What medication is prescribed for motion sickness?

Medication for Motion Sickness

For motion sickness prevention, scopolamine transdermal patch is the first-line medication, applied behind the ear at least 6-8 hours before anticipated motion exposure, with each patch lasting approximately 3 days. 1, 2, 3

First-Line Treatment: Scopolamine

• Scopolamine transdermal patch (1.5 mg) should be applied behind the ear 6-8 hours before the anti-motion sickness effect is needed, as this anticholinergic medication blocks acetylcolina to reduce neural mismatch that causes motion sickness 1, 2

• Each patch provides protection for approximately 3 days of continuous use 1, 2

• Scopolamine is FDA-approved specifically for prevention of nausea and vomiting from motion sickness in adults 2

Second-Line Treatment: Antihistamines

When scopolamine cannot be used due to contraindications or side effects, antihistamines are the alternative:

• Meclizine 12.5-25 mg three times daily is the most commonly recommended antihistamine, working by suppressing the central emetic center 1, 4

• Meclizine is probably more effective than placebo at preventing motion sickness symptoms under natural conditions (40% vs 25% symptom prevention) 5

• Dimenhydrinate (another first-generation antihistamine) is also effective and has been shown to reduce both motion sickness symptoms and gastric tachyarrhythmia 6

Severe Cases: Combination or Alternative Therapy

• For severe motion sickness requiring rapid onset, promethazine 12.5-25 mg can be used, though it carries risks of hypotension, respiratory depression, and extrapyramidal effects 1

• Combination therapy with scopolamine patch plus meclizine provides complementary mechanisms of action for severe symptoms 1

Critical Contraindications and Warnings

Scopolamine is absolutely contraindicated in:

• Angle-closure glaucoma 2
• Allergy to scopolamine or belladonna alkaloids 2

Use scopolamine with extreme caution in:

• Open-angle glaucoma (can precipitate angle closure) 2
• Elderly patients (higher risk of anticholinergic side effects and falls) 1, 7
• Pregnant women with preeclampsia (risk of seizures) 2
• Patients with urinary retention, seizure history, or psychosis 2

Important Side Effects to Counsel Patients About

Scopolamine commonly causes:

• Blurred vision and dilated pupils (especially if patch contacts eyes) 2
• Dry mouth 2
• Sedation 2
• Withdrawal symptoms if used for several days then stopped abruptly (dizziness, nausea, vomiting, confusion) 2

Antihistamines commonly cause:

• Sedation (66% with antihistamines vs 44% with placebo) 5
• Anticholinergic effects, though less pronounced than scopolamine 4
• Increased fall risk, particularly in elderly patients 1, 4

Medications That Do NOT Work

• Nonsedating antihistamines are NOT effective for motion sickness prevention 3
• Ondansetron is NOT effective for motion sickness 3
• Ginger root is NOT effective for motion sickness 3

Duration of Use Warning

• Vestibular suppressant medications should only be used short-term (during acute exposure), not as long-term treatment, as they can interfere with vestibular compensation and central adaptation 1, 4, 7

• For conditions like Ménière's disease that may be confused with motion sickness, these medications should only be used during acute attacks, not continuously 4, 7

Special Populations

• Safety and effectiveness in children have not been established for scopolamine transdermal system 2

• Pregnant women should discuss risks versus benefits, as scopolamine passes into breast milk and severe preeclampsia patients have experienced seizures with injectable scopolamine 2

• Elderly patients require closer monitoring due to significantly increased risk of falls and anticholinergic toxicity 1