What are the treatment options for motion sickness?

Motion Sickness Treatment Options

Scopolamine transdermal system is the first-line medication for prevention of motion sickness, with clinical studies showing a 75% reduction in motion-induced nausea and vomiting. 1

First-Line Pharmacological Options

• Scopolamine transdermal patch should be applied to a hairless area behind the ear at least 4 hours before anticipated motion exposure for optimal prevention 1
• First-generation antihistamines are effective alternatives:
  • Meclizine (12.5-25 mg three times daily) is commonly used for peripheral vertigo and motion sickness symptoms 2, 3
  • Promethazine (12.5-25 mg) is recommended for severe cases where rapid onset is needed 3
  • Dimenhydrinate and cinnarizine have shown effectiveness in preventing motion sickness symptoms under natural conditions 4

Second-Line Options

• Prokinetic antiemetics such as metoclopramide can be useful adjuncts for managing nausea and vomiting associated with motion sickness 2
• Prochlorperazine may be used for short-term management of severe nausea or vomiting in patients with motion sickness who are severely symptomatic 2

Behavioral and Environmental Strategies

• Identify situations that will lead to motion sickness and minimize exposure to unpleasant motion by positioning in the most stable part of the vehicle 5
• Watch the true visual horizon, steer the vehicle when possible, tilt head into turns, or lie down with eyes closed 5
• Slow, intermittent exposure to motion can help reduce symptoms through habituation 5, 6
• Reduce other sources of physical, mental, and emotional discomfort that may exacerbate symptoms 5

Medication Administration Considerations

• Scopolamine transdermal patch:
  • Apply at least 4 hours before activity to prevent nausea and vomiting 1
  • Effective for up to 3 days; if longer treatment is needed, remove and apply a new patch behind the other ear 1
  • Wash hands thoroughly after application to prevent medication from getting into eyes 1
• Antihistamines should be taken before departure for maximum effectiveness 7

Ineffective Treatments

• Nonsedating antihistamines, ondansetron, and ginger root have not shown effectiveness in the prevention and treatment of motion sickness 5

Special Considerations and Cautions

• Children between 2 and 12 years old are most susceptible to motion sickness, and women are more frequently affected than men 8
• Vestibular suppressant medications should be used for short-term management rather than long-term treatment, as they can interfere with natural adaptation to motion 2, 3
• Common side effects of scopolamine include dry mouth, dizziness, blurred vision, feeling agitated or irritable, drowsiness, and confusion 1
• First-generation antihistamines may cause significant sedation compared to placebo (66% vs 44%) 4
• Medications primarily treat symptoms rather than addressing the underlying sensory conflict 2

Treatment Algorithm

1. For planned travel or motion exposure:

   • Apply scopolamine transdermal patch 4-16 hours before motion exposure 1
   • If scopolamine is contraindicated, use meclizine 12.5-25 mg taken 1 hour before travel 3

2. For unexpected or immediate motion exposure:

   • Use promethazine 12.5-25 mg for rapid onset 3
   • Implement behavioral strategies (focus on horizon, minimize head movement) 5

3. For severe symptoms despite prevention:

   • Add prokinetic antiemetics like metoclopramide as adjuncts 2
   • Consider prochlorperazine for severe nausea and vomiting 2