Stugeron - Letters to Latitude 38 Magazine

Richard, this is the stuff from the Latitude 38 letter and response about Stugeron.

Stugeron is a bad actor and should be used with real caution or not at all.

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April 2006

A LACK OF CRITICISM FOR THE BRAND NAME DRUG

I am writing in response to your comment about using StugeronT for
seasickness - and your annoyance that the Federal Drug Administration
doesn't approve it for sale in the United States.

I talked about medical preparations for cruising at the 2006
Zihuatanejo SailFest, and used that opportunity to review medications
for seasickness - including StugeronT, which is a brand name for
cinnarizine. Even though many people have found that cinnarizine is
effective in preventing seasickness without noticeable side-effects,
it is not a good drug. Cinnarizine is a 'sloppy' drug that interacts
with at least three different receptors in the brain and the rest of
the body, histamine and acetylcholine receptors like most drugs for
seasickness, along with dopamine receptors. In addition, it is a
calcium channel blocker. Incidentally, almost all adverse effects of
cinnarizine are found by looking for information under the generic
name. There is very little literature criticizing the brand name drug.

Low-dose cinnarizine, 25 mg, is sold in many countries as StugeronT
(among more than 40 brands) for vertigo and motion sickness.
Cinnarizine is banned - even in low doses - by airline pilots in the
United States because it impairs judgement. Higher dose cinnarizine,
75 mg, is sold as Stugeron ForteT in countries where it is available,
and is used to relax arteries due to its calcium channel blocking
effects. High doses have also been reported to unmask Parkinson's
disease, or make Parkinson's disease worse due to blocking dopamine
receptors. Drugs that have such different uses with such small
differences in dose are just not good drugs - even if they are
effective in some instances.

In these many regards, cinnarizine is similar to other medications
taken for nausea and seasickness - including PhenerganT and
CompazineT, which are available in the U.S. and have similar physical
and psychological side effects. In fact, all of the drugs for
seasickness - including original DramamineT, meclizine (non-drowsy
DramamineT), and Transderm-scopT - have many significant side-effects
and need to be used with caution, especially if someone is operating
complex and expensive equipment in situations where good judgment and
clear thinking are critical.

Cinnarizine is commonly sold in other countries as 25 mg tablets, but
it is usually effective at lower doses. Cinnarizine is not safe for
pregnant women, or children younger than five. People who have taken
cinnarizine, and who have found it to work without side-effects,
should take the lowest effective dose. But they should consult their
physician, especially if they have Parkinson's disease, take
medications for depression, or have heart disease. Higher dose 75 mg
tablets of cinnarizine, such as Stugeron ForteT, are aimed at a
different problem than seasickness.

Don't hold your breath waiting for the FDA to approve it for sale in
the United States.

Roy Verdery, M.D.
Jellybean, Pearson 36
Northern California / Santiago Bay, Mexico

Roy - We're not annoyed with the FDA, we're just confused as to why
the FDA and the drug approval agencies in many European countries
have come to such dramatically different conclusions about the wisdom
of using Stugeron. After all, if we're not mistaken, you can buy the
stuff over the counter in countries on the other side of the Atlantic.

Just for the record, we're going to remind everyone that it's very
foolish to take any drugs without consulting a physican - especially
as people get older and tend to take more medications.

These are copies of a couple of letters to Latitude 38 Magazine, read on. The original author did not have their name published. Suggest you consult Lat 38's site and search on seasickness (latitude38.com).

I'm reluctant to write this, but it may help some of your readers. We also heard that Stugeron was a good cure
for motion sickness. We read a little bit of anecdotal information on the Internet that portrays it to be a safe drug
with no known side-effects. Since friends of ours had used it for two years without side-effects, we purchased
some in Mexico for use while sailing.

Anyone opting to take Stugeron should be careful when purchasing the product. We, for example, were not
aware that it comes in 75 mg tablets and 150 mg capsules. Because of the language barrier in Mexico and our
own ignorance, we assumed that Stugeron was a motion sickness medication - like Dramamine. Consequently,
we wound up taking the capsule. One person in our group of six became very ill and another was drowsy for eight
hours. The rest of us felt a little queasy.

Because of these reactions, we decided to do a little more research on the product to learn more and determine
the proper dose. What we learned has caused us to rethink the use of such a powerful drug for just motion
sickness. The reason stronger doses of Stugeron are available is because it's used in the treatment of epilepsy,
Meniere¹s Disease, migraine headaches, vestibular irritation, labyrinthine arteriosclerosis, arteriosclerosis,
vasospasm, vertigo - and a host of other serious disorders. It is a powerful calcium channel blocker, a strong
antihistamine, and a vascular spasmolytic. It also reduces motion sickness. Your readers should give careful
consideration to whether motion sickness is a sufficient illness to warrant the use of such a powerful drug.

In addition, we subsequently found that Stugeron is not a 'new' drug - as had been our impression. Cinnarazine,
the generic name, has been around since the '70s - although the United States Food & Drug Administration has
yet to approve it for use. We contacted Janssen, the manufacturer, directly and a researcher, who shall remain
nameless, suggested that for casual sailors other remedies might be more prudent choices for combating motion
sickness.

Stugeron may eventually prove to be a good choice for treating motion sickness, however for the moment we
have opted to return to taking approved over-the-counter medications. Should the USDA eventually give Stugeron
the green light for use in treating motion sickness, we'll then be the first in line. In the meantime, we'd suggest
that everyone heed Latitude's advice of talking to their doctor before taking Stugeron.

I'm not interested in getting into a debate on this, so please withhold my name.

Readers - Modern drugs have the ability to do fantastic good - as well as harm - so it's just common sense to
proceed with caution. Even though a number of cruisers have raved about Stugeron to combat mal de mer, it
would be very foolish for anyone to take it without having consulted their doctor first. After all, the last thing you
need at sea is a bad reaction to - or overdose from - a powerful drug.

Having left Ariadne II in Trinidad for hurricane season, I recently returned to the States. When I did, I noticed
several letters in Latitude about using Stugeron to combat mal de mer. I was tipped off to Stugeron several years
ago in Mexico by another cruiser who happened to be a veterinarian. Finding that scopalomine produced dry
mouth and was taken off the market for other reasons, I was pleased to find that Stugeron - which was available
in 75 mg tablets - worked wonderfully. While the tablets didn't come with any instructions, one 75 mg tablet taken
at the start of a sea passage usually provided total relief for me - with no side effects. We used them sparingly
after leaving Mexico, as we didn't know how to replenish our stock.

While in England last year, we found that local drugstores sold Stugeron over the counter in non-prescription 15
mg tablets. In fact, they were sold in colorful retail packages with instructions to start with two 15 mg tablets and
repeat - as I recall - with one tablet every four hours. There was a daily limit which I don't recall. I've since found
that a single dose of two 15 mg tablets at the start of a passage works as well for me as the 75 mg Mexican
tablet I had been using. Another cruiser told me that the 75 mg tablet was intended for really serious nausea,
such as that associated with chemotherapy.

Unless England is more lax with regard to OTC medicines than I suspect, Latitude's advice not to take Stugeron
without a doctor's advice may be a bit strong - though certainly on the side of caution. I'm not sure if Stugeron is
available in the 'English' islands of the Caribbean.

Roger - Thanks for the great information. Our advice continues to be not to take any medicine without checking
with your doctor - or at least some doctor - for possible problems or bad reactions with other medicines you
may be taking. This is powerful stuff. And whatever you do, don't take a full 'Mexican dose'.