Artigo 20/40 mg Tablet (Cinnarizine + Dimenhydrinate) – ACI Limited

1. About Artigo 20/40 mg (Cinnarizine + Dimenhydrinate)

Artigo 20/40 mg Tablet contains Cinnarizine 20 mg + Dimenhydrinate 40 mg, the standard-strength fixed-dose antivertigo combination by ACI Limited, Bangladesh. The “20/40” designation specifies the precise strengths: 20 mg cinnarizine (peripheral vestibular calcium-channel blockade) and 40 mg dimenhydrinate (central antiemetic and vestibular nuclei suppression).

This is the classic, evidence-based antivertigo formulation used widely across Bangladesh and South Asia for BPPV, Menière’s disease, vestibular neuritis, labyrinthitis, and motion sickness. Multiple European and Asian RCTs confirm the 20/40 mg ratio as optimal for balancing efficacy with tolerability.

2. Mechanism of Action

Cinnarizine 20 mg: Selective vestibular calcium channel blocker — stabilises semicircular canal hair cell activity, reduces pathological nystagmus, improves inner ear blood flow, and suppresses excessive endolymph production in Menière’s disease. Additionally blocks central H1 histamine and D2 dopamine receptors.

Dimenhydrinate 40 mg: Theoclate salt of diphenhydramine — potent H1 + muscarinic antagonist. Suppresses the chemoreceptor trigger zone (CTZ), vomiting centre, and vestibular nuclei activity. Provides reliable antiemetic action and reduces anxiety-related amplification of vertigo.

Optimal 20/40 ratio: The 20 mg cinnarizine dose produces peripheral vestibular stabilisation without excessive D2 blockade (Parkinsonism risk minimised at this dose vs higher cinnarizine doses). The 40 mg dimenhydrinate dose provides central antiemetic coverage. Together they address all three components of vertigo: peripheral, central, and autonomic (nausea/vomiting).

3. Indications

• BPPV (adjunct to repositioning manoeuvres)
• Menière’s disease — acute attacks and maintenance prophylaxis
• Vestibular neuritis and labyrinthitis
• Motion sickness prevention and acute treatment
• Vertigo from migraine, head trauma, or vertebrobasilar insufficiency

4. Dosage and Administration

Adults (standard): 1 tablet three times daily (TDS) after meals.

Motion sickness: 1–2 tablets taken 30 minutes before travel; repeat every 6–8 hours during journey.

Elderly: 1 tablet twice daily (BD) — increased sensitivity to sedation and anticholinergic effects.

Maximum dose: 6 tablets/day (120 mg cinnarizine / 240 mg dimenhydrinate).

Not recommended in children under 12 years. Take after meals to reduce GI irritation.

5. Contraindications

• Hypersensitivity to cinnarizine, dimenhydrinate, or diphenhydramine
• Established Parkinson’s disease
• QTc prolongation or concurrent QTc-prolonging medications
• Porphyria

6. Warnings and Precautions

Drug-induced Parkinsonism: Cinnarizine is a dopamine D2 antagonist. Prolonged use (months to years) can induce Parkinsonian symptoms — tremor, rigidity, bradykinesia, especially in elderly with reduced dopaminergic reserve. Withdraw if these symptoms develop. Contraindicated in Parkinson’s disease.

Sedation: Do not drive, operate machinery, or perform safety-critical activities. Significant drowsiness especially in first week. Alcohol markedly worsens sedation.

QTc risk: Dimenhydrinate prolongs QTc. Avoid with other QTc-prolonging drugs: amiodarone, azithromycin, haloperidol, ondansetron, quinolones.

Elderly — Beers Criteria: High anticholinergic burden increases fall risk, urinary retention, constipation, and confusion. Use minimum effective dose at BD frequency.

7. Side Effects

Common: Drowsiness, dry mouth, blurred vision, constipation, headache.

Uncommon: Weight gain (long-term cinnarizine), gastric discomfort.

Rare: Drug-induced Parkinsonism, QTc prolongation, cholestatic jaundice, blood dyscrasias.

8. Drug Interactions

• CNS depressants — additive sedation
• QTc-prolonging drugs — increased arrhythmia risk
• Dopamine antagonists (metoclopramide, antipsychotics) — increased extrapyramidal risk
• Anticholinergics — additive dry mouth, urinary retention, cognitive impairment

9. The 20/40 mg Ratio: Why It Matters

The specific 20 mg cinnarizine / 40 mg dimenhydrinate ratio in Artigo 20/40 mg is clinically validated. Cinnarizine doses above 25 mg increase D2 blockade and Parkinsonism risk without proportional additional vestibular benefit. Dimenhydrinate at 40 mg provides full CTZ suppression — increasing to 50 mg adds sedation without additional antiemetic benefit. This precise ratio delivers maximum efficacy with an optimised safety profile, representing the standard of care for pharmacological vertigo management in Bangladesh.

10. Storage

• Below 30°C, cool and dry, protected from light. Keep in original packaging.

Frequently Asked Questions (FAQ)

Q1: What is Artigo 20/40 mg used for?

Artigo 20/40 mg (Cinnarizine 20 mg + Dimenhydrinate 40 mg) is ACI Limited’s standard-strength antivertigo tablet for BPPV, Menière’s disease, vestibular neuritis, labyrinthitis, and motion sickness. The 20/40 designation specifies the milligram strengths of each component — the clinically validated ratio for antivertigo treatment. One tablet TDS is standard for acute vestibular episodes; motion sickness prevention requires 1–2 tablets 30 minutes before travel.

Q2: How is Artigo 20/40 mg different from other Artigo variants?

Artigo 20/40 mg explicitly labels the component strengths (20 mg cinnarizine + 40 mg dimenhydrinate per tablet), confirming the precise formulation. All standard Artigo tablets by ACI contain this 20/40 ratio as the established antivertigo dose. The naming distinguishes this product from potential higher-strength formulations and helps prescribers specify the exact dose clearly. Clinically, all Artigo 20/40 mg tablets provide identical antivertigo efficacy.

Q3: Can Artigo 20/40 mg be crushed or split for lower doses?

Tablets can generally be split if needed for dose adjustment (e.g., elderly requiring half-dose). Check the tablet for a score line indicating it is designed to be split. Crushing is generally acceptable as there is no modified-release coating on standard Artigo tablets. For patients requiring very small doses (e.g., frail elderly), the tablet may be crushed and mixed with food. Consult a pharmacist for specific instructions on the batch.

Q4: How long does Artigo 20/40 mg take to work?

Onset of action is typically 15–30 minutes after oral administration, with peak effect at 1–2 hours. For motion sickness prevention, taking 1–2 tablets 30 minutes before travel exploits this pharmacokinetic profile optimally. For acute BPPV or vestibular neuritis, maximum benefit is seen with regular TDS dosing over 2–5 days. Some patients notice partial relief within 30–60 minutes of the first dose for acute vertigo attacks.