What are non-sedative medication options for motion sickness?

Non-Sedative Medication Options for Motion Sickness

Transdermal scopolamine is the most effective non-sedative medication option for motion sickness prevention, delivering consistent blood levels over 72 hours with significantly fewer sedative effects compared to traditional antihistamines. 1

First-Line Non-Sedative Option

Transdermal Scopolamine

• Mechanism: Anticholinergic that blocks muscarinic receptors in the vestibular apparatus
• Formulation: Transdermal patch (TTS-S) containing 1.5mg scopolamine programmed to deliver 0.5mg over 3 days
• Administration: Apply behind the ear at least 6-8 hours before travel
• Efficacy: 60-80% reduction in motion sickness incidence and severity 1, 2
• Advantages:
  • Maintains steady plasma levels (approximately 100 pg/mL) for up to 72 hours
  • Significantly less sedating than oral antihistamines 1
  • Comparable or superior efficacy to dimenhydrinate and other motion sickness medications 1
  • Particularly useful for longer journeys (>6 hours) 1

Second-Line Options with Lower Sedation Potential

Second-Generation Antihistamines

• While not specifically indicated for motion sickness, certain second-generation antihistamines have minimal sedative properties:
  • Fexofenadine: No sedation at recommended doses 3
  • Loratadine and desloratadine: No sedation at recommended doses (may cause sedation at higher doses) 3

Combination Therapy

• For faster onset of protection: Transdermal scopolamine patch applied 1 hour before journey plus oral scopolamine (0.3 or 0.6mg) 1

Ineffective Non-Sedative Options

The following have been shown to be ineffective for motion sickness prevention:

• Non-sedating antihistamines (as a class)
• Ondansetron
• Ginger root 4

Important Considerations

Side Effects of Transdermal Scopolamine

• Dry mouth (50-60% of users)
• Transient visual accommodation issues (avoid touching eyes after handling patch)
• Allergic contact dermatitis (10%)
• Rare CNS effects including toxic psychosis (mainly in elderly and pediatric patients) 1

Performance Effects

• Short-term use of transdermal scopolamine does not significantly affect performance 1
• Studies show significantly fewer reports of performance decrements compared to sedating alternatives 1

Contraindications

• Glaucoma (particularly narrow-angle)
• Prostatic hypertrophy
• Cognitive impairment
• Caution in elderly patients due to increased risk of anticholinergic effects 3

Clinical Decision Algorithm

1. For journeys >6 hours: Transdermal scopolamine patch applied 6-8 hours before travel
2. For shorter journeys or faster onset needed: Consider combination of transdermal patch plus oral scopolamine
3. For patients with contraindications to scopolamine: Consider fexofenadine, loratadine, or desloratadine (understanding these have limited evidence for motion sickness)
4. For patients with previous patch reactions: Consider oral non-sedating antihistamine options

Behavioral Strategies to Complement Medication

• Position in the most stable part of the vehicle
• Watch the true visual horizon
• Tilt head into turns
• Minimize other sources of physical or mental discomfort 4

Transdermal scopolamine remains the gold standard non-sedative option for motion sickness prevention, with a well-established efficacy profile and manageable side effect profile when used appropriately.