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  #21  
Old 02-14-2013
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Re: Seasick medication

Believe in the "good old days" they gave the ladies scop before childbirth. Didn't help the pain but they had a good trip and didn't remember much of anything.
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Old 02-15-2013
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Re: Seasick medication

Quote:
any of you folks ever get land sick.
Yeah, Also known as "Mal de debarquement" the admiral doesn't get seasick but the first time she had this we went to a large medical center after a couple days. They were baffled except for an ENT doctor who'd read about it but never seen it. They did some Physical therapy for balance etc. but the real cure was 2 Valium and 10 hours sleep.
Turns out the old sailor's cure was to get drunk and go to sleep, the doctor called it "Doing a hard reboot on the semi-circular canals".
I like the idea that getting drunk and sleeping on the boat is medicinal.
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  #23  
Old 02-15-2013
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Re: Seasick medication

Here you go guys, and gals. Reproduced from my $500/year online medical textbook. Underlining in the text is my emphasis to higlight what I feel are the more salient points. (or is it SAIL-ent points)

Oh, and BTW for those thinking of cutting trans-dermal medications... DON'T CUT THE PATCH!

My recommendations are as follows:
1. If you know you get seasick badly and you're going offshore, try scopalamine on land. If it works, use that, but you must start it before you get on the boat and only use it for 3 days. It's what NASA gives its austranauts.
2. If you can't tolerate scopalamine or don't get seasickness really bad, or are only going out for the day, use meclizine or bonine. Take it before you go on the boat, or before a storm, or before offshore, or generally before the situation that makes you get sick.
3. If you don't often get seasick but sometimes get it bad, keep promethazine + caffeine aboard and use it after you get sick.
4. Accupuncture and ginger are harmless and may be effective but don't rely on them if you have a critical role and know that you're prone to bad seasickness.

MedSailor

-----------
TREATMENT AND PREVENTION — A number of interventions can be used to prevent or alleviate motion sickness [34]. Treatments may be more effective when used for prevention rather than after symptoms have developed.

Environmental modification — Since conflicting sensory cues are believed to induce the symptoms of motion sickness, a straightforward treatment approach is to minimize the discrepancy between these cues. If visual and vestibular information are congruent, motion sickness is less likely to occur.

Labyrinthine cues cannot be readily manipulated, so this approach is based on providing visual information that contains equivalent motion information to that sensed by the vestibular system. Since the labyrinth senses motion in an inertial (earth-fixed) reference frame, this can be accomplished by viewing an earth-fixed environment during motion rather than a head-fixed environment. As an example, motion sickness on a ship is reduced if passengers view the horizon or land masses from the deck rather than their cabin. Similarly, passengers in a car should sit in the front seat and look through the window rather than sitting in the rear and focusing on an object moving with the interior of the car (such as a book).

Motion sickness does not occur during self-generated movements under normal conditions, so a second way to reduce the susceptibility to these symptoms is to control the motion of the vehicle. The driver of a car is less prone to motion sickness than a passenger, presumably because the driver's brain can utilize the motor commands related to controlling the car to predict in an approximate manner the motion of the head.

Medication — Drug therapies can be used to suppress conflicting sensory cues in the brain regions that process afferent signals or to treat nausea. In general, the effectiveness of medications depends upon inhibition of activity in the vestibular nuclei, where labyrinthine and visual sensory cues are combined and synthesized. Drugs that reduce activity in the vestibular nuclei include antihistamines, anticholinergics, and benzodiazepines; other medications that reduce motion sickness include antidopaminergics and sympathomimetics (table 1) [15,35].

In general, medications should be taken before passive motion begins, since they are less effective in relieving symptoms that have already developed.

AntihistaminesA number of antihistamines can be used to treat motion sickness, and their effect is probably related to their anticholinergic effects [15]. Medications include dimenhydrinate (Dramamine), diphenhydramine, chlorpheniramine [36], meclizine, cyclizine, and cinnarizine [37]. Dimenhydrinate is available as a chewable tablet. Cinnarizine is not available in the United States, but is widely used in other countries.

Side effects are mainly related to anticholinergic effects and can include sedation, blurred vision, mouth dryness, and, in the elderly, confusion and urinary retention. One small study suggested that cyclizine may be less sedating than dimenhydrinate at a dose that is equally effective for symptoms of motion sickness [38].

Nonsedating antihistamines do not appear to be effective for the treatment of motion sickness [39,40].

AnticholinergicsScopolamine is commonly used for the management of motion sickness. A systematic review of randomized trials concluded that scopolamine is effective for prevention of motion sickness, but that no trials had examined its effectiveness in treating established motion sickness, and that the evidence comparing scopolamine with other treatments was inadequate [32].

At least three randomized trials were performed after the systematic review:

In a trial of experimentally induced motion sickness in 75 patients, scopolamine was more effective in preventing motion sickness than promethazine, meclizine, and lorazepam [41].
In a trial of the prevention of seasickness in 76 naval crew members, scopolamine was more effective than cinnarizine, an antihistamine [42]. Although differences were marginally significant, scopolamine was associated with fewer adverse effects than cinnarizine.
In a trial of preventing motion sickness in 64 helicopter passengers, the combination of promethazine and caffeine appeared to be more effective than scopolamine alone [43].

Scopolamine is most commonly administered as a transdermal patch applied every 72 hours. Side effects include those discussed above (sedation, blurred vision, mouth dryness, and, in older adults, confusion and urinary retention), and scopolamine is contraindicated in people at risk for angle closure glaucoma. Some instances of poor clinical response to scopolamine patches may be due to inadequate transdermal absorption leading to inappropriately low scopolamine levels in the blood [44].

Antidopaminergics Promethazine can be used both for prevention and treatment of motion sickness [15,45]. In two trials of the prevention of motion sickness cited above, promethazine appeared to be less effective than scopolamine but more effective than meclizine or lorazepam [41], and promethazine and caffeine appeared to be more effective than scopolamine [43].

Metoclopramide has also been used for motion sickness, but there is somewhat less evidence for its efficacy than that of promethazine [46,47].

Side effects of antidopaminergics include sedation and extrapyramidal effects.

Sympathomimetics — Ephedrine and amphetamines have been used both to treat motion sickness and to counteract the sedating effects of other medications [15]. (See 'Effect on performance' below.) Ephedrine may have some benefit even after symptoms have developed [47]. Amphetamines are controlled substances with potentially significant side effects and the potential for addiction. Although less studied, pseudoephedrine is readily available in the United States including in combination medications with sedating antihistamines.

Caffeine may also be of benefit when used in combination with other medications. A randomized trial in 64 patients examined the effects of promethazine 25 mg plus caffeine 200 mg, meclizine 25 mg, scopolamine patch 1.5 mg, and an acustimulation wristband [43]. Only the combination of promethazine and caffeine produced a significant decrease in symptoms; the combination also improved reaction times.

Other medications

Benzodiazepines may be of some benefit for motion sickness, but they are sedating [48].
Standard antiemetics such as prochlorperazine or ondansetron can relieve nausea, which is usually the most prominent symptom of motion sickness [49]. However, in two studies in highly susceptible subjects, one in a laboratory model of simulated rotation and one at sea, ondansetron was ineffective in preventing motion sickness [50,51]. (See "Migrainous vertigo", section on 'Treatment'.)
GABA agonists such as baclofen or gabapentin inhibit the "velocity storage" mechanism in the central vestibular system that may be specifically responsible for producing motion sickness. The utility of these drugs has not been extensively studied to date and their potential usefulness is currently based on results from experiments that use complex movements to induce motion sickness and on case reports [10,11].
Effect on performance — Treating motion sickness can be a particular problem in patients who need to perform tasks such as flying a plane or acting as crew on a ship, since most of the medications used are sedating [52,53].

Dimenhydrinate (Dramamine U.S.) may have particularly negative effects on performance [54]. A controlled trial of medications for experimental motion sickness in 67 adults suggested that, at clinically useful doses, the drugs had the following order from best to worst for cognitive side effects: meclizine, scopolamine, promethazine, lorazepam [55].

One trial found that administering amphetamine, but not pseudoephedrine, with promethazine appeared to prevent the sleepiness and impairment of psychomotor performance seen with promethazine alone [56]. Another trial found that ephedrine decreased sleepiness and improved performance in patients administered chlorpheniramine, although it did not add to the effectiveness of chlorpheniramine in treating motion sickness [57].

Treatment in pregnancy — As mentioned above, pregnant women may be particularly susceptible to motion sickness. Medications that are felt to be safe for the treatment of morning sickness can also be used for motion sickness. These include the antihistamines (meclizine, diphenhydramine, and dimenhydrinate), and prochlorperazine, which is listed as category C in pregnancy by the US Food and Drug Administration (FDA) (table 2). (See "Clinical features and evaluation of nausea and vomiting of pregnancy".)

Other

Physical therapy — As discussed above, the vestibular response to head motion can decline over time (habituate), if a given motion pattern is presented repetitively. For this reason, physical therapy approaches that utilize recurrent head movements and associated visual cues can sometimes reduce the sensitivity to motion sickness in subjects who are particularly prone to this problem.

Ginger — Ginger has been used as an alternative medicine to prevent motion sickness. Randomized trials both in experimental motion sickness and in naval cadets at sea have found benefit with pretreatment with one to two grams of ginger [58,59]. The mechanism of benefit with ginger appears to be related to its effects on gastric motility rather than the vestibular system [60,61].

Acupressure— Pressure at the P6 acupressure point on the anterior wrist (three fingerbreadths proximal to the proximal wrist fold, between the palmaris longus and flexor carpi radialis tendons) (picture 1) either by manual pressure or with a wrist band has been reported to be effective for motion sickness in some [62-64], but not all [65-67], controlled trials. A randomized trial with a device that applies electrical stimulation to the P6 point found no benefit [43].

While these results raise the possibility that acupressure may be of benefit for motion sickness, trials of this sort can be difficult to perform with adequate blinding and allocation concealment. It remains uncertain whether acupressure is effective.

Magnets — Although sometimes promoted for this use, we know of no studies evaluating the efficacy of magnets in the treatment of motion sickness.

Nicotine deprivation — One small observational study found that overnight nicotine deprivation in smokers resulted in a reduction in motion sickness susceptibility [68]. The effect was most pronounced in subjects who were heavy smokers and with mild to moderate susceptibility to motion sickness

References:
-Murdin L, Golding J, Bronstein A. Managing motion sickness. BMJ 2011; 343:d7430.
-Brandt T, Dichgans J, Wagner W. Drug effectiveness on experimental optokinetic and vestibular motion sickness. Aerosp Med 1974; 45:1291.
-Buckey JC, Alvarenga D, Cole B, Rigas JR. Chlorpheniramine for motion sickness. J Vestib Res 2004; 14:53.
-Lucertini M, Mirante N, Casagrande M, et al. The effect of cinnarizine and cocculus indicus on simulator sickness. Physiol Behav 2007; 91:180.
-Weinstein SE, Stern RM. Comparison of marezine and dramamine in preventing symptoms of motion sickness. Aviat Space Environ Med 1997; 68:890.
-Kohl RL, Homick JL, Cintron N, Calkins DS. Lack of effects of astemizole on vestibular ocular reflex, motion sickness, and cognitive performance in man. Aviat Space Environ Med 1987; 58:1171.
-Cheung BS, Heskin R, Hofer KD. Failure of cetirizine and fexofenadine to prevent motion sickness. Ann Pharmacother 2003; 37:173.
-Dornhoffer J, Chelonis JJ, Blake D. Stimulation of the semicircular canals via the rotary chair as a means to test pharmacologic countermeasures for space motion sickness. Otol Neurotol 2004; 25:740.
-Gil A, Nachum Z, Tal D, Shupak A. A comparison of cinnarizine and transdermal scopolamine for the prevention of seasickness in naval crew: a double-blind, randomized, crossover study. Clin Neuropharmacol 2012; 35:37.
-Estrada A, LeDuc PA, Curry IP, et al. Airsickness prevention in helicopter passengers. Aviat Space Environ Med 2007; 78:408.
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Last edited by MedSailor; 02-15-2013 at 12:57 AM. Reason: formatting
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  #24  
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Re: Seasick medication

I don't know of any adverse reastions using less than a whole patch esp if an entire patch creates side effects. Is there a problem with patch longevity when cutting into one?
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Re: Seasick medication

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Originally Posted by jobberone View Post
Is there a problem with patch longevity when cutting into one?
The patch is like a really small jelly donut. It appears flat to the naked eye but the medication is contained in a small pocket in the middle of the patch. It slowly gets released through the membrane of the patch and onto your skin for absorption. When you cut it, all the medication leaks out the cut end and onto your skin at once. It is a 72 hr patch so even cut in half you are still getting 36 hrs worth of medication in one shot.

It isn't a harmless drug at all. It is used as a date rape drug which is why it is regulated and by RX only. We also use it to accelerate the dying process in terminally ill patients. (what is called a "Comfort Measure" drug) When somebody is within days of death we apply Scopolamine in combination with some other drugs and instead of days they pass in hrs.
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  #26  
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For me, Bonine will work even after I start feeling sick. It's a huge benefit not to have to take it continuously on a trip, but I can wait until I know I really need it.
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Re: Seasick medication

On board Distant Shores II we use Stugeron. On rough ocean passages I (Paul) can get seasick and Stugeron definitely works for me.

I have tried Scopolomine and MUST WARN if you want to use it - try it in advance. It is very potent and had bad hallucinogenic effect on me - also nausea?? Others have even reported temporary blindness.

Paul Shard - Aboard Distant Shores II - St Martin
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Re: Seasick medication

Quote:
Originally Posted by IronSpinnaker View Post
The patch is like a really small jelly donut. It appears flat to the naked eye but the medication is contained in a small pocket in the middle of the patch. It slowly gets released through the membrane of the patch and onto your skin for absorption. When you cut it, all the medication leaks out the cut end and onto your skin at once. It is a 72 hr patch so even cut in half you are still getting 36 hrs worth of medication in one shot.

It isn't a harmless drug at all. It is used as a date rape drug which is why it is regulated and by RX only. We also use it to accelerate the dying process in terminally ill patients. (what is called a "Comfort Measure" drug) When somebody is within days of death we apply Scopolamine in combination with some other drugs and instead of days they pass in hrs.
There is a membrane between the skin and the drug which limits the release of scopolamine which has only 1 mg of drug in the entire patch. I'll get a patch and cut it to see if the area with the drug leaks out the side and I'll get back to all.
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  #29  
Old 02-15-2013
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Re: Seasick medication

I like a more natural approach to sea sickness and find that sitting under an old oak tree for just a few minutes hepls a heck of a lot more then any pill I have seen so far.

ATB

Michael
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Old 02-15-2013
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Re: Seasick medication

Quote:
Originally Posted by jobberone View Post
There is a membrane between the skin and the drug which limits the release of scopolamine which has only 1 mg of drug in the entire patch. I'll get a patch and cut it to see if the area with the drug leaks out the side and I'll get back to all.
NO NO NO NO NO! This is a very dangerous thing you are playing with here. Don't cut the patch, not even for an experiment, and if you must, then please wear gloves so you don't give yourself a toxic dose.

Using the words "only 1mg of drug" is very VERY concerning to me. You know not what you are doing here. Prescription, and other drugs, are not all equal in their effects at the same number of milligrams. 1mg of tylenol is ineffective, whereas 1mg of thyroid medication will give a heart attack to a healthy person.

1mg of scopalamine, delivered over 1hr with a cut patch is not "just 1 mg" it is 72 times the recommended dose. That could be fatal. If I were having this conversation in my office I would tear up the scopalamine prescription and call the patient's pharmacy and cancel all their other scopalmamine prescriptions.

Please be safe. These medications are safe and effective when taken as directed and dangerous or deadly when abused.

MedSailor

PS Why do you want to decrease the dose so badly? In the article I referenced above they mentioned that it looked like the times scopalamine didn't work were the times when not enough was given. If you really want to tinker with the dose, get the pill or injectable form of scopalamine and take a lesser dose that way.
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