Dipipanone hydrochloride with cyclizine

How it works

Dipipanone is an opioid agonist that relieves pain through opioid receptors, while cyclizine is an antihistamine with antiemetic and antimuscarinic properties intended to counter opioid-induced nausea.

Prescribing in practice

• The fixed combination is generally not recommended for prolonged use or palliative care because the opioid dose cannot be increased without also raising the cyclizine dose, and cyclizine can cause adverse cardiac and antimuscarinic effects and is associated with misuse.
• As it contains an opioid it carries the usual risks of respiratory depression, dependence and constipation, and controlled drug requirements apply.
• The cyclizine component adds sedation and antimuscarinic effects, so caution applies in conditions such as urinary retention, glaucoma and in the elderly.

Monitoring

Monitor analgesic response, sedation, respiratory function and antimuscarinic effects, bearing in mind the constraints of the fixed-dose combination.

Counselling the patient

• It may cause marked drowsiness; do not drive or operate machinery if affected.
• Avoid alcohol while taking it.
• Report inadequate pain relief rather than taking extra, as the dose cannot be increased freely.

Evidence & guidelines

Its place in therapy is informed by long-standing clinical experience and prescribing guidance that limits its use compared with single-agent opioids.