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To familiarize themselves with common side effects, patients should first take medications in a comfortable environment before using them for motion sickness during travel.First-line medication for prevention; transdermal formulation available by prescription; oral formulation not available in the United States; causes more dry eyes and dry mouth than antihistamines, but less sedation; may double dose or combine with antihistamines, or combine oral and transdermal formulations (increased risk of side effects); use with caution in older patients; not recommended for children younger than 10 years First-line medication for prevention; transdermal formulation available by prescription; oral formulation not available in the United States; causes more dry eyes and dry mouth than antihistamines, but less sedation; may double dose or combine with antihistamines, or combine oral and transdermal formulations (increased risk of side effects); use with caution in older patients; not recommended for children younger than 10 years24 A Cochrane review of 14 randomized controlled trials (RCTs) showed that scopolamine is effective for the prevention of motion sickness.14 A more recent RCT of 76 naval crew members showed that transdermal scopolamine is more effective and has fewer side effects than the antihistamine cinnarizine (not available in the United States).15 If the recommended dose of scopolamine does not adequately relieve symptoms, the dose may be doubled.The pathogenesis of motion sickness is not clearly understood, but it is thought to be related to conflict between the vestibular, visual, and other proprioceptive systems.2 Rotary, vertical, and low-frequency motions produce more symptoms than linear, horizontal, and high-frequency motions.1Although nausea may be the first recognized symptom of motion sickness, it is almost always preceded by other subtle symptoms such as stomach awareness (i.e., a sensation of fullness in the epigastrium), malaise, drowsiness, and irritability.

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Search dates: March 2012 through March 2014all author info ANDREW BRAINARD, MD, MPH, FACEM, FACEP, is an emergency medicine physician at Middlemore Hospital, Auckland, New Zealand.

Although mild symptoms are common, severely debilitating symptoms are rare2 Prevention of motion sickness is more effective than treating symptoms after they have occurred.



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