Cyclizine Abuse among a Group of Opiate Dependents Receiving Methadone

Abstract

Twenty opiate dependents receiving long-term prescriptions of oral methadone, were identified as being habitual abusers of the anti-emetic drug cyclizine. A semi-structured interview elicited the dosage of cyclizine used, its effects, the reasons for starting and persisting with abuse of cyclizine and the attitudes of the patients to it. Cyclizine was taken in large doses intravenously with methadone. The effects initially were of intense stimulation, often with hallucinations, sometimes with aggressive behaviour, and occasionally with epileptic fits. Subsequent depressive mood changes occurred often accompanied by a craving for cyclizine. Tolerance to the drug occurred but no clear cut withdrawal syndrome is apparent. It seems that dependence upon cyclizine occurs. The significance of these findings for doctors, pharmacists and for drug treatment units is discussed. The paucity of information on the pharmacology and pharmacokinetics is noted.

Prescription of diamorphine, dipipanone and cocaine in England and Wales

“…Applications are subject to recommendations by a Senior Medical Officer in the Department of Health (Doll) [6]. In certain areas of the United Kingdom these are especially sought after due to the particular 'rush' experienced after injecting them [8]. The drugs are dispensed by a community pharmacist or by a hospital pharmacist.…”

“…It is a synthetic opioid whose particular interest to addicts comes from its combination with an anti-emetic, cydizine, in diconal tablets. In certain areas of the United Kingdom these are especially sought after due to the particular 'rush' experienced after injecting them [8]. Diamorphine, dipipanone and cocaine are usually dispensed daily, for consumption off-site.…”

Acute infections in intravenous drug users

“…Good management requires a frank and non-judgemental approach, and clear behavioural boundaries should be outlined, including explanations of the consequences of abusing staff, demanding medications other than those prescribed and obstructing the continuity of care. 29 Opiates and other drugs that could be misused, including intravenous cyclizine, 30 should be prescribed by a single sufficiently experienced prescriber.…”

Letters to the Editor

“…10 It has been postulated that, because opiates, alcohol and cannabis can produce antimuscarinic like effects, opioid abusers can be particularly sensitive to the anti-muscarinic effects of antihistamines such as cyclizine and there is the possibility of an additive effect. 11 A report by Smith & Davis of the non-medical use of butorphanol and diphenhydramine described users experiencing ª a possible`rush' of exhilaration followed by general stimulation and sometimes hallucinationsº . 12 Psychological tolerance and mild withdrawal symptoms following a case of massive diphenhydramine abuse and withdrawal from the drug have also been recorded.…”

“…13 Comparisons could be made between the Glasgow experience with diphenhydramine soft gel liquid-® lled capsules of diphenhydramine and previous experiences in Glasgow and elsewhere with cyclizine. In 1989 Ruben et al 11 reported on the habitual use of cyclizine by 20 opiate dependants receiving long-term prescriptions for oral methadone. Cyclizine was taken in large doses intravenously with methadone.…”