motion sickness

chapter 74

What are the main treatment options for motion sickness?

Anticholinergics or antihistamines

What are some non-drug treatment options for motion sickness?

Sea-Band, ginger, peppermint

Which anticholinergic is recommended for motion sickness?

Scopolamine

How is scopolamine used?

Placed behind the ear

How long do scopolamine patches last

Three days

Which antihistamines can you use for motion sickness

Diphenhydramine, Dimenhydrinate, Meclizine

When should you take oral motion sickness medications

30-60 minutes before

Transderm Scop

Scopolamine

Benadryl

Diphenhydramine

Dramamine

Dimenhydrinate

Dramamine Less Drowsy

Meclizine

Bonine

Meclizine

Long-acting piperazine antihistamines

Dimenhydrinate, meclizine

All antihistamines used for motion sickness have _____ effects similar to scopolamine

Anticholinergic

Which medication is Rx only and is reserved for patients who don’t respond to antihistamines?

Promethazine

What medications are not effective for motion sickness.

Metoclopromide and the 5-HT3 receptor antagonists

When should you apply the scopolamine patch?

4 hours before

When should you apply the scopolamine patch for surgery?

Night before or one hour before

Scopolamine contraindication

Hypersensitivity to belladonna alkaloids

Scopolamine side affects

Anticolinergic effects, CNS effects, eye stinging, pupil dilation (blurry vision), risk of IOP, withdrawal symptoms (if used for more than 3 days)

What should be avoided when using scopolamine?

Alcohol

Can scopolamine be used in children?

No

Should the scopolamine patch be removed before an MRI?

Yes, it contains metal

Dimenhydrinate dosing for motion sickness

50-100 mg Q4-6H

Dimenhydrinate dosing for nausea and vomiting

IM, IV: 50-100 mg Q4H

Dimenhydrinate and meclizine warnings

CNS depression, risk of IOP

Dimenhydrinate and meclizine side effects

CNS effects, anticholinergic effects, blurry vision, tachycardia,

Which antihistamine is commonly used for vertigo?

Meclizine

Scopolamine application directions

• Press firmly against the skin behind the ear for at least 30 seconds.

• Avoid placing over hair.

• Wash hands after applying to avoid mydriasis, stinging, and blurry vision

• Do not drive: high level of drowsiness, dizziness, and confusion!