I have read and understood the Patient Group Direction and agree to administer this medicine only in accordance with this document. PGDs do not remove inherent professional obligations or accountability. It is the responsibility of each professional to practice only within the bounds of their own competence and in accordance with their own Code of Professional Conduct. This signed page must be retained by the member of staff, together with the full PGD, which must be available in clinical practice.

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