Cinnarizine: Calcium Channel Blocker for Vertigo and Motion Sickness
Cinnarizine is a first-generation antihistamine with prominent calcium channel-blocking properties. It is widely used for vertigo, Meniere's disease, motion sickness, and other vestibular disorders. Cinnarizine reduces the excitability of the labyrinthine apparatus and normalises vestibular nystagmus.
Available over-the-counter in many countries (Stugeron, Cinnarizine 25 mg), it has a long history of use since the 1960s. At higher doses it is also used for peripheral vascular disorders.
Mechanism of Action
Cinnarizine blocks voltage-gated calcium channels in the inner ear vasculature and vestibular cells, reducing vasospasm and vestibular excitability. Its H1-antihistaminic activity provides additional anti-nausea and anti-emetic effects via the vomiting centre.
Indications & Use
Vertigo and dizziness (peripheral and central), Meniere's disease, motion sickness (travel sickness), tinnitus, and cerebrovascular insufficiency. Also used as second-line therapy for peripheral arterial occlusive disease.
Dosage
Vertigo: 25 mg three times daily; severe cases up to 75 mg three times daily. Motion sickness prevention: 25 mg 2 hours before travel, then every 8 hours. Reduce dose in elderly (start with 25 mg twice daily).
Side Effects
Common: drowsiness, fatigue, dry mouth, weight gain. Long-term use: extrapyramidal symptoms (drug-induced Parkinsonism) — especially in elderly. Rare: depression, cholestatic jaundice, lupus-like syndrome.
Drug Interactions
CNS depressants, alcohol, sedatives: additive sedation. Other antihistamines: increased anticholinergic effects. Antihypertensives: potential additive hypotension. Dopamine antagonists: risk of extrapyramidal side effects.
Contraindications
Parkinson's disease or parkinsonism (risk of worsening). Severe liver impairment. Hypersensitivity to cinnarizine. Caution in elderly (extrapyramidal risk), glaucoma, urinary obstruction.
Frequently Asked Questions
Can cinnarizine cause Parkinson-like symptoms?
Yes — long-term use, especially in elderly patients, can cause drug-induced Parkinsonism (tremor, rigidity, bradykinesia). If these symptoms occur, cinnarizine should be discontinued.
Is cinnarizine the same as meclizine for motion sickness?
Both are antihistamines effective for motion sickness. Cinnarizine also has calcium channel-blocking properties, making it particularly effective for vestibular vertigo. Meclizine is more sedating.
How quickly does cinnarizine work for vertigo?
Effects typically begin within 1–2 hours of oral administration. For chronic vestibular conditions, regular dosing for 2–4 weeks may be needed for full benefit.
References
- EMA assessment cinnarizine
- Cochrane Review: Antihistamines for Vertigo
- BPPV and Vestibular Disorders Guidelines
Medical Disclaimer: This information is for educational purposes only and does not replace professional medical advice.