What is the most effective treatment for kinetosis (motion sickness)?

From the Guidelines

The most effective treatment for motion sickness is to take antihistamines like meclizine or diphenhydramine, which can relieve nausea and vomiting associated with motion sickness. When considering treatment options for motion sickness, it's essential to evaluate the available evidence and choose the most effective approach. According to the study 1, antihistamines appear to have a suppressive effect on the central emetic center, relieving nausea and vomiting associated with motion sickness. Some key points to consider when treating motion sickness include:

• Antihistamines like meclizine and diphenhydramine are commonly used to treat symptoms of vertigo and associated motion sickness 1
• Benzodiazepines, such as diazepam and clonazepam, can reduce the subjective sensation of spinning but may interfere with central compensation in peripheral vestibular conditions 1
• Other medications like promethazine, a phenothiazine with antihistamine properties, and ondansetron, a serotonin-5-hydroxytryptamine-3 antagonist, can also be used to treat motion sickness 1
• Anticholinergic medications like scopolamine can help with motion sickness by reducing neural mismatching 1 It's crucial to note that while these medications can provide relief, they may have side effects and interact with other medications. In terms of specific treatment regimens, the example answer provides guidance on dosage and administration for various medications, including dimenhydrinate, meclizine, and scopolamine patches. Non-medication approaches, such as sitting in positions with minimal motion, avoiding reading or screen time during travel, ensuring good ventilation, and trying ginger supplements, can also be effective in managing motion sickness. Ultimately, the best approach will depend on the individual's specific needs and circumstances, and combining medication with positioning strategies typically works best for severe cases.

From the FDA Drug Label

In 195 adult subjects of different racial origins who participated in clinical efficacy studies at sea or in a controlled motion environment, there was a 75% reduction in the incidence of motion-induced nausea and vomiting. Scopolamine transdermal system was applied from 4 to 16 hours prior to the onset of motion in these studies.

The best treatment for motion sickness is scopolamine transdermal system, which has been shown to reduce the incidence of motion-induced nausea and vomiting by 75% when applied 4 to 16 hours prior to the onset of motion.

• Key points:
  • Apply one scopolamine transdermal system to the skin on a hairless area behind one ear at least 4 hours before the activity to prevent nausea and vomiting.
  • If the treatment is needed for longer than 3 days, remove the scopolamine transdermal system from the hairless area behind the ear and apply a new one to the hairless area behind the other ear. 2

From the Research

Treatment Options for Motion Sickness

• Antihistamines are probably more effective than placebo at preventing motion sickness symptoms under natural conditions, with a risk ratio (RR) of 1.81 [ 3 ].
• The evidence is very uncertain about the effect of antihistamines on preventing motion sickness under experimental conditions [ 3 ].
• Antihistamines may result in little or no difference in gastric tachyarrhythmia under experimental conditions, with a mean difference (MD) of -2.2 [ 3 ].
• Antihistamines may be more likely to cause sedation when compared to placebo, with a risk ratio (RR) of 1.51 [ 3 ].

Comparison with Other Treatments

• The evidence is very uncertain about the effect of antihistamines on preventing motion sickness under natural conditions when compared to scopolamine [ 3 ].
• Antihistamines may result in little or no difference in the prevention of motion sickness under experimental conditions when compared to antiemetics, with a mean difference (MD) of -0.20 [ 3 ].
• The evidence is very uncertain about the effects of antihistamines on the prevention of motion sickness under experimental conditions when compared to acupuncture [ 3 ].

Other Considerations

• Habituation remains the most effective non-pharmacological method to reduce motion sickness [ 4 ].
• A variety of novel techniques has been investigated with promising results, but an efficient method to reliably prevent or minimize motion sickness has yet to emerge [ 4 ].
• Meclizine, an antihistamine, may not primarily work through sensory-specific mechanisms, but rather on a more central level [ 5 ].