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Current module (1/6)
Non-pharmacological treatment
A number of self-help measures may be recommended to avoid or reduce the symptoms of motion sickness: Keep motion to a minimum (sit in the front of a car, over the wing of a plane or in the middle of the deck on a boat) Breathe fresh air Close the eyes/try to sleep Do not read or watch films Focus on a fixed spot above the horizon Avoid heavy meals or alcohol before travel Drink plenty of cold water to ease nausea and avoid dehydration Break long journeys if possible Relax and remain calm – symptoms are more likely to occur if an individual is stressed. For those who do not wish or are unable to take traditional medication for motion sickness, a number of products are available. Ginger has long been used to combat nausea and, although there is little scientific evidence for its effectiveness, many people find it beneficial. It is available in a variety of formulations including tablets or capsules as well as tea and ginger biscuits. Acupressure bands claim to work by applying pressure to a particular point between the two tendons on the inside of the wrist. Again, there is little scientific evidence to show how they work to prevent nausea, but they have no adverse effects and may be an option.
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Pharmacological treatment
Pharmacological preparations for the treatment of motion sickness consist of either hyoscine or a sedating antihistamine. All preparations should be taken before travel because they are of little benefit once an individual is experiencing symptoms. Hyoscine is an antimuscarinic (anticholinergic) drug. As hyoscine butylbromide, it is used to reduce intestinal motility and relieve the pain of gastrointestinal smooth muscle spasm. The hydrobromide salt of hyoscine is used in motion sickness preparations. It is also known as scopolamine hydrobromide and works by reducing the release of acetylcholine by the vestibular system, and hence the subsequent stimulation of the vomiting centre in the brain. It is the most effective drug for the prevention of motion sickness and is available as chewable 150mcg or 300mcg tablets and as self-adhesive patches. The tablets are suitable for children aged three years and over at a dose of 75mcg, repeated once after six hours, if necessary. Children aged between four and 10 years should take between 75mcg and 150mcg every six hours as required, up to a maximum of 450mcg a day. Adults and children over 10 years may take 150mcg to 300mcg every six hours as required, up to a maximum daily dose of 900mcg. The tablets should be taken up to 30 minutes before the start of the journey. Hyoscine patches release approximately 1mg of hyoscine over 72 hours on application to a clean, dry, hairless area of skin. They should be applied five to six hours before the journey. They are not recommended for use in children under 10 years of age. Patients should be counselled on the importance of thoroughly washing their hands after applying or touching the patch. Only one patch may be applied at any one time and the application site should be washed after the patch has been removed. The most common side effects of hyoscine are the typical anticholinergic effects of dry mouth, constipation, urinary retention, drowsiness and blurred vision. Hyoscine should be avoided in people with angle-closure glaucoma or prostatic enlargement and used with caution in patients with urinary problems, hyperthyroidism and hypertension or heart disease. Sedating antihistamines cinnarizine and promethazine are also used as the active ingredients in some motion sickness preparations. Antihistamines are slightly less effective against motion sickness than hyoscine, but tend to be better tolerated. They need to be taken two hours before travel, which can be problematic, but their effects last longer than hyoscine. The dose for cinnarizine is one 15mg chewable tablet two hours before travel for children aged five to 12 years, with an extra 7.5mg every eight hours if necessary. Adults and children over 12 years should take 30mg two hours before travel and 15mg every eight hours if necessary. Promethazine is available as hydrochloride and teoclate salt. Promethazine teoclate has a longer duration of action than the hydrochloride. Adults and children over 10 years should be advised to take one 25mg tablet the night before travel, repeated six to eight hours later if necessary. Children aged five years and over may take half the adult dose of promethazine teoclate. Promethazine hydrochloride is available in a liquid formulation. A dose of 5mg for children aged between two and five years or 10mg for children aged between five and 10 years may be given the night before travel, and repeated after six to eight hours if needed. Sedation is very common with these antihistamines, particularly promethazine, and it is often recommended that it is taken at night, with a second dose the following morning if necessary. Other possible side effects include headache, antimuscarinic effects and, more rarely, photosensitivity. Sedating antihistamines should not be recommended to people with angle-closure glaucoma, prostatic hypertrophy or urinary retention and should be used with caution in patients with epilepsy.