Two Cases of Effective Combined Treatment with a Histamine H₁ Receptor Antagonist and Perospirone for Intractable Nausea and Vertigo Induced by Opioid Treatment

Abstract

Intractable nausea and vertigo induced by opioid treatment are occasionally difficult to treat. It has been reported that antiemetic drugs and opioid rotation may be effective in treating nausea in such cases; however, this approach has been occasionally ineffective. Symptomatic treatment has not been developed for vertigo induced by opioid treatment. Here, we report a case study where combined treatment with perospirone and a histamine H₁ receptor antagonist was used in 2 patients who developed intractable nausea and vertigo induced by opioid treatment. Treatment with a histamine H₁ receptor antagonist drug (tablet form, containing 40 mg diphenhydramine salicylate and 26 mg diprophylline) suppressed the nausea and vertigo. However, increasing the opioid dosage exacerbated the symptoms, and treatment involving the histamine H₁ receptor antagonist and opioid rotation was ineffective. Subsequently, combination treatment with the histamine H₁ receptor antagonist (3 tablets per day) and perospirone (maximum daily dose, 16 mg) improved the symptoms. The results of the present study suggest that combination treatment with a histamine H₁ receptor antagonist and perospirone might improve intractable nausea and vertigo induced by opioid treatment.