Pharmacological options for a Motion Sickness

Previous Post: Non Pharmacological interventions for a Motion Sickness

1. ANTIHISTAMINES – They  are the most frequently used and widely available medications for motion sickness; non-sedating ones appear to be less effective. None is approved for age < 2yrs.
2. Dimenhydrinate (Dramamine*), 1–1.5 mg/kg per dose
3. Diphenhydramine (Benadryl*), 0.5–1 mg/kg per dose up to 25 mg
4. Promethazine (Phenagan*, Avomin*), 0.5-1mg/kg/dose
5. Hydroxyzine (Atarax*), 0.5-1 mg/kg/dose

It is important to note that these doses are higher than doses used for antiallergic purposes and can result in Over-sedation of young children

Some children have paradoxical agitation with these medicines, a test dose should be given at home before departure. 

• ANTI CHOLINERGICS – Scopolamine or hyoscine hydrobromide – oral or  transdermal. 

Transdermal Patches are not easily available in India at retail stores, however they are available from online stores without a prescription.

Transdermal Patch is available as 1.5 mg patches, stick one patch just behind ear 5-6 hours before the start of journey and remember to remove it after arrival. The effect of the patch can last up to 72 hours, so it is suitable for people taking long journeys.

Transdermal Patches are not approved for use in age group < 12 years age.

Oral Hyoscine Hydrobromide is approved for pediatric use but is Not available in India. It should be noted that it is different from Hyoscine butyl bromide (Buscopan*) which is an antispasmodic medicine

Recommended doses of oral Hyoscine hydrobromide : For adults and children over 10 years of age: 150-300 micrograms. 4-10 years: 75-150 micrograms. Age 3-4 years: 75 micrograms. Not approved for < 3 yrs age.

• ANTI-EMETICS

Metoclopramide (Perinorm*), helps only little due to its blockage effect on dopamine and serotonin receptors at higher doses of 0.3 mg/kg/dose. At these doses, Extrapyramidal effects in younger children may be seen.

Ondansetron – Recent Studies have failed to prove any benefit with Ondansetron, as it acts on vagal afferent pathways and has no effect on vestibular afferents

• GINGER EXTRACTS —Use of ginger in form of ginger extract mixed with honey or hard ginger candies. Studies have shown that ginger has effect on gastric motility and a central effect on serotonin receptor subtypes .

Depending upon the individual susceptibility, these Pharmacological  measures can be used in solo or in combination and should be given 45 min – 60 min before travel and repeated every 6 hours during the trip. 

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