From the Guidelines
For severe motion sickness in a young adult, I recommend using scopolamine patches applied behind the ear 4 hours before travel, lasting up to 72 hours, as they are the most effective option with the longest duration of action, according to the most recent evidence 1.
Treatment Options
- Over-the-counter medications like dimenhydrinate (Dramamine) 50-100mg or meclizine (Bonine) 25-50mg taken 30-60 minutes before travel, with effects lasting 4-6 hours, can be used as alternative options 1.
- Non-medication approaches include sitting in positions with less motion (front seat of car, middle of boat, over wings on plane), focusing on the horizon, avoiding reading or screens, ensuring good ventilation, and using ginger supplements (250mg capsules or ginger tea).
Mechanism of Action
These treatments work by targeting the vestibular system in the inner ear, which sends conflicting signals to the brain during motion sickness. Antihistamines like dimenhydrinate block signals to the vomiting center, while scopolamine reduces nerve signals from the inner ear 1.
Side Effects
Side effects may include drowsiness with antihistamines and dry mouth with scopolamine, so it is essential to avoid alcohol when using these medications 1.
Considerations
It is crucial to consider the potential risks and benefits of each treatment option, including the risk of drug dependence associated with benzodiazepines 1.
Patient Preferences
The choice of treatment should take into account the patient's preferences and the severity of their symptoms, as indicated by the clinical practice guideline 1.
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.
Scopolamine transdermal system can treat severe motion sickness in a young adult.
- 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, get a new scopolamine transdermal system, and place it on the hairless area behind the other ear 2.
From the Research
Treatment Options for Severe Motion Sickness
- Scopolamine is a first-line medication for the prevention of motion sickness and can be administered transdermally several hours before the anticipated motion exposure 3, 4
- First-generation antihistamines are also effective in preventing motion sickness, although they can be sedating 3, 5
- A combination of scopolamine and d-amphetamine has been shown to be effective in preventing motion sickness 6
- Anticholinergic agents and antihistamines are effective in the prophylaxis and/or treatment of motion sickness 5
Non-Pharmacological Methods
- Habituation remains the most effective non-pharmacological method to reduce motion sickness 7
- Behavioral strategies such as watching the true visual horizon, steering the vehicle, tilting their head into turns, or lying down with their eyes closed can help reduce symptoms 3
- Simple environmental modifications such as avoiding difficult conditions while traveling or positioning themselves in the most stable part of the vehicle can also be effective 3
Severity of Motion Sickness
- Severe motion sickness can be treated with a combination of pharmacological and non-pharmacological methods 5, 7
- In most cases, motion sickness can be prevented by behavioral and environmental modifications, but pharmacotherapy should be considered in the prevention and/or treatment of more severe motion sickness 5