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Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Side Effect of Transdermal Scopolamine for Motion Sickness

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Transdermal scopolamine 1.5 mg is provided in a patch with the trade name Transderm Sc?p, distributed by the pharmaceutical company Novartis. It is commonly used to treat motion sickness (such as seasickness), and is very effective. On our recent great white shark diving adventure, many of the participants wore patches at the outset of the journey, because we made our initial crossing to Guadalupe Island in the tail of some higher-than-usual (for this time of year) seas.

Here is some information on motion sickness:

Motion sickness (seasickness, or “mal de mer”) is a common annoying, and sometimes disabling, problem for boaters and divers. Motion sickness is a complex phenomenon that involves the cerebellum (the part of the brain that controls, among other things, balance), vestibular system (labyrinth of the inner ear that plays a major role in the control of equilibrium), the nerve connections between the eyes and the inner ear, and the gastrointestinal tract. It is made worse by alcohol ingestion, emotional upset, noxious odors (e.g., boat exhaust fumes), and inner ear injury or infection. Most persons adapt to real motion after a few days, but may require treatment until they are adjusted to the environment.

Signs and symptoms of motion sickness include a sensation of dizziness or spinning, a sensation of falling, pale skin color, sweating, nausea, headache, drowsiness, weakness, yawning, and increased salivation. Vomiting may provide temporary relief, but prolonged salvation doesn’t occur until the inner ear labyrinth acclimatizes to motion or you are able to intervene with an anti-motion-sickness device or medication. Persons who suffer from prolonged vomiting become dehydrated and exhausted.

To manage motion sickness:

1. Keep your eyes fixed on a steady point in the distance. If on board a ship, stay on deck. Splash your face with cold water. If the seas are rough, be careful to not slip or fall overboard. If you can have someone next to you who is not suffering, that is better than leaning over the rail by yourself to vomit when you are dizzy.

2.Use the ReliefBand device. It is advertised to relieve nausea and vomiting with gentle, noninvasive electrical stimulation on the underside of the wrist. It can be used before or after symptoms begin; carries no restrictions on food, beverages, or the use of medications; and has no drug-like side effects. The device looks like a wristwatch. The Adventurer model contains a battery-powered electrical stimulator that is easily adjustable for five different stimulation levels. The device is positioned over the P6 acupuncture site (the Neiguan, or Nei Kuan, point on the pericardial meridian). This is located 2 fingerbreadths toward the heart from the wrist joint between the two prominent finger flexor tendons. When the device is turned on, a pulse is generated every 4 seconds, and the user feels the episodic tingling sensation. It is theorized that the electrical signal transmitted via the median nerve in the wrist interrupts the nausea and vomiting messages that are transmitted between the brain and the stomach. The only side effect noted so far with the device is rare irritation where the electrodes make contact with the skin. This is easily managed by moving the device to the other wrist.

3. Some persons report that wearing a “sea band” is helpful. This is a knitted, elastic stretch band with a button(s) that applies pressure to an acupuncture point(s). This would not be expected to be nearly as effective as the ReliefBand device, but might help out in a pinch.

4. Ingest meclizine (Antivert, Bonine) 25 mg , cyclizine (Marezine) 50 mg , or dimenhydrinate (Dramamine) 50 mg orally every 4 to 6 hours, or cinnarizine (Sturgeron) 15 mg every 8 hours as necessary to prevent and control motion sickness. These are adult doses. To be most effective, the first dose of medication should precede the environmental change by 1 hour. Medication given after the onset of seasickness will often be ineffective. Obviously, if you are vomiting so severely that you cannot keep any medication down, you may need to use a suppository, such as prochlorperazine (Compazine) 25 mg or promethazine (Phenergen) 25 mg, noting that these drugs won’t cure the motion sickness–they might control vomiting, but have the side effect of drowsiness.

5. Place a transdermal scopolamine patch (Transderm-Sc?p 1.5 mg) on the skin behind the ear. This patch releases the drug slowly through the skin and can be very effective against motion sickness for up to 3 days. Side effects include drowsiness, blurred vision (sometimes with a dilated pupil in the eye on the side of the patch), decreased sweating, difficulty with urination (particularly in elder males with enlarged prostate glands), dry mouth, and a propensity to be susceptible to heat illness during times of heat exposure. Persons with glaucoma should not use the patch. On a rare occasion, a person who uses a patch can become delirious or even psychotic as a side effect. Normal behavior returns within a few hours after the patch is removed.

The patch should be positioned at least 3 hours before rough seas are encountered. If you touch the medicated (sticky) side of the patch with a finger and then let that finger come in contact with your eye, your pupil will almost certainly dilate and stay that way for up to 8 hours. So, as the distributor strongly recommends, be sure to wash your hands thoroughly with soap and water immediately after handling the patch, so that any drug that might get on your hands will not come in contact with your eyes. Also, local absorption of the drug through the skin can dilate the pupil of the eye on the same side of the patch, causing difficulty with focusing of vision. The picture here shows someone with a dilated pupil associated with a patch.

6. Reduce head movement. Do not consume alcoholic beverages, because these make you more prone to vertigo. If you are on a large boat that is rocking bow to stern, seek the middle (equilibrium) of the vessel, so that motion is minimized. Look out from the boat and find a broad view of the horizon. Don’t do close-focused visual tasks like reading, writing, and navigation. If you are becoming motion sick and can’t control your symptoms, you might find some relief by lying faceup in a well-secured and ventilated bunk. Close your eyes and try to sleep.

7. Some people recommend “keeping something in your stomach” during a bout of motion sickness. You can put something in there, but if you are truly sick, it won’t stay there for long. Try to maintain your fluid intake with sips of something like an electrolyte-containing sports beverage (e.g., Gatorade or Gatorade G2). If you are known to suffer from motion sickness, take particular care to be well hydrated before your journey, because you will at a minimum have decreased appetite and fluid intake, and in the worst case, lose a fair bit of fluid by vomiting. While some persons recommend a light diet with predominately carbohydrates, there is no evidence that any particular food or diet is beneficial. Ginger (Zingiber officinale) is sometimes recommended to curb nausea. It is taken as 1,000 mg (two 500 mg capsules) every 6 hours, supplemented by gingersnap cookies, ginger ale, and candied ginger.

Headache, ringing in the ears, weakness in an arm or leg, difficulty with speech, difficulty swallowing, decreased vision, or palpitations are not features of motion sickness and should raise suspicion for another cause of dizziness. If any of these occur, particularly if the seas are not particularly rough and no one else is suffering, the victim should seek medical attention. Similarly, if the symptoms occur after a dive, one must consider the possibility of central nervous system decompression sickness (bends) or arterial gas embolism.

Finally, don’t try to cure serious motion sickness by putting on your dive gear and heading underwater. Mild nausea attributable to seasickness may disappear when you get under the surface (and the objectionable motion ceases), but if you are ready to vomit, you shouldn’t put yourself and your companions in a situation where you throw up underwater. It is not easy to vomit underwater and coordinate breathing through your regulator, and getting sick when you are in the water can lead to panic and a serious diving accident. Don’t dive until you are feeling well.

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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.

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