Buccastem (Prochlorperazine) for Motion Sickness
Direct Recommendation
Buccastem (prochlorperazine) is not recommended as a first-line treatment for motion sickness in adults, as there is no evidence supporting its efficacy for this specific indication, and it is primarily indicated for chemotherapy-induced nausea and severe vertigo-associated vomiting rather than motion sickness. 1, 2
Evidence Analysis
Lack of Motion Sickness-Specific Evidence
No clinical trials or guidelines specifically support prochlorperazine for motion sickness prevention or treatment. The available evidence focuses on chemotherapy-induced nausea 3, vertigo-associated symptoms 1, 2, and emergency department vomiting 4, 5.
Research comparing antiemetics for motion sickness found that metoclopramide showed superiority over diphenhydramine and placebo during ambulance transport in mountainous terrain, but prochlorperazine was not evaluated in this context 6.
FDA-Approved Dosing (Not for Motion Sickness)
The FDA label provides dosing for severe nausea and vomiting (not motion sickness specifically):
- For severe nausea/vomiting: 5-10 mg orally 3-4 times daily, with maximum daily dose of 40 mg 7
- Dosage should begin at the lowest recommended dose and be adjusted to individual response 7
Why Prochlorperazine Is Inappropriate for Motion Sickness
Prochlorperazine works by inhibiting dopamine receptors centrally, primarily reducing nausea and vomiting rather than addressing the vestibular mechanisms underlying motion sickness 2.
Guidelines explicitly recommend against routine use of vestibular suppressants like prochlorperazine for vertigo, as they do not address underlying causes and can cause significant side effects including drowsiness, cognitive deficits, and increased fall risk 1, 2.
When used for vertigo-associated nausea, prochlorperazine is recommended only for short-term management of severe symptoms (5-10 mg orally or intravenously, maximum three doses per 24 hours), not as primary or preventive treatment 1.
Better Alternatives for Motion Sickness
First-Line Options
Antihistamines (meclizine, dimenhydrinate, chlorpheniramine) are the evidence-based first-line treatments for motion sickness, with chlorpheniramine showing significant efficacy in controlled trials (increasing tolerance time from 7.2 to 11.7 minutes at 12 mg dose) 8.
Scopolamine transdermal patches are highly effective for motion sickness prevention when applied before travel 9.
Natural Alternatives
Ginger (whole root or extract containing gingerols) acts directly on the stomach rather than the central nervous system and does not cause sedation, making it suitable when alertness is required 9.
Ginger has antiplatelet activity, so caution is needed in patients on anticoagulants 9.
Critical Clinical Pitfalls
Do not prescribe prochlorperazine prophylactically for motion sickness – there is no evidence for this indication and better alternatives exist 1, 2.
If prochlorperazine is used for severe vomiting from any cause (including motion sickness that has already occurred), monitor for extrapyramidal symptoms, especially dystonic reactions 3.
Avoid in patients with CNS depression, those using adrenergic blockers, or those with severe hypotension 1.
The medication can cause significant drowsiness and cognitive impairment, making it particularly unsuitable for travelers who need to remain alert 1, 2.
If Severe Vomiting Has Already Occurred
For active vomiting from any cause (not prevention), intravenous prochlorperazine 2.5 mg given slowly can provide rapid control (mean time 8.5 minutes), with repeat dosing of 2.5 mg after 20 minutes if needed 5.
However, in emergency department studies of nausea/vomiting from various causes, prochlorperazine showed no statistically significant superiority over placebo (mean VAS reduction of only -1.80,95% CI -14.40 to 10.80) 4.