Motion sickness is a feeling of wooziness and nausea usually experienced when traveling by car, boat, train, or plane. The theory is that certain individuals are susceptible to experiencing motion sickness when there is a mismatch between the movement of the body and the movement detected visually. It is most likely related to the workings of the inner ear and the vestibular systems that help you maintain your balance.
Symptoms of motion sickness can include dizziness, nausea, vomiting, and sweating. Some individuals may experience only mild motion sickness but for others it can be completely debilitating. Motion sickness is still being studied by various research institutions with a stake in finding the best treatment. The Navy has researched scopolamine nasal spray for preventing sea sickness, and NASA is studying its use in astronauts as well.
The exact reason why some individuals are susceptible to motion sickness and others are not is not known. It may have a genetic component based on studies that have been done with twins. If you suffer from nausea and dizziness when you travel, you may have first tried some of the tactics outlined at the end of this article. However for those who experience severe motion sickness, or who travel frequently, a medication for reducing symptoms can be essential.
Medications for Motion Sickness
Motion sickness pills or patches are commercially available in many preparations. Drugs that are used include scopolamine (prescription only), dimenhydrinate (Dramamine), and meclizine (Bonine). Scopolamine is more effective than any of the over-the-counter treatments available because it reduces symptoms and has less of a sedative effect. Some of the medications that fall into the primarily antihistamine category also have some anticholinergic effects, but they are more likely to result in drowsiness. Some, like promethazine, are even used as mild sedatives for surgical procedures.
It is important to remember that medications that are typically used for nausea may not always work for motion sickness. Motion sickness may result in nausea but its causes are not primarily the result of gastrointestinal distress.
Scopolamine is one of the most effective drugs for motion sickness. In the U.S. it is only available in patches but it can be made by a compounding pharmacy into capsules or troches. Also sometimes referred to as hyoscine, it is a metabolite of plants in the nightshade family. The nightshade family includes plants like Belladonna that produce alkaloids with interesting effects. Belladonna naturally produces scopolamine and has been used medicinally or ritualistically for centuries. This chemical is an anticholinergic agent, which means it blocks the neurotransmitter acetylcholine. Specifically it is a muscarinic receptor antagonist. It is thought to work by blocking the signals of imbalance that cause motion sickness.
Dimenhydrinate is available over-the-counter as Dramamine, and is somewhat effective at treating motion sickness. Dimenhydrinate is actually a combination of diphenhydramine (Benadryl) and another chemical that helps counteract the drowsiness caused by the drug. However it can still cause significant drowsiness. Compared to the other antihistamines (with the exception of meclizine) dimenhydrinate has a lower possible risk of sedation.
Meclizine, available over-the-counter as Bonine, also has antihistamine and anticholinergic mechanisms to reduce symptoms of motion sickness. In general, meclizine is not strong enough to treat more severe cases of motion sickness. However it may be effective for mild cases. It is also sold over-the-counter as Dramamine II (Less Drowsy Formulation).
Cinnarizine is an antihistamine that is not available in the United States. The side effects of this medication can be more severe than some other antihistamines. It has been shown that cinnarizine can lead to drug-induced Parkinson’s disease. The elderly are especially susceptible to this adverse effect.
Promethazine is another antihistamine that is most often prescribed for treating nausea or for use as a sedative. It is also sometimes used for treating allergies or in combination with other medications for treating cold symptoms. A topical formulation can be compounded for treating nausea. However for motion sickness, promethazine is generally not a first-line choice because of its more severe sedative effects.
Transdermal Patch vs. Oral Capsules, Tablets, or Troches
Motion sickness medicine usually needs to be taken before traveling as it has to be active in the blood when the symptoms might occur. All motion sickness treatments are preventative for individuals who know they are likely to get motion sickness. The scopolamine patch needs to be placed at least 4 hours before but ideally 12-18 hours before traveling. Tablets and capsules usually can be taken 1-2 hours before traveling, and sometimes even less.
Patches are usually prescribed in packages of four, which means you may frequently have to request more from your doctor. Capsules can be made in quantities of 30 or more to provide a longer supply to take as-needed. In addition, having scopolamine compounded can be more cost effective. The patches vary in price but can average about $85 for 4 patches (each lasting about 3 days), while the current pricing (11/1/2019) from Woodland Hills Pharmacy for 30 scopolamine capsules is $60.
Ginger and Vitamin C are recommended as additional supplements that may be used to improve symptoms. Ginger has been shown to reduce vomiting and cold sweating associated with seasickness. It is also frequently recommended for pregnant women as a non-toxic way to alleviate nausea. It is used in a dose of about 250mg to 1g of dry powder, one to four times daily. The evidence for the use of Vitamin C is less significant but it still may have a slight effect on motion sickness symptoms.
Other Methods for Preventing Motion Sickness
One tactic that can sometimes work to reduce motion sickness is to focus your vision on the horizon in the direction you are traveling. It may help your body reorient itself so that your vision and your other senses are more in sync. Taking a nap or just keeping your eyes closed may also help achieve the same effect. Unpleasant odors can make motion sickness worse, so sometimes changing the air quality by opening a window can help. On a long trip, like on a boat, you may adjust to the motion after a few days and feel less sick. For shorter trips, or trips that are interrupted by a change in motion, this adjustment may not occur. Habituation methods have been successfully used that simulate sea motion over a period of weeks before a voyage. These simulations are really only available to people working in industries where they may frequently experience motion sickness.
Of course, these methods do not always work and you may not always be able to just sleep through it. That is when medications can be used to help you get through your trip. If you are suffering from car sickness, sea sickness, or airplane sickness, a go-to medication can be essential for keeping you alert and ready for wherever you are going.