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  #61  
Old 02-16-2013
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Re: Seasick medication

Quote:
Originally Posted by IronSpinnaker View Post
It is illegal to use it in any manner other than what is approved by the FDA
Absolutely not true - ever heard of "off label"?
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  #62  
Old 02-16-2013
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Re: Seasick medication

Quote:
Originally Posted by Geoff54 View Post
Absolutely not true - ever heard of "off label"?
Correct. If the provider prescribes it to be used in a non-FDA approved way, then it is off label and legal. As Iron Spinnaker mentioned though, a pharmacist might not fill a prescription that had instructions to cut the patch.

On the other hand, perhaps it is now re-formulated in the polymer matrix that was mentioned by another poster and it won't "dump the dose". Maybe it still is in the old medium and will dump the dose. Maybe the one you test here in the USA won't, but then the one you buy in Mexico will.

As for using it in a non-prescribed way, I'm not sure if that's legal or not. I should know that though... If it's true, then I could call the cops on 99% of my patients.

Likely safe if used as directed, and possibly unsafe if not. Be careful, that's all.

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Last edited by MedSailor; 02-16-2013 at 09:11 PM. Reason: The auto-censor doesn't like the word s-c-r-i-p-t
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  #63  
Old 02-16-2013
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Re: Seasick medication

It is absolutely not illegal to prescribe a medication in a way the manufacturer does not advocate. In 30 years I and most physicians have used one and generally multiple medications on many occasions outside their intended use and/or dosage. You do open yourself up to civil liability and if you're doing something no other physician is doing and creating problems then you are open to criticism from the medical board of your state. If I actually were to tell a patient to cut a patch (and I'm not advocating that) you can avoid problems with the pharmacy by writing the prescription to be taken as directed.

I still haven't cut a patch myself but I made some calls. There is no recognized leakage when cut although there could certainly be some leakage not recognizable to the human eye. The content of one patch is 1 mg. Cut in half you would have 0.5mg. Oral bioavailability is quoted as 7-27% of ingested amount and percutaneous bioavailability is quoted as 60-90%. So 0.5mg x 75% would be 0.375 mg of scopolamine available. Even if you assumed 75% would be immediately available then 0.28mg of scopolamine could be absorded over 15-60 minutes. Hardly a fatal dose. That does not appear to be the case.

If there isn't any leakage then you've merely reduced the total dose in the patch to 50% which would be absorbed over three days in a controlled manner. The rate of release of medication would be the same cut or not but you have halved the amount absorbed over that time period.

I see little benefit for cutting the patch and would not personally do so myself for self administration and again I'm not advising anyone here medically about anything. If you are sensitive to scopolamine (not talking about those who cannot tolerate even tiny doses) then you may be better served taking the oral form which should absolutely be taken as advised by the manufacturer or alternatively by your physician or perhaps just avoiding it. Obviously if you are taking the patch without problems then carry on.

I'll mention that anecdoctally I've been told that applying it to the midline of the back of the neck will avoid dilating one pupil more than the other as can happen when placed behind the ear. Dilation of the pupil(s) is one cause of not being able to focus well. Application to the back of the neck may result in some decreased absorption of the drug relative to applying it to the back of the ear.

Someone above gave great practical advice which should be reviewed by those interested with favor. I would add that the advice of going up top and sailing the vessel is a great idea. You can interfere with some of the data coming from the canals by focusing on the horizon which is supposed to override some of the data from the canal. This should be done as early as possible. Getting your head out of the boat is great advice as is not overeating nor having an empty stomach. In time the brain will generally process the information in a way to avoid getting sick (for most).
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Old 02-17-2013
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Re: Seasick medication

Humbly disagree with jobberone- Would suspect the anisocoria is not the usual cause of the poor vision in most cases. Also suspect it would not commonly relate to where the patch is placed. Believe the agent is absorbed percutaneously into the blood stream which the delievers it to the entrire circulation and brain. Rather the loss of accommendation usually of both eyes causes the blurry vision. Have had many crew and self place the patch in any non hairy spot and it works well. Lots of folks like to keep it out of the wet and somewhere it won't be rubbed.
May want to take a look in Grey's or Carpentiers as to vaso nervosum for ciliary ns. just recalling info stored from years ago.May be wrong but suspect not given neuro anatomy.
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Last edited by outbound; 02-17-2013 at 12:15 AM. Reason: increase unedrstandng
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  #65  
Old 02-17-2013
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Re: Seasick medication

Rather than cut a patch, if you want to reduce the dosage, why not apply a piece of tape and then apply the patch so that only half of it contacts the skin?
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  #66  
Old 02-17-2013
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Re: Seasick medication

Quote:
Originally Posted by outbound View Post
Humbly disagree with jobberone- Would suspect the anisocoria is not the usual cause of the poor vision in most cases. Also suspect it would not commonly relate to where the patch is placed. Believe the agent is absorbed percutaneously into the blood stream which the delievers it to the entrire circulation and brain. Rather the loss of accommendation usually of both eyes causes the blurry vision. Have had many crew and self place the patch in any non hairy spot and it works well. Lots of folks like to keep it out of the wet and somewhere it won't be rubbed.
May want to take a look in Grey's or Carpentiers as to vaso nervosum for ciliary ns. just recalling info stored from years ago.May be wrong but suspect not given neuro anatomy.

You may be right about it being multifactoral and I'd be surprised if it weren't. However, even dilating one eye creates problems with focus and distance perception. I'm not an opthalmologist but having had my eyes dilated yearly at least now, I can say there is difficulty seeing well even with uv filters on. It's not just the aniscoria if any nor is it just related to the mechanics of the eye. It is definitely a CNS depressant and can alter sensorum. I'm not a particular fan of the drug but it works for many with minimal side effects. There have been a few cases of extremely altered sensorum in some patients who did not have the history or exam of the patch revealed and it has caused some diagnostic problems for their attendings when they also presented with anisocoria. That is my reasoning for placing it in the midline. If your experience dictates that placing it further from the eyes also reduces anisocoria then I've learned something. My guess is placing it postauricular increases absorption since that area is likely more vascular than away from the face/head/neck.
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  #67  
Old 07-07-2013
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Re: Seasick medication

Quote:
Originally Posted by Geoff54 View Post
Please excuse the thread drift but this is something I know a little about. If it makes you feel better to send emails go right ahead but don’t expect anything from Reletex (Neurowave Medical Technologies) because I believe that they are only interested in maximizing profit and they have a method to do that. Here’s the storey:

Reliefband was owned/manufactured by Woodside Biomedical, Inc., in Carlsbad, California.

In the search for antiemetics with less side effects and/or that were cheaper (oh, the irony) there were several clinical trials that tried Reliefband to help alleviate post-operative and chemo. induced nausea. Anyone who is interested can look these up in PubMed. I’m not sure who paid for these trials and I can’t be bothered to research it but they were probably paid for in full or part by NIH grants, i.e. U.S. taxpayer dollars.

Abbott Laboratories either purchased Woodside Biomedical or purchased the rights to Reliefband and Woodside Biomedical closed down.

Based on the advantages as described in the medical trials, someone, I believe Abbott but possibly Neurowave Medical Technologies, gained FDA approval. This is the key thing because it then allowed Reliefband (now known as Reletex) to become an approved medical device that could be charged to medical insurance, thus opening the doors significantly larger profits.

Abbot sold the rights to Neurowave Medical Technologies. Neurowave Medical Technologies is a privately held Illinois coporation based in Chicago. If you want to find out who owns the company, you can pull the corporate record if you want but the board of directors comprises middle eastern medical marketers and U.S. venture capitalists as follows:
Khalid Alagel is the Founder and CEO of The Gulf Care Group (GCG), an innovative healthcare consulting company which develops international patient programs for client hospitals.
Wilbur H. Gantz, III is President and Chief Executive Officer of PathoCapital LLC, a privately owned company investing in the healthcare field.
Farhan Hussain is the President and CEO of Neurowave Medical Technologies. Prior to NMT, Mr. Hussain was a founding partner of The Gulfcare Group (GCG).
Bruce V. Rauner is chairman of GTCR, a Chicago-based venture capital and private equity firm.

Also address for the U.S. office of Gulf Care Group is the same as the address of Neurowave Medical Technologies.

Clearly their model is to maximize profits by marketing single use medical devices to medical facilities who will use them help their patients. And because it is now a medical device and insurance will pay, they can charge much higher prices than before. And because it is single use, they can sell more of them.

I don’t believe they have any incentive to market to the public or to make a device with reusable batteries. I will leave you to draw your own conclusions.
An interesting update to the Reletex/Neurowave saga: West Marine is now offering the ComfortQuest anti-motion sickness wrist band - correction, it is in the catalog and on the web site, but is shown as "out of stock." This device has a different design from the (former) Relief band, but the description is very similar (excerpt from the West Marine web site):

"The Comfort Quest Anti-Seasickness Band is a small, medical device designed to be worn on the underside of the wrist. It provides fast, moderate relief from nausea and vomiting due to motion sickness by applying gentle electrical stimulation to the nerves in your wrist. Approximately 150 hours of battery life at medium strength. Water resistant. Includes two CR2032 standard watch batteries, which are replaceable and available in many locations. Band does not require conductivity gel."

Note the key phrase about replaceable batteries!

But there is a fly in this ointment: On June 24, Neurowave filed a lawsuit against ComfortQuest alleging patent infringement. The details are quite interesting; apparently the former Director of Operations at Neurowave and its predecessor company, a Thomas Mann, is a director or officer of ComfortQuest. A Joseph Norris, also alleged to be a director or officer of ComfortQuest, was a sales rep for Neurowave. I gleaned this information from the complaint which you can read here:

http://www.knobbemedical.com/wp-cont...omplaint12.pdf

Speculation: might this lawsuit have something to do with West Marine now showing the ComfortQuest watch band as "out of stock"? Who knows. As of this morning (July 7), it is available from drugstore.com for $99, a significant savings over WM. I snapped up two; we'll see if they actually ship. Also available at various online sites is the "anti-morning sickness" version of the ComfortQuest band - which looks identical to the "anti-motion sickness" version except for the feminine color scheme. Get 'em while they are hot!

For those who, like myself, harbor considerable resentment and animosity towards Neurowave for its greed - so carefully documented in the lengthly quote above from Geoff54 - the complaint says that Neurowave has been planning for re-entry into the Over-the-Counter market of its devices and that this effort has been "materially hindered by Defendant Comfort Quest’s selling of the Accused Products to Neurowave’s former customer of the OTC Devices." Gee, isn't it nice to learn that Neurowave considers the people it abandoned its "customers"?
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  #68  
Old 07-07-2013
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Re: Seasick medication

Thank you soooo much for finding this. My wife has the original version that has replacement batteries. It is the only thing that works for her. I just went on Drugstore.com to order a backup for her. The level of greed Neurowave demonstrates is epic.

Quote:
Originally Posted by sparrowe View Post
An interesting update to the Reletex/Neurowave saga: West Marine is now offering the ComfortQuest anti-motion sickness wrist band - correction, it is in the catalog and on the web site, but is shown as "out of stock." This device has a different design from the (former) Relief band, but the description is very similar (excerpt from the West Marine web site):

"The Comfort Quest Anti-Seasickness Band is a small, medical device designed to be worn on the underside of the wrist. It provides fast, moderate relief from nausea and vomiting due to motion sickness by applying gentle electrical stimulation to the nerves in your wrist. Approximately 150 hours of battery life at medium strength. Water resistant. Includes two CR2032 standard watch batteries, which are replaceable and available in many locations. Band does not require conductivity gel."

Note the key phrase about replaceable batteries!

But there is a fly in this ointment: On June 24, Neurowave filed a lawsuit against ComfortQuest alleging patent infringement. The details are quite interesting; apparently the former Director of Operations at Neurowave and its predecessor company, a Thomas Mann, is a director or officer of ComfortQuest. A Joseph Norris, also alleged to be a director or officer of ComfortQuest, was a sales rep for Neurowave. I gleaned this information from the complaint which you can read here:

http://www.knobbemedical.com/wp-cont...omplaint12.pdf

Speculation: might this lawsuit have something to do with West Marine now showing the ComfortQuest watch band as "out of stock"? Who knows. As of this morning (July 7), it is available from drugstore.com for $99, a significant savings over WM. I snapped up two; we'll see if they actually ship. Also available at various online sites is the "anti-morning sickness" version of the ComfortQuest band - which looks identical to the "anti-motion sickness" version except for the feminine color scheme. Get 'em while they are hot!

For those who, like myself, harbor considerable resentment and animosity towards Neurowave for its greed - so carefully documented in the lengthly quote above from Geoff54 - the complaint says that Neurowave has been planning for re-entry into the Over-the-Counter market of its devices and that this effort has been "materially hindered by Defendant Comfort Quest’s selling of the Accused Products to Neurowave’s former customer of the OTC Devices." Gee, isn't it nice to learn that Neurowave considers the people it abandoned its "customers"?
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  #69  
Old 07-07-2013
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Thumbs up Re: Seasick medication

$$$ Saving Tip
Looked through the tread and didn't see it mentioned (may have missed it)... As a cost saving tip, Bonine (et al?) cost WAY, WAY less if you go to the pharmacist and ask for the generic equivalent Meclozine. I bought a bottle of 100 for ~$14.00
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  #70  
Old 07-07-2013
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Re: Seasick medication

I would be scared to pull the patch off if I was offshore after a couple days. Sure, your body is probably used to the motion and will be fine but what if you are not? Seasick meds only work if you take them before you get sick so what if you pull the patch and start heaving?
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