Treatment Of Motion Sickness Research Articles

Assessment of the effect of pharmaceuticals used to treat motion sickness on adaptation to model conditions involving prolonged rotation

The pharmacological preparation P-4 administered according to a reduced scheme (the first dose, 1.5–2 h before stimulation; the second dose, 2 h after stimulation) efficiently alleviated the main symptoms of motion sickness, accelerated the process of adaptation and increased its efficiency in persons prone to motion sickness upon exposure to slow rotation during four days. Administration of the preparation according to the scheme described above did not cause the abstinence syndrome.

An HPLC–ESI-MS method for simultaneous determination of fourteen metabolites of promethazine and caffeine and its application to pharmacokinetic study of the combination therapy against motion sickness

The combination therapy, promethazine and caffeine had been proven effective in treating motion sickness and counteracting some possible side effects of using promethazine alone while the mechanism and interaction remained unclear. Therefore, an HPLC–ESI-MS method for simultaneous determination of both drugs, and their metabolites was developed for purpose of pharmacokinetic study. To determine as many metabolites as possible, the influence of parameters such as column, flow rate and pH value of mobile phase, ionization polarity and fragmentation voltage were optimized. Fourteen target analytes were well separated and all of them could be identified and determined in plasma after administration of promethazine and caffeine. The LODs and LOQs were 0.9–6.0 and 2.50–16.0ng/ml, respectively; the recoveries of three levels of quality control samples were from 86.7% to 102%; the intra-day and inter-day precisions were less than 3% and 9%, separately; and the RSDs of compound stability were all lower than 10% within 24h after sample preparation. As a pharmacokinetic study of the combination therapy in 30 healthy volunteers, concentration–time curves of the drugs and metabolites were studied. The present method for simultaneous measurement of more than ten metabolites is valuable for the study of mechanism and interaction of the combination therapy.

Motion Sickness: Comparison of Metoclopramide and Diphenhydramine to Placebo

This is an evaluation of the efficacy of metoclopramide (MTCP) or diphenhydramine (DPH) to relieve symptoms of motion sickness in patients being transported via ambulance in a mountainous setting. This is a prospective, randomized, double-blinded, placebo-controlled study of patients transported by ambulance in the Sierra Nevada mountains of Fresno County. Consenting patients who met the inclusion criteria were asked to rate their motion sickness every five minutes using a visual analog scale (VAS) during transport. If motion sickness occurred, they were randomized to receive MTCP (20 mg IV), DPH (50 mg IV), or placebo (normal saline), and remaining symptoms were recorded every five minutes. If signs and symptoms of motion sickness persisted after 15 minutes, a rescue dose of MTCP was offered. Twenty-six patients were enrolled in the study. Twenty-two (84.6%) developed motion sickness and were randomized to MTCP, DPH, or placebo. Eight patients received MTCP, seven received DPH, and seven received placebo. The MTCP group showed a statistically significant decrease in the mean VAS score at 15 minutes compared to the DPH and placebo groups. There was no significant difference in the decrease in VAS score between the placebo and the DPH group. Twelve out of 22 patients requested a rescue dose of MTCP after 15 minutes. At 25 minutes, there was no significant difference in the VAS score between the three groups. During ambulance transport in a mountainous setting, the administration of MTCP is superior to both DPH and placebo in the treatment of motion sickness. Diphenhydramine is not superior to placebo.

Scopolamine (hyoscine) for preventing and treating motion sickness.

This is an update of a Cochrane Review first published in The Cochrane Library in Issue 3, 2004 and previously updated in 2007 and 2009.Motion sickness, the discomfort experienced when perceived motion disturbs the organs of balance, may include symptoms such as nausea, vomiting, pallor, cold sweats, hypersalivation, hyperventilation and headaches. The control and prevention of these symptoms has included pharmacological, behavioural and complementary therapies. Although scopolamine (hyoscine) has been used in the treatment and prevention of motion sickness for decades, there have been no systematic reviews of its effectiveness. To assess the effectiveness of scopolamine versus no therapy, placebo, other drugs, behavioural and complementary therapy or two or more of the above therapies in combination for motion sickness in persons (both adults and children) without known vestibular, visual or central nervous system pathology. We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 14 April 2011. All parallel-arm, randomised controlled trials (RCTs) focusing on scopolamine versus no therapy, placebo, other drugs, behavioural and complementary therapy or two or more of the above therapies in combination. We considered outcomes relating to the prevention of onset or treatment of clinically-defined motion sickness, task ability and psychological tests, changes in physiological parameters and adverse effects. Two authors independently extracted data from the studies using standardised forms. We assessed study quality. We expressed dichotomous data as odds ratio (OR) and calculated a pooled OR using the random-effects model. Of 35 studies considered potentially relevant, 14 studies enrolling 1025 subjects met the entry criteria. Scopolamine was administered via transdermal patches, tablets or capsules, oral solutions or intravenously. Scopolamine was compared against placebo, calcium channel antagonists, antihistamine, methscopolamine or a combination of scopolamine and ephedrine. Studies were generally small in size and of varying quality.Scopolamine was more effective than placebo in the prevention of symptoms. Comparisons between scopolamine and other agents were few and suggested that scopolamine was superior (versus methscopolamine) or equivalent (versus antihistamines) as a preventative agent. Evidence comparing scopolamine to cinnarizine or combinations of scopolamine and ephedrine is equivocal or minimal.Although sample sizes were small, scopolamine was no more likely to induce drowsiness, blurring of vision or dizziness compared to other agents. Dry mouth was more likely with scopolamine than with methscopolamine or cinnarizine.No studies were available relating to the therapeutic effectiveness of scopolamine in the management of established symptoms of motion sickness. The use of scopolamine versus placebo in preventing motion sickness has been shown to be effective. No conclusions can be made on the comparative effectiveness of scopolamine and other agents such as antihistamines and calcium channel antagonists. In addition, we identified no randomised controlled trials that examined the effectiveness of scopolamine in the treatment of established symptoms of motion sickness.

Efficiency of scopolamine hydrobromide orally disintegrating tablets in treatment of motion sickness

Objective To evaluate the efficiency of scopolamine hydrobromide orally disintegrating tablets(SHODT) based on nanoparticles-in-microsphere system in treatment of motion sickness.Methods(1) Each mouse was placed in a rotation device to induce motion sickness;the animals received gastric infusion of SHODT(6 mg/kg,12 mg/kg,and 24 mg/kg) 20 min before rotation to observe the preventive and therapeutic effect of SHODT.(2) Paraoxon(10 μl) was locally applied to the right carotid artery of rabbits to induce forced reverse circling(exceeding 3 round/ min was taken as positive).Ten minutes before application of paraoxon,SHODT(0.12 mg/kg,0.24 mg/kg,0.36 mg/kg,0.48 mg/kg,0.72 mg/kg,0.96 mg/kg,and 1.44 mg/kg) was put into rabbit mouths for natural disintegration and swallow;symptoms of motion sickness was observed 40 min after paraoxon application.Results We found that SHODT at 6 mg/kg had a similar effect to the same dosage of normal tablets for motion sickness in mice(P=0.674) and had a significantly different effect with blank control(P=0.001).The anti-motion sickness effect of SHODT was in a dose-dependent manner within the range of 6-24 mg/kg.The ED50 value of SHODT was 0.476 mg/kg in rabbits treated with local paraoxon.The linearity formula between the dose in logarithmic and the efficiency was y=0.679x+0.724,R=0.929.Conclusion SHODT based on nanoparticles-in-microsphere system possess an effective anti-motion sickness effect.

Meclizine: Safety and Efficacy in the Treatment and Prevention of Motion Sickness

Motion sickness is a self-limiting but uncomfortable phenomenon experienced by many people. It is common during civilian travel and also among professionals during travel or military manoeuvres. Meclizine is a piperzine antihistamine that is effective for the prevention and treatment of motion sickness, particularly during mild civilian travel. It is well tolerated with few adverse effects and its oral dosage form is convenient for patients to take prior to exposure to motion as a preventative measure.

Development of Zingiber officinale in oral dissolving films: Effect of polymers on in vitro, in vivo parameters and clinical efficacy

Oral dissolving drug delivery system offers a solution for those patients having difficulty in swallowing tablets/capsules,etc. Zingiber officinale, has been used for medicinal purpose since antiquity to treat motion sickness, pregnancy, and cancer-chemotherapy-induced vomiting, mild stomach upset, cough, chronic bronchial problems, and low-grade infections of all kinds and anorexia condition. This work investigates the possibility of developing Zingiber officinale oral dissolving films allowing fast, reproducible dissolution in oral cavity; thus bypassing first pass metabolism. The oral dissolving films were prepared by solvent-casting method. Prepared films were evaluated for film-forming properties, physico-mechanical properties, palatability, microbial limit test, accelerated stability studies, and clinical efficacy test. The different polymers such as hydroxypropyl methylcellulose 5cps, maltodextrin, pullulan, and polyvinyl alcohol were explored individually and in combination with each other for the formation of film. Among all polymers, maltodextrin and HPMC 5 cps alone and in combination showed excellent film-forming properties as well as very good physico-mechanical properties. The films resulted into excellent palatability along with least disintegrating time. But at accelerated stability studies, only HPMC 5 cps was found to be stable when compared with other formulations. So, it was concluded that HPMC 5 cps is the best film forming as well as stable polymer with respect to Zingiber officinale oral dissolving film.

Perspectives on the Use of Scopolamine as an Adjunct Treatment to Enhance Survival Following Organophosphorus Nerve Agent Poisoning

Scopolamine (SCP) is an anticholinergic drug used clinically for decades to treat motion sickness, as a surgical preanesthetic, and as a smooth muscle antispasmodic. It has also been used experimentally as a pretreatment and/or treatment adjunct to mitigate the toxic sequelae of organophosphorus (OP) nerve agent intoxication. SCP has been reported to increase survival, prevent or terminate seizures, and reduce morbidity from nerve agent intoxication in a number of animal models. The purpose of this study was to evaluate the effect of atropine dose, pyridostigmine bromide (PB) pretreatment, and oxime selection on the efficacy of SCP as an adjunctive treatment to enhance survival following lethal nerve agent exposure in guinea pigs. The results indicate that the use of an effective oxime and/or PB pretreatment was a critical factor in determining the efficacy of SCP. SCP can also reduce the dose of atropine required for survival against lethal nerve agent intoxication.

Extracts from The Cochrane Library: Scopolamine (hyoscine) for preventing and treating motion sickness

The “Cochrane Corner” is a quarterly section in the Journal that highlights systematic reviews relevant to otolaryngology–head and neck surgery, with invited commentary to aid clinical decision making. This installment features a Cochrane Review entitled “Scopolamine (hyoscine) for preventing and treating motion sickness,” which concludes that scopolamine is more effective than placebo, but no conclusions can be made regarding comparative efficacy with other interventions or the ability of scopolamine to treat established symptoms.

Anticholinergic syndrome following an unintentional overdose of scopolamine

Scopolamine hydrobromide (hyoscine) is an antimuscarinic drug which is primarily used in the prophylaxis and treatment of motion sickness and as a premedication to dry bronchial and salivary secretions. In acute overdosage, the main clinical problem is central nervous system (CNS) depression. In Australia, tablets containing scopolamine hydrobromide 0.3 mg are available over the counter in packs of ten. The recommended dose for adults is one to two tablets as a single dose, repeated four to six hours later, if required. The maximum dose stated on the pack is four tablets over a 24-hour period with a caution regarding drowsiness and blurred vision. We describe a patient who presented with symptoms of anticholinergic syndrome secondary to an unintentional overdose of scopolamine. Whilst at work, the patient noticed that he had forgotten his prescribed medication, domperidone, at home; a friend gave him some travel sickness medication which contained scopolamine for relief of nausea. On a previous occasion, he had experienced a similar, less severe reaction with another anticholinergic agent, loperamide. This report highlights the need to consider nonprescription products, ie, over the counter medications, herbal/nutritional supplements as causes of anticholinergic syndrome when a patient presents with symptoms suggestive of this diagnosis.

113: The Treatment of Motion Sickness in the Out-of-Hospital Setting: A Comparison of Metoclopramide and Diphenhydramine to Placebo

To determine the incidence of motion sickness in patients being transported via ambulance in a mountainous setting while comparing metoclopramide and diphenhydramine to placebo in the treatment of these patients.

Scopolamine Sublingual Spray: An Alternative Route of Delivery for the Treatment of Motion Sickness

ABSTRACTThe purpose of this study was to develop a sublingual drug delivery spray formulation of scopolamine hydrobromide (L-(-)-hyoscine hydrobromide) and to determine the absolute bioavailability of scopolamine hydrobromide following sublingual delivery and to investigate the effect of a bioadhesive on the pharmacokinetic parameters of this drug in a rabbit model. Rabbits received a single scopolamine free base equivalent sublingual dose of 100 μg/kg and this was compared to intravenous administration of the drug. Blood samples were collected at different time points, and plasma scopolamine concentrations were determined using a new sensitive and specific LC/MS analytical method which utilized electrospray ionization detection. The bioavailability of sublingual scopolamine was determined by comparing plasma concentrations after sublingual spray delivery with equivalent intravenous doses. Following delivery of the sublingual spray dose, the average Cmax was 1024.4 ± 177 ng/mL, and the AUC value was found to be 61067.6 ± 9605 ng.min/mL. Relative to the intravenous dose (100% bioavailability), the bioavailability was 79.8% after sublingual spray administration. The addition of 2% chitosan, a bio-adhesive material and an absorption enhancer, showed a significant improvement in scopolamine sublingual absorption (p < 0.05) was observed. Considering the limitations of delivering scopolamine orally or transdermally to patients who experience motion sickness, the sublingual route of administration using a spray delivery dosage form, is a potential alternative modality for the prevention of nausea and vomiting associated with motion sickness.

Vertigo and Motion Sickness. Part II: Pharmacologic Treatment

Vertigo is a sensation of movement when no movement is actually occurring. It is often accompanied by visceral autonomic symptoms including pallor, diaphoresis, nausea, and vomiting. Vertigo is similar to motion sickness in that both may be caused by vestibular stimulation that does not match an internal model of expected environmental stimuli. Indeed, a functioning vestibular system is necessary for the perception of motion sickness. For this reason, many of the same drugs are used to treat both conditions. The investigation of drugs that treat motion sickness helps to discover medications that may treat vertigo caused by disease of the vestibular system. In this article, we discuss the pharmacologic agents that are now available for the treatment of vertigo and those agents that are still under study.

Both migraine and motion sickness may be due to low brain levels of serotonin

Scientists believe that low levels of a brain chemical called serotonin may make people susceptible to developing migraine headaches. Many people with migraine also have a problem with motion sickness, but it is not clear why this might be. We know that many drugs to treat motion sickness increase brain levels of serotonin, an important brain chemical. It is possible that low brain levels of serotonin may also be responsible for motion sickness. In this issue of Neurology, Drummond reports on a study that evaluated whether low brain levels of serotonin trigger motion sickness in people with and without migraine. More information about migraine can be found on the next page.

Scopolamine for preventing and treating motion sickness.

Motion sickness - the discomfort experienced when perceived motion disturbs the organs of balance - may include symptoms such as nausea, vomiting, pallor, cold sweats, hypersalivation, hyperventilation and headaches. The control and prevention of these symptoms have included pharmacological, behavioural and complementary therapies. Although scopolamine has been used in the treatment and prevention of motion sickness for decades, there have been no systematic reviews of its effectiveness. To assess the effectiveness of scopolamine versus no therapy, placebo, other drugs, behavioural and complementary therapy or two or more of the above therapies in combination for motion sickness in persons (both adults and children) without known vestibular, visual or central nervous system pathology. The Cochrane Ear, Nose and Throat Disorders Group Specialised Register, the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2003), MEDLINE (OVID, 1966 to March Week 1 2004), EMBASE (1974 to 2004) CINAHL (Ovid, 1982 to March Week 1 2004) and reference lists of retrieved studies were searched for relevant studies. No language restrictions were applied. All parallel-arm, randomised controlled trials (RCTs) focusing on scopolamine versus no therapy, placebo, other drugs, behavioural and complementary therapy or two or more of the above therapies in combination were included. Outcomes relating to the prevention of onset or treatment of clinically-defined motion sickness, task ability and psychological tests, changes in physiological parameters and adverse effects were considered. Data from the studies were extracted independently by two authors using standardised forms. Study quality was assessed. Dichotomous data were expressed as odds ratio (OR) and a pooled OR was calculated using the random effects model. Of 27 studies considered potentially relevant, 12 studies enrolling 901 subjects met the entry criteria. Scopolamine was administered via transdermal patches, tablets or capsules, oral solutions or intravenously. Scopolamine was compared against placebo, calcium channel antagonists, antihistamine, meth-scopolamine or a combination of scopolamine and ephedrine. Studies were generally small in size and of varying quality. Scopolamine was more effective than placebo in the prevention of symptoms. Comparisons between scopolamine and other agents were few and suggested that scopolamine was superior (versus meth-scopolamine) or equivalent (versus antihistamines) as a preventative agent. Evidence comparing scopolamine to cinnarizine or combinations of scopolamine and ephedrine is equivocal or minimal. Although sample sizes were small, scopolamine was no more likely to induce drowsiness, blurring of vision or dizziness compared to other agents. Dry mouth was more likely with scopolamine than with meth-scopolamine or cinnarizine. No studies were available relating to the therapeutic effectiveness of scopolamine in the management of established symptoms of motion sickness. The use of scopolamine versus placebo in preventing motion sickness has been shown to be effective. No conclusions can be made on the comparative effectiveness of scopolamine and other agents such as antihistamines and calcium channel antagonists. In addition, no randomised controlled trials were identified that examined the effectiveness of scopolamine in the treatment of established symptoms of motion sickness.

Vestibular testing abnormalities in individuals with motion sickness.

The goal of this study was to compare the results of vestibular testing in individuals with motion sickness to a group of control subjects. Studying motion sickness is difficult, because no animal model has been developed and symptoms rarely occur outside motion environments. Tests that can be performed in normal laboratory settings, which help to identify individuals with motion sickness, may be valuable in characterizing this disorder. Twenty active duty military individuals with well-documented motion sickness were tested. The test battery included sinusoidal rotational chair testing to calculate vestibulo-ocular reflex function, step-velocity testing to calculate vestibular time constants, and posturography testing to assess vestibulo-spinal reflex status. The results of this test battery were compared with a set of age- and sex-matched controls without motion sickness. Vestibular test abnormalities were demonstrated in individuals with motion sickness. Vestibulo-spinal reflex function on posturography was normal in the control group but abnormal in 70% of the individuals with motion sickness. In addition, 5% of the control group demonstrated a minimal shortening of the absolute time constant, whereas 60% of the individuals with motion sickness had abnormal absolute time constants. A significant percentage of individuals with motion sickness demonstrate abnormalities in their time constant or vestibulo-spinal reflex function. These abnormalities can be detected using standard, land-based vestibular tests. These preliminary results have implications in understanding the etiology of motion sickness and may provide outcome measures to be used in treating motion sickness.

Drug treatment for vertigo

The approach to drug treatment of vertigo is almost exclusively symptomatic. There are 3 major goals for drug treatment of vertigo: to eliminate the hallucination of motion, to reduce the accompanying neurovegetative and psychoaffective signs (nausea, vomiting, anxiety), and to enhance the process of "vestibular compensation" to allow the brain to find a new sensory equilibrium in spite of the vestibular lesion. Three different types of vertigo drug treatment must be distinguished: the treatment of acute vertigo attacks, the treatment of chronic vertigo, and the treatment of patients with Menière's disease to avoid vertigo attacks. Furthermore, this paper deals with the treatment of motion sickness and of the postoperative nausea and vomiting.

Treatment of Motionsickness in Prehospital Trauma Victims: OxyarmTM Is More Effective Than a Venturi Mask

Treatment of Motionsickness in Prehospital Trauma Victims: OxyarmTM Is More Effective Than a Venturi Mask

A new goldfish model to evaluate pharmacokinetic and pharmacodynamic effects of drugs used for motion sickness in different gravity loads

This paper proposes a new goldfish model to predict pharmacodynamic/pharmacokinetic effects of drugs used to treat motion sickness administered in differing gravity loads. The assumption of these experiments is that the vestibular system is dominant in producing motion sickness and that the visual system is secondary or of small import in the production of motion sickness. Studies will evaluate the parameter of gravity and the contribution of vision to the role of the neurovestibular system in the initiation of motion sickness with and without pharmacologic agents. Promethazine will be studied first. A comparison of data obtained in different groups of goldfish will be done (normal vs. acutely and chronically bilaterally blinded vs. sham operated). Some fish will be bilaterally blinded 10 months prior to initiation of the experiment (designated the chronically bilaterally blinded group of goldfish) to evaluate the neuroplasticity of the nervous system and the associated return of neurovestibular function. Data will be obtained under differing gravity loads with and without a pharmacological agent for motion sickness. Experiments will differentiate pharmacological effects on vision vs. neurovestibular input to motion sickness. Comparison of data obtained in the normal fish and in acutely and chronically bilaterally blinded fish with those obtained in fish with intact and denervated otoliths will differentiate if the visual or neurovestibular system is dominant in response to altered gravity and/or drugs. Experiments will contribute to validation of the goldfish as a model for humans since plasticity of the central nervous system allows astronauts to adapt to the altered visual stimulus conditions of 0-g. Space motion sickness may occur until such an adaptation is achieved.

Primary neurotransmitters and regulatory substances onto vestibular nucleus neurons.

This review article focused on the primary neurotransmitters involved in transmission from the otolith to the vestibular nucleus (VN), especially in relation to the neurotransmission to the VN neurons (gravity-sensitive neurons) activated by tilt stimulation. The medial vestibular nucleus (MVN) neurons were classified in 8 types (alpha-theta) according to the patterns in response to the clockwise and counterclockwise tilt-stimulations. The tilt-induced firing was inhibited by GDEE (a non-selective glutamate receptor antagonist) and/or atropine (a muscarinic receptor antagonist). Thus, glutamate and/or acetylcholine may serve as the primary neurotransmitters. This conclusion is supported by the previous findings that glutamate exists in the vestibular nerve and is released from the nerve besides the presence of glutamate receptor subtypes in the VN. In addition, acetylcholine induced atropine-reversible firing of MVN neurons, and the enzymes involved in acetylcholine synthesis/metabolism are also found in the VN. Furthermore, serotonin was found to inhibit the MVN neuronal activities via the 5-HT1A receptors. As such, the 5-HT1A agonist, tandospirone, may be effective in preventing and/or treating motion sickness and/or space sickness.