From the Guidelines
For kinesthetic sickness (motion sickness), the most effective treatment is over-the-counter antihistamines like meclizine (Bonine) 25mg taken 30-60 minutes before travel, with effects lasting 4-6 hours, as supported by the study 1. This approach is prioritized due to its direct impact on reducing the symptoms of motion sickness, including nausea and vomiting, thereby improving the patient's quality of life and reducing morbidity associated with these symptoms.
Treatment Options
- Over-the-counter antihistamines: Meclizine (Bonine) is recommended due to its efficacy in suppressing the central emetic center to relieve nausea and vomiting associated with motion sickness, as discussed in 1.
- Prescription options: Scopolamine patches can be considered for longer journeys, applied behind the ear 4 hours before travel, lasting up to 72 hours.
- Non-medication strategies: Sitting in the front seat of a car, focusing on the horizon, avoiding reading, ensuring good ventilation, and considering ginger supplements (250mg capsules) may also help reduce nausea, as touched upon in 1, although ginger's primary benefit may be more related to its calming effect rather than a direct antinausea action during motion sickness.
Mechanism and Side Effects
These medications work by either suppressing signals in the inner ear or blocking histamine receptors that trigger nausea when the brain receives conflicting motion signals. However, side effects such as drowsiness, dry mouth, and blurred vision can occur, necessitating caution with driving or alcohol consumption when using these medications.
Evidence Quality and Clinical Decision
Given the information from 1 and considering the principles of prioritizing the most recent and highest quality study, the recommendation for meclizine as a first-line treatment is based on its established efficacy and safety profile for motion sickness. Although 1 discusses ginger, its role is more adjunctive, and the primary approach should be pharmacological intervention with antihistamines for effective management of kinesthetic sickness.
From the FDA Drug Label
To help prevent nausea and vomiting from motion sickness: • Apply one scopolamine transdermal system to your 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 scopolamine transdermal system from the hairless area behind your ear Get a new scopolamine transdermal system and place it on the hairless area behind your other ear.
The treatment for kinesthetic sickness (motion sickness) is to apply one scopolamine transdermal system to the skin on a hairless area behind one ear at least 4 hours before the activity. If treatment is needed for longer than 3 days, remove the system and apply a new one behind the other ear. 2
From the Research
Treatment for Kinesthetic Sickness (Motion Sickness)
The treatment for kinesthetic sickness, also known as motion sickness, can be managed through various methods, including:
- Behavioral strategies
- Pharmacologic interventions
Behavioral Strategies
Behavioral strategies to prevent motion sickness include:
- Avoiding difficult conditions while traveling
- Positioning oneself in the most stable part of the vehicle
- Watching the true visual horizon
- Steering the vehicle
- Tilting the head into turns
- Lying down with eyes closed
- Reducing other sources of physical, mental, and emotional discomfort 3
Pharmacologic Interventions
Pharmacologic interventions for motion sickness include:
- Scopolamine, which is a first-line medication for prevention and can be administered transdermally several hours before motion exposure 3, 4, 5
- First-generation antihistamines, which are effective but sedating 3, 6
- Anticholinergics, which are effective in prophylaxis and/or treatment of motion sickness 7
- Sympathomimetics, which are also effective in prophylaxis and/or treatment of motion sickness 7
Comparison of Treatments
Comparisons between scopolamine and other agents suggest that scopolamine is superior or equivalent as a preventative agent 5. Antihistamines may be more likely to cause sedation when compared to placebo 6. The evidence for other outcomes and comparisons is of low or very low certainty 6.
Limitations
No studies have evaluated the treatment of existing motion sickness, and there are few data on the effect of antihistamines in children 6, 5.