Motion Sickness

Essentials

• Mild symptoms need no other treatment than advice to the patient.
• Occasional symptoms and symptoms in children over 12 years of age can be treated with antihistamines (cyclizine or meclozine).
• Severe symptoms and symptoms in persons above 10 years of age can be treated with a scopolamine patch.
• In Finland, only prochlorperazine is registered for use in children under 10 years of age. Regulations may vary from country to country.
• The medication is most efficient if started before the journey.

Pathogenesis and epidemiology

• Motion sickness is caused by motion, either of the body or just the visual field. Irritation of the semicircular canals is the pathogenetic mechanism.
• About a third of the population is susceptible to motion sickness. Children under 2 years are rarely affected, but children aged 2-12 years suffer from motion sickness most frequently. Women are more often affected than men, particularly during menses and pregnancy.

Symptoms

• Paleness and cool, sweating skin
• Yawning, increased salivation, sighing
• Nausea that is temporarily relieved by vomiting
• Increased respiratory frequency, belching, flatulence, and constipation or diarrhoea.
• Other variable symptoms include: headache, confusion, a cold feeling on face and limbs, agitation, loss of appetite, a feeling of weakness, a pressing sensation on the chest, feeling hot.

Prevention

• Avoidance of alcohol before and during travel. Alcohol is not a medication for motion sickness.
• Light meals and sufficient fluid intake during travel. On short trips the intake of food should be avoided.
• Staying in the middle section of vehicles such as boats, ships, or aeroplanes. In the car the best place is on the front seat with a view ahead. In a boat it is best to stay on deck with sight directed far to the horizon.
• Having the neck bent forwards is the worst posture. For example, children susceptible to motion sickness should not read while travelling in a car. Supporting the head on the head-support is recommended.
• Lying is the best position, preferably with the eyes closed.
• Strong odours may predispose to motion sickness. Fresh air and good ventilation should be ensured.
• Warm clothing may prevent motion sickness.
• Psychological factors may play a role. Do not intimidate persons with the risk of motion sickness. Passengers should have something to occupy themselves with rather than merely wait to become motion sick.

Drug treatment

1. Scopolamine as a depot patch is the most efficient drug Scopolamine for Motion Sickness.
   • Place the patch behind the ear on dry, clean, hairless skin 5-6 hours before travel.
   • The duration of action is 72 hours. If a shorter action is needed the patch can be removed earlier (even during the journey): the blood concentration of the drug decreases slowly as the drug absorbed by the skin is slowly released into the circulation.
   • If a longer action is needed the patch is removed after 3 days, and a new patch placed behind the other ear.
   • Wash hands after handling the patch because the drug may dilate the pupils if transferred to the eyes on the hands. The site where the patch was worn should also be washed thoroughly.
   • Anticholinergic adverse effects are usually mild if the drug is used properly: dryness of the mouth, somnolence, and impairment of near vision. Caution is needed e.g. when treating patients with a tendency to urinary retention or with a history of increased intraocular pressure.
   • Scopolamine is not recommended for children below 10 years of age or for pregnant women. Alcohol should not be used during treatment.
2. Antihistamines are the most commonly used drugs.
   • Cyclizineis registered for use in children over 12 years of age. Available as over-the-counter drug in some countries.
   • Meclozinehttp://www.dynamed.com/drug-monograph/meclizine can be used by children over 12 years of age and during pregnancy if prevention and treatment is particularly indicated. Available as over-the-counter drug in some countries.
3. Metoclopramide and prochlorperazine are as efficient as mild antihistamines and do not cause much fatigue.
   • Metoclopramide is available as tablets and oral solution. The dosage is 10 mg 1-3 times daily. It should not be used in children under 18 years of age. Extrapyramidal symptoms may occur as adverse effects.
   • Prochlorperazine is available as tablets. The dosage is 2.5 mg twice daily in childen between 1 and 5 years of age; 5 mg 2-3 times daily in children between 6 and 11 years of age; 5 mg 3 times daily in children between 12 and 16 years of age; and 5-10 mg 3 times daily for adults.

Principles of drug treatment

• All drugs are most effective if taken before travel.
• Conditioning for motion occurs after 2-3 days at sea, and the need for drugs decreases.
• Tolerance for drugs often develops; avoid regular routine medication if there are no clear indications.
• For the vomiting patient suppositories are most efficient.
• Alcohol and drugs acting on the CNS increase the drowsiness caused by drugs used for motion sickness.