Motion Sickness Prevention

July 25, 2016
Heidi Moawad, MD

At least 80% of leisure cruise passengers report some degree of motion sickness. Our blogger offers advice for your patients.

Motion sickness is a real problem for a substantial portion of individuals who take vacation cruises. At least 80% of leisure cruise passengers report some degree of motion sickness. Not all of the reactions are severe, but some vacationers can end up with dehydration and a ruined vacation. As cruises are becoming more popular among families and healthy seniors, pre-emptive anticipation of motion sickness prompts many patients to approach their doctors for advice about how to prevent illness on a planned cruise vacation. Deciding on a prevention plan is a way for a neurologist to help healthy patients enjoy an upcoming trip without getting debilitating motion sickness.

Medications for Motion Sickness

Scopolamine, an anticholinergic, is one of the common treatments for seasickness. It is sold in oral or in patch form. The most widespread method of using scopolamine for motion sickness is by placing the over-the-counter patch behind the ears, as recommended. A recent Cochrane meta-analysis looked at a number of scopolamine studies to see if scopolamine is, indeed, effective in the treatment and prevention of motion sickness.

The drug was found to be effective for prevention of motion sickness, with minimal side effects. It did not, however, prove to be useful in treating the illness once motion sickness is already underway, so it is important for patients to take it preventatively.

Meclizine is an antihistamine that also has anticholinergic effects. It comes in oral form in several over-the-counter and prescription strengths. There have not been specific studies evaluating the effectiveness of meclizine on motion sickness, but the Cochrane review stated that scopolamine is equivalent to antihistamines in it efficacy.

For patients who do not want to take medication, acupressure wristbands may help in prevention of mild to moderate motion sickness. The wristbands also are preventative, but they are not curative if symptoms have already started. 

Strategies for Preventing Motion Sickness

Most of the medications for seasickness are sold over the counter. Most patients decide on a preferred route of treatment based on an Internet search or on recommendations from friends. Yet, a number of patients ask their doctor for advice. 

Key Points to Keep in Mind:

• Vacation cruise ships are often known for serving alcohol. It is important to remind people who are not sure of their own degree of motion sickness to take it slow with the alcohol in order to avoid nausea and motion sickness, as the combination of alcohol and motion affects people differently than alcohol on land. 

• Alcohol can exacerbate the side effects of meclizine or scopolamine, so it is important to avoid using them together.

• There are no side effects of acupressure wristbands, and therefore using them prophylactically is not counter-indicated. They can be used along with scopolamine or meclizine.

• Some people are not able to swallow pills when they are nauseated, and thus patches may be a better option when nausea or vomiting is a concern. 

• Patients should be reminded not to use more medication than the recommended dose. If your patients feel any side effects or feel that they need more effective treatment for motion sickness while on the cruise, they should visit the cruise ship medical team.

Have you had cruise-bound patients inquire about motion sickness?

Reference: Spinks A, Wasiak J. Scopolamine (hyoscine) for preventing and treating motion sickness. Cochrane Database Syst Rev. 2011 Jun 15;(6):CD002851.