Page 176 - 2022 Ranger Medic Handbook

MECLIZINE (ANTIVERT)
Class: H 1 -receptor antagonist; antihistamine, antivertigo agent
Action: Long-acting piperazine antihistamine with marked effect in blocking histamine-induced vasopressive re-
sponse, but only slight anticholinergic action; marked depressant action on labyrinthine excitability and on conduction
in vestibular – cerebellar pathways; exhibits CNS depression, antispasmodic, antiemetic, and local anesthetic activity
Dose: For motion sickness, 25–50mg PO 1 hour before travel, may repeat q24hr prn for duration of journey; for ver-
tigo, 25–100mg/d PO in divided doses
Indications: For management of nausea, vomiting, and dizziness associated with motion sickness and vertigo associ-
ated with diseases affecting the vestibular system
Contraindications: Hypersensitivity to meclizine; pregnancy category may use during pregnancy and consider alter-
native while breastfeeding
Adverse/Side-effects: Drowsiness; dry mouth; blurred vision; fatigue
Interactions: Alcohol and CNS depressants may potentiate sedative effects; do not drive or engage in potentially
hazardous activities until response to drug is known
SECTION 4 Mission Impact: GROUNDING medication for personnel on flight status

MELATONIN
Class: Hormone produced by the pineal glands involved in mammalian circadian rhythms.
Dose: 0.3–3mg for short periods of time (no longer than 2 weeks). Do not exceed 3mg due to paroxysmal hyperstimu-
lation from elevated melatonin levels.
Indications: Insomnia and sleep disturbances
Contraindications: Hypersensitivity
Adverse/Side-effects: Stomach discomfort, morning grogginess, daytime “hangover”, feeling of a heavy head, de-
pression, HA, lethargy, amnesia, increased seizure activity, suppression of male libido, hypothermia, retinal damage,
and gynecomastia
Interactions: ASA, NSAIDs, benzodiazepines, β-blockers, corticosteroids, alcohol
Mission Impact: GROUNDING medication for personnel on flight status

MELOXICAM (MOBIC) *
Class: NSAID; COX-2 Inhibitor, anti-inflammatory, analgesic, antipyretic
Action: Inhibits cyclooxygenase
Dose: 7.5–15mg PO qd
Indications: For mild to moderate pain management, osteoarthritis, rheumatoid arthritis
Contraindications: NSAID or salicylate hypersensitivity; rhinitis, urticaria, angioedema, asthma; severe renal or he p atic
disease; pregnancy category caution advised in 1st trimester and avoid use remainder of pregnancy. Consider alterna-
tive while breastfeeding (caution advised in patients trying to conceive)
Adverse/Side-effects: Edema, flulike syndrome, pain; abdominal pain, diarrhea, dyspepsia, flatulence, nausea, con-
stipation, ulceration, GI bleed, anemia; arthralgia; dizziness, headache, insomnia; pharyngitis, upper respiratory tract
infection, cough; rash, pruritus; urinary frequency, UTI
Interactions: May decrease effect of ACE inhibitors and diuretics; may increase lithium levels and toxicity; aspirin may
increase GI bleed risk; warfarin and herbals (feverfew, garlic, ginger, ginkgo) may increase bleeding

162 SECTION 4 RANGER MEDIC PHARMACOLOGY & FORMULARY