What’s the Best Way to Prevent Motion Sickness?

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Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Some lucky people don’t get motion sickness—but if you are affected, it can ruin a cruise or sailing trip.

You may have tried Dramamine, Bonine, and other non-prescription treatments, but in the end, preventing motion sickness may require planning ahead with a prescription from your doctor.

So what’s the best treatment for motion sickness—and why do some folks suffer while others don’t?

Why me?

The most widely held explanation for why some of us experience motion sickness is called the “sensory conflict hypothesis.” Simply put, each person has an internal representation of bodily movement. This internal picture is continuously updated by information your body receives from your eyes, the vestibular system (the balance system in the inner ear), and receptors in joints and muscles.

Motion sickness occurs when there is a mismatch. The body can’t figure out if it’s moving, the water is moving, or your legs are moving, and it’s not happy. Conflicting sensory inputs are received because you are moving on the ocean or in the car and the results are nausea and vomiting.

What’s the best medication to prevent motion sickness?

Scopolamine patches (Transderm Scop) are available with a prescription and they are the best way to prevent nausea associated with motion sickness.

Dramamine (dimenhydrinate) is over-the-counter. It is as effective as scopolamine, but makes you sleepy.

Scopolamine is more effective than meclizine (Antivert or Bonine) and as effective as Dramamine.

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What doesn’t work for motion sickness?

Ondansetron (Zofran) and the antihistamines cetirizine (Zyrtec) and fexofenadine (Allegra) do not reduce symptoms of motion sickness and should not be used.

Tell me about the Transderm Scop patch.

Scopolamine is prescribed as a transdermal patch (a patch you put on the skin). This helps make up for the short amount of time scopolamine works when it’s taken by mouth. The patch contains 1.5 mg of scopolamine and is meant to deliver 0.5 mg per day over a 3-day period. So you change the patch every 3 days.

Why does the Transderm Scop patch go behind my ear?

The postauricular (behind your ear) area is the most permeable site—it’s the place on your skin where the medication can get through the easiest. It’s been shown that this more permeable skin requires a lower scopolamine content for effectiveness.

How does the patch work?

The proposed way that Transderm Scop patches work is complicated—but basically, they work by helping your brain in the effort to readjust to environmental orientation. It helps your vestibular system (balance and equilibrium) adjust to motion by interfering with the transmission of vestibular input to the central nervous system.

What are the side effects of the patch?

Dry mouth is a common complaint, and other side effects include some drowsiness, dilated pupils and rapid heartbeat. Generally though, the patch is very well tolerated.

Any other downsides?

Transderm Scop is still brand-only. It is covered by most insurance plans, often with a moderate or tier 2/preferred brand co-pay, so it isn’t the most expensive drug out there if you’re insured. However, if you’re paying cash, you could be looking at $80 – $90 for 4 patches—something to weigh against the drowsy side effects of Dramamine.

Dr O.

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