What medications can prevent nausea and vomiting while traveling?

Medications for Prevention of Travel-Related Nausea and Vomiting

For motion sickness prevention during travel, scopolamine transdermal patch is the FDA-approved first-line option, applied at least 4 hours before travel and effective for up to 3 days. 1

Primary Pharmacologic Options

Scopolamine Transdermal System (Preferred)

• Apply one 1 mg transdermal patch behind the ear at least 4 hours before anticipated motion exposure 1
• Delivers medication continuously over 3 days; if longer prevention needed, remove first patch and apply new one behind opposite ear 1
• Most common side effects include dry mouth (>15%), drowsiness, blurred vision, and pupil dilation 1
• Wash hands thoroughly after application to avoid accidental eye contact, which causes temporary pupil dilation and blurred vision 1

Contraindications for scopolamine:

• Angle-closure glaucoma (absolute contraindication) 1
• Hypersensitivity to scopolamine or belladonna alkaloids 1
• Use caution in patients with open-angle glaucoma, seizure history, psychiatric disorders, gastrointestinal obstruction, or urinary retention 1

Antihistamines (Alternative Options)

Dimenhydrinate and other first-generation antihistamines are probably effective for motion sickness prevention under natural travel conditions, reducing symptom development from 25% (placebo) to 40% (antihistamine). 2

• Antihistamines may cause more sedation than placebo (66% vs 44%) but show little difference in blurred vision or cognitive impairment 2
• Dimenhydrinate specifically demonstrated efficacy in reducing post-operative nausea/vomiting and may be extrapolated to travel contexts 3
• Take medication before travel begins for optimal prevention 2

Ondansetron (5-HT3 Antagonist)

Ondansetron is NOT recommended as first-line for motion sickness prevention - research shows it does not prevent motion sickness in highly susceptible individuals, despite effectiveness for chemotherapy-induced and post-operative nausea 4

• May be considered for breakthrough nausea during travel if prophylaxis fails 5, 6
• Does not cause sedation or akathisia, making it suitable when alertness is required 6
• Can prolong QT interval on ECG - use caution in patients with cardiac conduction abnormalities 5

Clinical Algorithm for Selection

Step 1: Assess contraindications

• If angle-closure glaucoma present → avoid scopolamine, consider antihistamines 1, 2
• If sedation unacceptable (e.g., driver, pilot) → avoid antihistamines, consider scopolamine with caution 2
• If cardiac conduction issues → avoid ondansetron 5

Step 2: Choose primary agent

• For most adults: Scopolamine patch applied 4+ hours before travel 1
• For patients with scopolamine contraindications: First-generation antihistamines (dimenhydrinate) 2
• For breakthrough symptoms despite prophylaxis: Add ondansetron 6

Step 3: Timing and duration

• Scopolamine: Apply minimum 4 hours pre-travel, effective 3 days 1
• Antihistamines: Administer before travel initiation 2
• Replace scopolamine patch after 3 days if continued travel 1

Important Caveats

Pediatric considerations: Scopolamine safety and efficacy not established in children 1. Antihistamine data primarily from adults aged 16-55 years 2.

Pregnancy: Scopolamine effects on fetus unknown; discuss risks/benefits before use 1. Limited data on antihistamine safety in pregnancy for motion sickness specifically 2.

Drug interactions: Scopolamine may reduce oral medication absorption and interacts with other anticholinergics, sedatives, and CNS depressants 1. Avoid alcohol with scopolamine due to increased risk of serious side effects 1.

Withdrawal symptoms: Removing scopolamine patch before 24 hours may cause anticholinergic withdrawal symptoms 1. If severe symptoms develop after removal, seek immediate medical care 1.

Water exposure: Limit swimming/bathing with scopolamine patch as it may detach; if detached, discard and apply new patch behind opposite ear 1