Pizotifen


   Issues for Surgery 


Recurrence of vascular headache, classical migraine, common migraine, or cluster headache if omitted.

Risk of withdrawal symptoms if omitted (see Further Information).


  Advice in the Perioperative period 


Elective and Emergency Surgery
Continue


Post-operative Advice
Restart post-operatively when dose next due.


  Interaction(s) with Common Anaesthetic Agents 


CNS Depression see also Interaction(s) with other Common Medicines used in the Perioperative Period Pizotifen has CNS depressant effects which may be additive with other medicines that also have CNS depressant effects such as 1, 2, 3: -
  • benzodiazepines 
  • inhalational anaesthetics and intravenous anaesthetics
  • local anaesthetics 
  • opioids
(Consult British National Formulary for available drugs in each class)

   Interaction(s) with other Common Medicines used in the Perioperative Period 


CNS Depression see also nteraction(s) with Common Anaesthetic Agents Sedating antihistamines have CNS depressant effects which may be additive with other medicines that also have CNS depressant effects such as 1, 2, 3: -
  • antiemetics (e.g. cyclizine, prochlorperazine)
  • opioids

(Consult British National Formulary for available drugs in each class) 

Seizure threshold

Pizotifen may lower the seizure threshold; concurrent use with other drugs that lower the seizure threshold (e.g. tramadol) might result in additive effects 3.


   Further Information 


Withdrawal
Acute withdrawal reactions including anxiety, tremors, insomnia, nausea, and loss of consciousness have been reported following abrupt cessation of pizotifen therefore gradual withdrawal is recommended 2.



  References  


  1. Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 5th November 2020]
  2. Summary of Product Characteristics – Pizotifen 0.5mg Tablets. Rivopharm UK Ltd. Accessed via www.medicines.org.uk 05/11/2020 [date of revision of the text October 2015]
  3. Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 5th November 2020]