|Oral, Rectal, I.V.|
Dimenhydrinate (in US marketed under brand names Dramamine, Driminate, Gravol, Gravamin, Vomex, and Vertirosan) is an over-the-counter drug used to prevent nausea and motion sickness. It is marketed in Portugal as Viabom, in Brazil as Dramin, in Hungary as Daedalon, and in Indonesia under the brand name Antimo. It is most commonly used as pills, although it is also available in liquid form and in suppositories. Chemically, dimenhydrinate is a salt of two drugs: diphenhydramine, and 8-chlorotheophylline, a chlorinated derivative of theophylline.
The effects of dimenhydrinate are very similar to those of diphenhydramine. The main differences are a lower potency, and a longer latency. 50 mg dimenhydrinate contains 27.2 mg of diphenhydramine, so it is less potent at equal doses. Also, dimenhydrinate must dissociate into diphenhydramine and its counterion in the body before it is active, so it produces effects more slowly than diphenhydramine.
Theophylline was added in order to counteract drowsiness. Theophylline is very closely related to caffeine and theobromine, mild central nervous system stimulants. It was thought[by whom?] that by combining the antiemetic effects of diphenhydramine with a stimulant, the extreme drowsiness induced by the former could be mitigated somewhat by the latter. The sedation caused by diphenhydramine, however, is substantially stronger than the stimulation caused by chlorotheophyllinate, so the overall effect is still mostly sedating. Diphenhydramine, an ethanolamine-class antihistamine, is found in most OTC sleep aids and allergy preparations, such as Tylenol PM and Benadryl. It is primarily a H1-antagonist, but also possesses an antimuscarinic effect. It is used in Dramamine to prevent nausea and emesis; however, the development of the chemical meclizine has overtaken its usage (marketed as "Dramamine II") because meclizine is less likely to cause drowsiness.
Dimenhydrinate is used as a deliriant at doses of 700 to 1200 mg, although body weight plays a significant part in dosing of this drug. Slang terms for Dramamine used this way include "dime," "dime tabs,"D-Q"" "substance D," and "d-house." Frequent users of Dramamine are sometimes called Dramatists, a pun on the name. Tripping on Dramamine is sometimes referred to as Dramatizing or "going a dime a dozen," a reference to the amount of Dramamine tabs generally necessary for a mild trip. The LD-50 (the dose at which 50% of animals tested produced fatal symptoms) for dimenhydrinate is 500 mg/kg in lab rats (LD50 levels can vary greatly between humans and other animals).
Many users report a side effect profile consistent with tropane glycoalkaloidal (e.g. atropine) poisoning as both show antagonism of muscarinic acetylcholine receptors in both the central and autonomic nervous system, which inhibits various signal transduction pathways. In the CNS, dimenhydrinate readily crosses the blood-brain barrier, exerting effects within the visual and auditory cortex.
The auditory/visual hallucinations coupled with the ensuing confusion and short-term memory loss often leads to mild or intense paranoia among the users. Though auditory hallucinations are more common than visual hallucinations, the visuals of a "Dramamine Trip" can seem very real. At higher doses the hallucinations are more frequent, realistic and in some cases, frightening. Taking Dramamine at higher doses is in no way advised or recommended as potential for overdose is a risk. Hallucinations induced by Dramamine abuse are sometimes shared among users; that is, it is common for Dramamine users to hear their own name being called, to see frightening creatures (such as insects or zombies), and to have conversations with non-existant people. When taken before going to sleep, users tend to sit up and look around at their surroundings at random, sometimes within 2-5 minute intervals.
Other CNS effects occur within the limbic system and hippocampus, causing confusion and temporary amnesia due to decreased acetylcholine. Toxicology also manifests in the autonomic nervous system, primarily at the neuromuscular junction, resulting in ataxia and extrapyramidal side-effects and the feeling of heaviness in the legs, and at sympathetic post-ganglionic junctions, causing urinary retention, pupil dilation, tachycardia, irregular urination, and dry red skin caused by decreased exocrine gland secretions, and mucous membranes. Considerable overdosage can lead to myocardial infarction (heart attack), serious ventricular dysrhythmias, coma and death. Such a side-effect profile is thought to give ethanolamine-class antihistamines a relatively low abuse liability. The specific antidote for dimenhydrinate poisoning is physostigmine, usually given by IV in a hospital.
Dimenhydrinate has successfully been used as an antiemetic and sedative in housepets. It is commonly used to reduce the effects of idiopathic vestibular syndrome. The suggested dosage is 50 mg for dogs and 10 mg for cats; duration of effect is 8 hours.
References in Culture
American alternative rock band Modest Mouse has a song on their first album entitled "Dramamine."
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