Mary Warner
Motion sickness can occur when riding in a car, train, airplane, boat, or even an amusement park ride. When your brain gets conflicting information from your eyes, inner ear, and body, the resulting confusion can cause dizziness, nausea, and vomiting. While avoiding situations that cause motion sickness is the best way to prevent it, that’s not always possible. Fortunately, several therapeutic options are available to calm the inner turmoil.
Motion sickness is most common in women and in children ages 2 to 12 years old. A family history of motion sickness, hormonal birth control, inner ear disorders, menstrual periods, migraines, Parkinson’s disease, and pregnancy can increase the likelihood of experiencing motion sickness. Common symptoms include cold sweats, dizziness, fatigue, headache, irritability, inability to concentrate, nausea, vomiting, pale skin, and rapid breathing. These symptoms generally resolve quickly once motion stops.
Common ways to avoid feeling sick include sitting in the front of a car, choosing a window seat on airplanes and trains, and looking at the horizon. Staying hydrated and eating small amounts of food frequently can also help. When these strategies are unsuccessful, medication may be needed.
Medications for motion sickness
Antihistamines are the most commonly used medications for treating motion sickness and easing symptoms. They’re most effective when taken before travel or at the early onset of symptoms and are effective and generally safe in addition to being well-tolerated for relieving nausea, vomiting, and dizziness related to motion sickness. Only the first-generation antihistamines meclizine, dimenhydrinate, and diphenhydramine are approved by FDA for this purpose. These medications are well-known to cause drowsiness, and patients wishing to avoid these sedative effects should be aware that the less-sedating second-generation antihistamines are ineffective for treating motion sickness. Meclizine may be less sedating and longer-acting than dimenhydrinate or diphenhydramine.
Formulations
Pharmacy shelves are full of tablets and chewables claiming to prevent motion sickness, with most but not all containing antihistamines. For example, Dramamine, one of the most common brands of motion sickness medications, is available in several versions, including Original (dimenhydrinate 50 mg), All Day Less Drowsy (meclizine HCI 25 mg), Kids (dimenhydrinate 25 mg), and Non-Drowsy (ginger root 500 mg). Several products contain ginger, which is known to calm an upset stomach.
Two types of nonmedicated wristbands are also marketed to relieve motion sickness, though these have shown mixed results in clinical trials. The first type uses acupressure to maintain steady pressure on the P6 point, which is located on the inner arm just below the wrist, stimulating the median nerve and interrupting motion sickness signals to the brain. Wristbands can be safely used by pregnant patients and children, making them particularly helpful to these patients.
Another option is a battery-powered acustimulation wristband that uses electrical pulses to stimulate the median nerve and disrupt nausea signals. Conductivity gel is applied to the P6 point before putting on the wristband; the patient can then adjust the pulse strength depending on the severity of the motion sickness. Pregnant patients can safely use these wristbands, but they’re far more expensive than other motion relief products.
What to tell your patients
Advise patients to always face forward while traveling, stay hydrated, and avoid alcohol and spicy foods. It can also be helpful to look at an object in the distance or at the horizon. Ensure that patients understand that only antihistamines that cause drowsiness will affect motion sickness and that children should not take meclizine, as it is not FDA-approved for children under 12 years old. Both diphenhydramine and dimenhydrinate are suitable for younger children.
Advise pregnant patients that they have increased susceptibility to motion sickness and that medications used for morning sickness can be used for motion sickness, including meclizine and dimenhydrinate.
For more information, see APhA’s Handbook of Nonprescription Drugs, available in print from the bookstore on pharmacist.com and online in PharmacyLibrary. ■