What are the recommended medications for a patient with a history of motion sickness to prevent sea sickness?

Sea Sickness Medication

Scopolamine transdermal patch is the first-line medication for preventing sea sickness, applied 4-16 hours before anticipated motion exposure, with a 75% reduction in motion-induced nausea and vomiting. 1

Primary Recommendation: Scopolamine Transdermal System

• Apply the scopolamine transdermal patch (1 mg/3 days) to the hairless area behind one ear at least 4 hours before departure, ideally 4-16 hours prior to motion exposure. 1
• The patch delivers approximately 1 mg of scopolamine over 3 days, with peak plasma concentrations reached within 24 hours and detectable levels within 4 hours of application. 1
• Clinical efficacy studies demonstrated a 75% reduction in motion-induced nausea and vomiting in 195 adult subjects exposed to motion at sea or in controlled motion environments. 1
• The patch can remain in place for up to 3 days of continuous protection. 1

Alternative: First-Generation Antihistamines

• First-generation antihistamines (such as dimenhydrinate or meclizine) are effective alternatives, though they cause sedation. 2
• Dimenhydrinate showed statistical superiority over placebo (p = 0.05) in preventing motion sickness at sea, though it was less effective than transdermal scopolamine (p = 0.0001). 3
• Antihistamines must be taken before departure to be effective in everyday motion sickness situations, but their overall effectiveness is limited compared to scopolamine. 4

Administration Details and Timing

• For scopolamine patch: Apply 4-16 hours before anticipated motion exposure; wash hands thoroughly with soap and water immediately after application. 1
• Use only one transdermal system at a time; do not cut the patch. 1
• If the patch becomes displaced, discard it and apply a new patch behind the other ear. 1
• Upon removal after 3 days, fold the used patch in half with sticky sides together and discard in household trash to prevent accidental contact. 1

Important Safety Considerations and Side Effects

• Common side effects of scopolamine include dry mouth, drowsiness, and blurred vision, though these are typically minimal with the transdermal formulation. 3
• Scopolamine acts centrally by blocking cholinergic transmission from the vestibular nuclei to higher CNS centers and can cause pupil dilation, increased heart rate, and decreased gastrointestinal motility. 1
• Avoid touching the patch during treatment, as pressure may cause scopolamine to ooze out at the edges. 1
• Wash hands and application site thoroughly with soap and water after patch removal. 1

What Does NOT Work

• Nonsedating antihistamines, ondansetron, and ginger root are NOT effective for prevention or treatment of motion sickness. 2

Behavioral Strategies to Combine with Medication

• Position yourself in the most stable part of the vessel (typically midship and on deck). 2
• Watch the true visual horizon rather than focusing on objects inside the vessel. 2
• Lie down with eyes closed if possible. 2
• Minimize other sources of physical, mental, and emotional discomfort. 2

Special Populations

• Children aged 2-12 years are most susceptible to motion sickness. 5
• Women are more susceptible than men, with increased risk during menstruation and pregnancy. 5
• Symptoms typically last no longer than 3 days in otherwise healthy individuals. 5