What are the treatment options for motion sickness (seasickness)?

Treatment Options for Motion Sickness (Seasickness)

Scopolamine transdermal patch is the first-line medication for prevention of motion sickness and should be applied 4-16 hours before anticipated motion exposure. 1, 2

First-Line Pharmacologic Options

Scopolamine Transdermal System

• Efficacy: 75% reduction in motion-induced nausea and vomiting in clinical studies 1
• Application: Apply behind ear on hairless skin 4-16 hours before travel 1
• Duration: Effective for up to 3 days 1
• Mechanism: Anticholinergic that blocks muscarinic receptors to suppress acute vertigo attacks 3
• Side effects: Dry mouth, drowsiness, blurred vision, confusion 1
• Cautions: Avoid in patients with glaucoma, urinary retention, asthma, peptic ulcer disease 4

First-Generation Antihistamines

• Meclizine (Antivert, Bonine)

  • Effective for short-term use but causes sedation 4
  • Take 1 hour before travel

• Dimenhydrinate (Dramamine)

  • Comparable efficacy to scopolamine in some studies 5
  • More effective against nausea than a single scopolamine patch 5
  • Causes significant sedation

Second-Line Options

Behavioral and Environmental Strategies

1. Positioning:

   • Sit in the most stable part of the vessel (center, lower deck)
   • Face forward in the direction of travel
   • Keep head stabilized, especially during rough conditions

2. Visual strategies:

   • Fix gaze on the true horizon when possible 2
   • Avoid reading or focusing on close objects
   • Close eyes if visual input worsens symptoms

3. Habituation techniques:

   • Slow, intermittent exposure to motion can reduce symptoms 2
   • Gradual exposure to increasingly challenging conditions

4. Other helpful approaches:

   • Fresh air circulation
   • Avoid strong odors
   • Maintain adequate hydration
   • Avoid heavy, greasy meals before travel

Ineffective Treatments

• Nonsedating antihistamines: Not effective for motion sickness 2
• Ondansetron: Despite being an effective antiemetic, not effective for motion sickness prevention 2
• Ginger root: Evidence does not support efficacy for motion sickness 2

Treatment Algorithm

1. For prevention in adults:

   • First choice: Scopolamine transdermal patch applied 4-16 hours before travel 1, 2
   • Alternative: Meclizine 25-50 mg or dimenhydrinate 50 mg 1 hour before travel

2. For acute symptoms during travel:

   • Implement behavioral strategies (fix gaze on horizon, move to stable part of vessel)
   • If medications weren't taken preventively, first-generation antihistamines may provide some relief but are less effective once symptoms begin

3. For high-risk individuals (history of severe motion sickness):

   • Combine pharmacologic and behavioral approaches
   • Consider scopolamine patch plus behavioral strategies

Special Considerations

• Elderly patients: Use caution with anticholinergics and antihistamines due to increased risk of falls, confusion, and urinary retention 4
• Prolonged exposure: For trips longer than 3 days with scopolamine patch, remove and apply a new patch behind the opposite ear 1
• Driving/operating machinery: Be aware that most effective medications cause drowsiness and may impair performance 1

Safety Warnings

• Avoid combining multiple sedating medications
• Apply scopolamine correctly to avoid accidental eye exposure which can cause pupil dilation and blurry vision 1
• Withdrawal symptoms may occur after removing scopolamine patch after several days of use 1
• Monitor for side effects such as dry mouth, drowsiness, and confusion, especially in older adults 4