DESCRIPTION

Motion sickness is a very common disturbance of the inner ear that is caused by repeated motion such as the wave action of water, the movement of a car, the motion in turbulent air while in a plane and other movement. It occurs when motion causes the eyes, the sensory nerves, and the vestibular apparatus of the ear to send conflicting signals to the brain, causing loss of equilibrium (disturbing the sense of balance) or a sense of vertigo (feeling of dizziness and disturbed sense of spatial orientation).

Motion sickness is usually experienced while riding in a car, airplane, train, boat, elevator, or on a swing or amusement rides. Anxiety, genetics, overeating, poor ventilation, and traveling immediately after eating are common contributing factors. A susceptibility to things such as offensive odors, sights, or sounds can often precede an attack of motion sickness.

Women are affected by this condition more frequently than men are. Elderly people and children under the age of 2 years usually are not affected.

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CAUSES

Motion is sensed by the brain through three different pathways of the nervous system that send signals coming from the inner ear (sensing motion, acceleration, and gravity), the eyes (vision), and the deeper tissues of the body surface (proprioceptors). When the body is moved intentionally, for example, when we walk, the input from all three pathways is coordinated by our brain. When there is unintentional movement of the body, as occurs during motion when driving in a car, the brain is not coordinating the input, and there is thought to be discoordination or conflict among the input from the three pathways. It is hypothesized that the conflict among the inputs is responsible for motion sickness.

For example, when we are sitting watching a picture that depicts a moving scene, our vision pathway is telling our brain that there is movement, but our inner ear is telling our brains that there is no movement. Thus, there is conflict in the brain, and some people will develop motion sickness in such a situation (even though there is no motion).

The cause of motion sickness is complex, however, and the role of conflicting input is only a hypothesis, or a proposed explanation, for its development. Without the motion-sensing organs of the inner ear, motion sickness does not occur, suggesting that the inner ear is critical for the development of motion sickness. Visual input seems to be of lesser importance, since blind people can develop motion sickness. Motion sickness is more likely to occur with complex types of movement, especially movement that is slow or involves two different directions (for example, vertical and horizontal) at the same time.

The conflicting input within the brain appears to involve levels of the neurotransmitters (substances that mediate transmission of signals within the brain and nervous system) histamine, acetylcholine, and norepinephrine. Many of the drugs that are used to treat motion sickness act by influencing or normalizing the levels of these compounds within the brain.

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SYMPTOMS

People suffering from motion sickness experience symptoms that range from severe headache to queasiness to nausea and vomiting while flying, sailing, or traveling in automobiles or trains. Other symptoms of motion sickness include:

• Dizziness (vertigo).
• Cold sweats.
• Fatigue.
• Loss of appetite.
• Pallor.
• Severe distress.
• Sleepiness.
• Weakness.
• Loss of appetite.
• General feeling of discomfort and not feeling well (malaise).
• Occasionally, breathing difficulties that can make you feel as though you are suffocating.

If severe, the attack can make you completely uncoordinated, and sometimes injury can occur from loss of balance. Once the stimulus is removed, the motion sickness usually goes away; however, it can persist for hours or days. If you suffer from motion sickness for a prolonged period of time, you may experience depression, dehydration, or low blood pressure. It can also worsen any other illness you may already have.

MOTION SICKNESS VS SEA SICKNESS

There is no difference between motion sickness and sea sickness. Some people experience nausea and even vomiting when riding in an airplane, automobile, or amusement park ride. This condition is generally called motion sickness. Many people experience motion sickness when riding on a boat or ship. This is commonly referred to as sea sickness (mal de mer), even though it is the same disorder. They are one and the same phenomenon and will subsequently be referred to as motion sickness.

AFFECTS OF MOTION SICKNESS ON SENSE OF BALANCE

The symptoms of motion sickness appear when the central nervous system receives conflicting messages from the other four systems -- the inner ear, eyes, skin pressure receptors, and the muscle and joint sensory receptors. For example, imagine you are riding in an airplane during a storm, and the plane is being tossed about by air turbulence. But your eyes do not detect all this motion because all you see is the inside of the airplane. Consequently, your brain receives messages that do not coordinate with each other. You might become "air sick." Or suppose you are sitting in the back seat of a moving car reading a book. Your inner ears and skin receptors detect the motion of your travel, but your eyes see only the pages of your book. You could become "car sick."

Another example illustrates an actual medical condition. Suppose you suffer inner ear damage on only one side from either a head injury or an infection. The damaged inner ear does not send the same signals to the brain as the healthy ear. These conflicting signals about the sensation of rotation can result in a sense of spinning or vertigo, as well as nausea.

Motion sickness is not usually a serious condition. For most people, motion sickness is just a minor annoyance (although it may not feel so minor at the time). Some travelers, however, can be incapacitated by motion sickness.

The distressing symptoms of motion sickness usually stop when the motion that causes it ceases. But this is not always true. There are people who suffer symptoms for even a few days after the trip is over. This is called the "mal d'embarquement" syndrome or, more properly, the "mal de debarquement" syndrome. ("Mal d'embarquement" is embarkment or departure sickness while "mal de debarquement" is disembarkment or arrival sickness.)



CONVENTIONAL MEDICAL TREATMENT

PREVENTION

SENSE OF BALANCE & EQUILIBRIUM

Motion sickness relates to our sense of balance and equilibrium. Researchers in space and aeronautical medicine call this sense spatial orientation, because it tells the brain where the body is "in space:" what direction it is pointing, what direction it is moving, and if it is turning or standing still. Our sense of balance is regulated by a complex interaction of the following parts of the nervous system:

1. The inner ears (also called the labyrinth) monitor the directions of motion, such as turning or forward-backward, side-to-side, and up-and- down motions.

2. The eyes observe where the body is in space (for example, upside down, right side up, etc.) and also the directions of motion.

3. Skin pressure receptors such as those located in the feet and seat sense what part of the body is down and touching the ground.

4. Muscle and joint sensory receptors report what parts of the body are moving.

5. The central nervous system (the brain and spinal cord) processes all the bits of information from the four other systems to make some coordinated sense out of it all.

PREVENTION OF MOTION SICKNESS

Motion sickness , sometimes referred to as sea sickness or car sickness, is a very common disturbance of the inner ear that is caused by repeated motion. In addition to sea travel, motion sickness can develop from the movement of a car or from turbulence in an airplane. The symptoms of motion sickness are nausea, vomiting, dizziness, sweating, and a sense of feeling unwell. These symptoms arise from the inner ear (labyrinth) due to changes in one's sense of balance and equilibrium. Motion sickness is easier to prevent than to treat. If you know you are prone to motion sickness or if you are suffering from it, here are some recommendations to help prevent or lessen the severity of symptoms:

• Always ride where your eyes will see the same motion that your body and inner ears feel.



• In a car, sit in the front seat and look at the distant scenery. If you know that you get motion sickness, keep your head still. Rest your head against your seat.



• If traveling on a bus, do not sit at the back of the bus. Try to choose a seat where you will experience the least motion. Instead, try sitting near the front of the bus so you can see out in front of you and you can see the scenery (like sitting in the front seat of a car) and it can sometimes help to keep your gaze fixed on the horizon or on a fixed point. Sitting over the front wheelwell is helpful since there is less motion during turns. The back of a bus seems to have more exaggerated "movement" when the bus turns or is traveling down roadways and there is often stronger odor of exhaust, fuel or in some cases, a toilet, in the rear of the bus.



• On a boat, go up on the deck and watch the motion of the horizon. On a ship, those in lower level cabins near the center of a ship generally experience less motion than passengers in higher or outer cabins.



• In an airplane, sit by the window and look outside. Choose a seat over the wings where the motion is minimized. The middle of an airplane over the wing is the calmest area of an airplane.



• Do not read while traveling if you are subject to motion sickness, and do not sit in a seat facing backward.



• Do not watch or talk to another traveler who is having motion sickness. Isolate yourself from others them since hearing others talk about motion sickness or seeing others becoming ill can sometimes make you feel ill yourself.



• Avoid strong odors (such as the smell of gasoline or diesel fuel), or avoiding strong food odors may also help prevent nausea. Any odors that do not agree with you (immediately before and during your travel) should be avoided. Open a vent or a window for a source of fresh air if possible. Pregnant women are often much more sensitive to strong odors.



• Watch your consumption of foods, drinks, and alcohol before and during travel. Avoid excessive alcohol and foods or liquids that "do not agree with you" or make you feel unusually full. Heavy, spicy, or fat-rich foods may worsen motion sickness in some people. You may wish to try having dry crackers or a carbonated beverage to settle your stomach in case your stomach is upset. Popular folk remedies such as soda crackers, ginger ale, ginger tea, or 7 Up or ginger products (such as chewing on pieces of candied ginger root available at health food stores) may be tried.





• The over-the-counter medication meclizine (Bonine, Antivert, Dramamine) can be a very effective preventive measure for short trips or for mild cases of motion sickness. Your health care provider also may choose to prescribe medications for longer trips or if you repeatedly develop severe motion sickness. See Medications below for various choices. Discuss your options with your health care provider.

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MEDICATIONS FOR MOTION SICKNESS

Antihistamine medications are commonly used in the prevention and treatment of motion sickness. These medicines seem to prevent and treat the nausea, vomiting, and dizziness caused by motion sickness by calming the stimulation of the inner ear. Examples of antihistamines used for this purpose include meclizine (Bonine, Antivert, Dramamine). Another class of medications (belladonna) used to prevent motion sickness is represented by the scopolamine skin patch (Transderm Scop). This medicated skin patch is applied behind the ear at least four hours in advance of the motion activity. The medication is slowly absorbed directly into the underlying skin.

When used specifically to prevent motion sickness, regardless of the type of medication, these medicines generally are most effective when administered well before the motion activity takes place.

ANTIHISTAMINES - INJECTION or ORAL

Generic Name: Antihistamine (Injection or Oral)

USES: This medication provides relief of symptoms of allergic reactions such as rash, hives, watery eyes, runny nose, itching eyes and sneezing. It may also be used to treat motion sickness relief of anxiety or tension, or sleeplessness.

HOW TO USE - INJECTION: This medication is usually injected into a large muscle.

HOW TO USE - ORAL: May be taken with food or milk if stomach upset occurs. Sustained-release or long acting tablets and capsules must be swallowed whole. Chewing or crushing the sustained-release/long acting tablets or capsules will destroy the long action and may increase side effects. For chewable tablets, chew thoroughly and swallow. Shake suspensions well before taking.

SIDE EFFECTS: May cause drowsiness, dizziness, headache, loss of appetite, stomach upset, vision changes, irritability and dry mouth and nose. These effects should subside as your body adjusts to the medication. If they persist or become bothersome, inform your health care provider. Notify your health care provider if you develop: breathing difficulties, heart pounding, irregular heartbeat, ringing in the ears, difficulty urinating. May cause dizziness especially when rising quickly from a seated or lying position. Change positions slowly and be careful on stairs. May cause drowsiness. Use caution engaging in activities requiring alertness. If you notice other effects not listed above, contact your health care provider or pharmacist.

PRECAUTIONS: Before using this drug, tell your health care provider your medical history, especially of: asthma or lung problems, glaucoma (narrow angle), stomach ulcers, difficulty in urinating due to an enlarged prostate gland, heart disease, heart disease, high blood pressure, seizures, an overactive thyroid gland. Change from a seated or lying position slowly to avoid dizziness. Limit the use of alcohol or other sedating type medications to avoid excessive drowsiness. A preservative (benzyl alcohol) which may be found in the injectable product or in the liquid used to mix this product (diluent) can infrequently cause serious problems (sometimes death), if given in large amounts (more than 100 mg/kg daily) to an infant during the first months of life (neonatal period). The risk is also greater with low birth weight infants. Symptoms include sudden gasping, low blood pressure, or a very slow heartbeat. Report these symptoms to the health care provider immediately should they occur. If possible, a preservative-free product should be used when treating neonates. Caution is advised when using this drug in the elderly because they may be more sensitive to the effects of the drug. Do not give long-acting oral antihistamines to a child younger than 12 years of age nor other dose forms of antihistamines to a child younger than 6 years of age without health care provider approval. This drug should be used only if clearly needed during pregnancy. Because this medication appears in breast milk, if you are breastfeeding consult your health care provider before breast-feeding. Do not take for several days before allergy testing. Test results can be affected.

DRUG INTERACTIONS: Tell your health care provider of all prescription and non-prescription medications you use, especially of: sleeping pills, sedatives, tranquilizers, muscle relaxants, medication for depression or seizures, narcotics (medication for pain), other medication for colds/hay fever/allergies. Because the oral medication may affect allergy testing, you may have to stop using this medication for several days before the tests are performed. Consult your health care provider about this. Do not take this drug if you have taken an MAO inhibitor (e.g., furazolidone, phenelzine, selegiline, tranylcypromine) within the last two weeks. Do not start or stop any medicine without health care provider or pharmacist approval.

OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly. Symptoms of injectable overdose in children may include hyperactivity, fever, flushed face, slurred speech, loss of coordination, or seizures. Symptoms of overdose in adults may include slow breathing, slow heartbeat, drowsiness, or unconsciousness. Symptoms of oral overdose in children may include abnormal eye movements, flushed face, dry mouth, change in amount of urine, fever, excitation, agitation, bizarre behavior, confusion, restlessness, irritability, delirium, twitching, tiredness, abnormal tongue movement, trembling extremities, slurred speech, or seizures. Symptoms of overdose in adults may include drowsiness, or unconsciousness, which may be followed by excitement or seizures.

NOTES: Do not share this product with others.

MISSED DOSE: If you miss a dose, use it as soon as remembered; do not use if it is almost time for the next dose, instead, skip the missed dose and resume your usual dosing schedule. Do not "double-up" the dose to catch up.

STORAGE: Store injectable medication at room temperature away from sunlight and moisture. Do not freeze. For oral medication, store at room temperature between 59-86°F (between 15-30°C) away from moisture and sunlight. Do not store in the bathroom. Do not freeze liquid forms of this medication.

MEDICAL ALERT: Your condition can cause complications in a medical emergency. For enrollment information call MedicAlert at 1-800-854-1166 (USA), or 1-800-668-1507 (Canada).

ATROPINE - ORAL

Generic Name: Atropine (Oral)
Brand Name(s): Sal-Tropine

USES: Atropine is used to treat a variety of stomach and intestinal tract disorders such as peptic ulcers, diarrhea, irritable bowel syndrome, diverticulitis, colitis, or pancreatitis. Atropine is also used to control bed-wetting and frequent urination, prevent motion sickness, treat alcohol withdrawal symptoms, Parkinson's disease, asthma and poisonings due to certain insecticides or plants.

HOW TO USE: Take this medication 30 minutes before meals. It is recommended to drink plenty of fluids while using this medication unless your doctor directs you otherwise. Take this medication as prescribed. Do not increase the dose or take it more frequently without consulting your health care provider.

SIDE EFFECTS: This medication may cause flushing of the face, problems sleeping, headache, blurred vision, drowsiness, increased sensitivity to light, constipation, dry mouth, reduced sweating or thirst. If these symptoms persist or worsen, notify your health care provider. Notify your health care provider if you develop: confusion, tremors, fast/irregular heartbeat, difficulty urinating. In the unlikely event you have an allergic reaction to this drug, seek immediate medical attention. Symptoms of an allergic reaction include: rash, itching, swelling, dizziness, trouble breathing. If you notice other effects not listed above, contact your health care provider or pharmacist.

PRECAUTIONS: Tell your health care provider your medical history, especially of: heart problems, glaucoma, stomach/abdominal/intestinal problems, prostate or urinary problems, contact lens wear, allergies (especially drug allergies). Because this medication can cause drowsiness, use caution when driving or performing tasks requiring alertness. Atropine reduces sweating which can lead to heat stroke in hot weather. Use caution engaging in strenuous activity during hot weather. Contact lens wearers may need to use appropriate lubricating solutions if this medication causes dry eyes. Elderly patients should use this medication with caution because they may be more sensitive to its effects. Children should use this medication with caution because they may be more sensitive to its effects. This medication should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your health care provider. Atropine may be excreted into breast milk. If you are breastfeeding, consult with your health care provider before using this medication.

DRUG INTERACTIONS: Tell your health care provider of all the medicines you may use (both prescription and non-prescription), especially of: antacids, digoxin, phenothiazines (e.g., chlopromazine), antihistamines (found in many cough/cold medicines), ketoconazole, potassium supplements, medications for Parkinson's disease, certain heart medicines (e.g., disopyramide, procainamide, quinidine), tricyclic antidepressants (e.g., amitriptyline). Do not start or stop any medicine without health care provider or pharmacist approval.

OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly. Symptoms of overdose may include: unusually dry mouth, excessive thirst, nausea, vomiting, difficulty breathing, blurred vision, dilated pupils, flushed/hot/dry skin, muscle weakness, unusual dizziness or drowsiness, restlessness, disorientation, seizures. seizures.

NOTES: Do not share this medication with others.

MISSED DOSE: If you miss a dose, take it as soon as remembered; do not take if it is almost time for the next dose, instead, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

STORAGE: Store at room temperature away from sunlight and moisture.

MEDICAL ALERT: Your condition can cause complications in a medical emergency. For enrollment information call MedicAlert at 1-800-854-1166 (USA), or 1-800-668-1507 (Canada).

BELLADONNA ALKALOIDS WITH BARBITURATES - ORAL

Generic Name: Belladonna Alkaloids with Barbiturates (Oral)

USES: This medication slows the activity of the digestive system, thereby reducing cramping and gastric motility. Barbiturates are used for their calming, sedative effects. Used to treat stomach and intestinal disorders, motion sickness premenstrual tension, bed-wetting and urinary frequency.

HOW TO USE: Take 30 minutes to one hour before meals, unless your health care provider tells you otherwise. May be taken with food or milk if stomach upset occurs. Do not take within one hour of an antacid or anti-diarrheal medication as effectiveness of this medication will be reduced. Take this drug as prescribed. Do not increase the dose or take it more often than instructed. Sustained-release tablets must be swallowed whole. Do not crush or chew them or the sustained activity will be destroyed and chance of side effects increased.

SIDE EFFECTS: May cause drowsiness. Use caution when performing tasks that require alertness. Other side effects include dry mouth, bloating, constipation, difficulty in urination, irregular pulse, confusion, tremors, restlessness, blurred vision, altered taste perception. Inform your health care provider if any of these effects continue or worsen. If this medication makes you constipated, increase your fiber intake by eating more fresh fruit and vegetables, salad, and whole grain breads. Exercise and drink plenty of water (unless your health care provider tells you not to). In the unlikely event you have an allergic reaction to this drug, seek medical attention immediately. Symptoms of an allergic reaction include: rash, itching, swelling, dizziness, trouble breathing. If you notice other effects not listed above, contact your health care provider or pharmacist.

PRECAUTIONS: If you ever had an unusual reaction to belladonna or to any barbiturate or if you are allergic to tartrazine (a yellow dye), tell your doctor before taking this medication. If you have any of the following health problems, inform your doctor before using this drug. This medication should not be used if you have: kidney disease, liver disease, glaucoma, heart problems, certain diseases of the urinary tract. Alcoholic beverages may add to the drowsiness caused by this drug. Avoid strenuous exercise especially in hot weather and avoid saunas while taking this medication. This drug reduces sweating which can lead to overheating. This combination product is not recommended for use during pregnancy. Consult your health care provider before using this drug. This drug is excreted into breast milk. The barbiturate in this drug has caused problems in nursing infants. If you are breastfeeding, consult your health care provider before using this medication.

DRUG INTERACTIONS: Many drugs can decrease the effects of this medication or increase its side effects. Tell your health care provider what prescription and non-prescription medications you are taking, especially drugs that cause drowsiness such as: cough-and-cold medicines, sleep medications, narcotic pain medications (e.g., codeine). This drug may interfere with the effectiveness of birth control pills. Discuss using other methods of birth control with your health care provider. Do not start or stop any medicine without health care provider or pharmacist approval.

OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly. Symptoms of overdose may include nausea/vomiting, blurred vision, unusual size of pupils, cold or hot dry and flushed skin, dry mouth, fast heartbeat, fever, headache, fast or slow and shallow breathing, change in amount of urine, drowsiness, blue skin, or unconsciousness.

NOTES: Do not share this product with others.

MISSED DOSE: If you miss a dose, take as soon as remembered; do not take if it is almost time for the next dose, instead, skip the missed dose and resume your usual dosing schedule. Do not "double-up" the dose to catch up.

STORAGE: Store at room temperature between 59-86°F (between 15-30°C) away from moisture and sunlight. Do not store in the bathroom. Do not freeze liquid forms of this medication.

MEDICAL ALERT: Your condition can cause complications in a medical emergency. For enrollment information call MedicAlert at 1-800-854-1166 (USA), or 1-800-668-1507 (Canada).

DIPHENHYDRAMINE - ORAL or INJECTION

Generic Name: Diphenhydramine
Brand Name(s): Benadryl (Oral or Injection), Genahist, Sominex, Uni-Hist

DRUG CLASS AND MECHANISM: Diphenhydramine is an antihistamine used for treating allergic reactions. Histamine is released by the body during several types of allergic reactions and - to a lesser extent - during some viral infections, such as the common cold. When histamine binds to its receptors on cells, it stimulates changes within the cells that lead to sneezing, itching, and increased mucus production. Antihistamines compete with histamine for cell receptors; however, when they bind to the receptors they do not stimulate the cells. In addition, they prevent histamine from binding and stimulating the cells. Diphenhydramine also blocks the action of acetylcholine (anticholinergic effect) and is used as a sedative because it causes drowsiness. The FDA originally approved diphenhydramine in 1946.

GENERIC AVAILABLE: Yes

PRESCRIPTION: No

PREPARATIONS: Capsules: 25 and 50 mg. Tablets: 12.5, 25, and 50 mg. Strips: 12.5 and 25 mg. Elixir, oral solution, liquid: 12.5 mg per teaspoon (5 mL). Suspension: 25 mg per 5 ml. Injection: 50 mg per ml.

PRESCRIBED FOR: Diphenhydramine is used for the relief of nasal and non-nasal symptoms of various allergic conditions such as seasonal allergic reactions such as rash, hives, watery eyes, runny nose, itchy eyes and sneezing. It is also used to alleviate cold symptoms and chronic urticaria (hives). Although antihistamines are the preferred class of drugs in allergic rhinitis, they only reduce symptoms by 40-60 percent. Diphenhydramine also is used for allergic reactions involving the eyes (allergic conjunctivitis), to prevent or treat active motion sickness, tension, sleeplessness (insomnia) or involuntary movements due to the side effects of certain psychiatric drugs (drug-induced Parkinsonism) and for mild cases of Parkinsonism. The last two uses (motion sickness and Parkinsonism) are based on the anticholinergic effects of diphenhydramine, and not its antihistamine effects.

DOSING: Diphenhydramine has its maximal effect about one hour after it is taken. When used to combat insomnia, it is prescribed at bedtime. Patients over the age of 60 years are especially sensitive to the sedating and anticholinergic effects of diphenhydramine, and the dose should be reduced. Doses vary depending on formulation. A common regimen for treating adult allergic reaction is 25-50 mg every 4-6 hours not to exceed 300 mg daily.

HOW TO USE - ORAL: May be taken with food or milk if stomach upset occurs. Follow health care provider's instructions. Do not take more than recommended.

HOW TO USE - INJECTION: This medication is injected into a vein or into a muscle. Be sure you learn the proper technique of injecting this drug and of proper disposal procedures. Follow health care provider's directions carefully. Do not use more often than prescribed.

SIDE EFFECTS: Diphenhydramine can commonly cause sedation (drowsiness), tiredness, sleepiness, dizziness, disturbed coordination, drying and thickening of oral (dry mouth) and other respiratory secretions (dry nose), and stomach distress. Diphenhydramine may also cause headache, low blood pressure, palpitations, increased heart rate, confusion, nervousness, irritability, vision changes such as blurred vision or double vision, tremor, loss of appetite, or nausea (upset stomach). These effects should subside as your body adjusts to the medication. If these effects persist or worsen, inform your health care provider. Notify your health care provider if you develop: breathing difficulties, pounding or irregular heartbeat, ringing in the ears, difficulty urinating. If you notice other effects not listed above, contact your health care provider or pharmacist. Diphenhydramine should be used with caution (if at all) in persons with narrow-angle glaucoma, prostatic hypertrophy (enlarged prostate gland), hyperthyroidism, cardiovascular disease, hypertension, and asthma.

PRECAUTIONS: Do not take for several days before allergy testing as test results can be affected. Tell your health care provider your medical history, especially of: asthma, glaucoma, ulcers, difficulty urinating (due to an enlarged prostate gland), heart disease, high blood pressure, seizures, an overactive thyroid gland. Change from a seated or lying position slowly to avoid dizziness. Use caution in performing activities requiring alertness. Limit alcohol intake or other sedating medications to avoid excessive drowsiness. Do not give regular tablets or oral liquid to a child younger than six years of age unless directed to do so by a health care provider. This drug should be used only if clearly needed during pregnancy. Discuss the risks and benefits with your health care provider. Because this medication appears in breast milk, if you are breastfeeding, consult your health care provider before using this medication.

DRUG INTERACTIONS: Tell your health care provider of all prescription and non-prescription medications you may use, especially of: sleeping pills, sedatives, tranquilizers, muscle relaxants, medication for depression, anti-seizure drugs, narcotic pain medication (e.g., codeine), other medications for colds/hay fever/allergies. Do not take if you have taken any MAO inhibitors (e.g., furazolidone, phenelzine, selegiline, tranylcypromine) within the last two weeks. Check the labels on all your medicines because they may also contain diphenhydramine. This includes diphenhydramine either taken by mouth or applied to the skin (e.g., anti-itch cream, ointment, or spray). Ask your pharmacist about the safe use of those products. Do not start or stop any medicine without health care provider or pharmacist approval.

Diphenhydramine adds to (exaggerates) the sedating effects of alcohol and other drugs than can cause sedation such as the benzodiazepine class of anti-anxiety drugs [for example, diazepam (Valium), lorazepam (Ativan), clonazepam (Klonopin), alprazolam (Xanax)], the narcotic class of pain medications and its derivatives [for example, oxycodone and acetaminophen (Percocet), and hydrocodone and acetaminophen (Vicodin), guaifenesin with hydromorphone (Dilaudid), Codeine, propoxyphene (Darvon)], the tricyclic class of antidepressants [for example, amitriptyline (Elavil), imipramine (Tofranil), desipramine (Norpramin)], and certain antihypertensive medications [for example, clonidine (Catapres), propranolol (Inderal)]. Diphenhydramine can also intensify the drying effects of other medications with anticholinergic properties [for example, dicyclomine (Bentyl), bethanechol (Urecholine), Probanthine].

PREGNANCY: Diphenhydramine has not been adequately evaluated in pregnant women. It should be used only if the benefit outweighs the potential but unknown risks.

NURSING MOTHERS: Diphenhydramine is secreted in breast milk. Because of the risk of stimulation and seizures in infants, especially newborns and premature infants, antihistamines should not be used by nursing mothers.

OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly. Symptoms of overdose may include drowsiness, dizziness, dry mouth, flushing, fever, weakness, tremor, muscle twitching, loss of consciousness, and seizures. In children, excitement may occur first followed by loss of coordination, drowsiness, loss of consciousness, and seizures.

NOTES: Do not share this product with others.

MISSED DOSE: If you miss a dose, take as soon as remembered; do not take if it is almost time for the next dose, instead, skip the missed dose and resume your usual dosing schedule. Do not "double-up" the dose to catch up.

STORAGE: Store Diphenhydramine at room temperature between 59-86°F (between 15-30°C) away from moisture and sunlight. Do not store in the bathroom. Do not freeze liquid forms of this medication. Protect injection form from freezing and light.

MEDICAL ALERT: Your condition can cause complications in a medical emergency. For enrollment information call MedicAlert at 1-800-854-1166 (USA), or 1-800-668-1507 (Canada).

HYOSCYAMINE - DISINTEGRATING ORAL TABLET

Generic Name: Hyoscyamine (Disintegrating Oral Tablet)
Brand Name(s): Nulev

USES: Hyoscyamine is used to treat a variety of stomach and intestinal tract disorders such as peptic ulcers, diarrhea, irritable bowel syndrome, diverticulitis, colitis, or pancreatitis. It is also used to control bed-wetting and frequent urination, prevent motion sickness, treat alcohol withdrawal symptoms, Parkinson's disease or poisonings due to certain insecticides and plants.

HOW TO USE: Place this medication on your tongue. It will rapidly dissolve, after which you swallow the drug, with or without water. Take this medication as prescribed. Do not increase the dose or take it more frequently without consulting your health care provider. Antacids interfere with the absorption of hyoscyamine. If you use antacids, take them one hour after taking hyoscyamine. Drink plenty of fluids while taking this medication unless your health care provider directs you otherwise.

SIDE EFFECTS: This medication may cause flushing of the face, problems sleeping, headache, blurred vision, drowsiness, increased sensitivity to light, constipation, dry mouth, reduced sweating or thirst. If these symptoms persist or become severe, inform your health care provider. Notify your health care provider promptly if you develop: confusion, tremor, fast/irregular heartbeat, difficulty urinating. In the unlikely event you have an allergic reaction to this drug, seek immediate medical attention. Symptoms of an allergic reaction include: rash, itching, swelling, dizziness, trouble breathing. If you notice other effects not listed above, contact your health care provider or pharmacist.

PRECAUTIONS: Tell your health care provider your medical history, especially of: heart problems, glaucoma, stomach/intestinal problems, prostate or urinary problems, phenylketonuria, any allergies. Because this medication may cause drowsiness, use caution when driving or performing tasks requiring alertness. This medication can reduce sweating, leading to heatstroke in hot weather. Avoid strenuous activity in hot weather. If you have phenylketonuria, be advised this medication contains phenylalanine. Contact lens wearers may need to use appropriate lubricating solutions if this medication causes dry eyes. Elderly patients should use this medication with caution as they may be more sensitive to its effects (e.g., confusion). Children should use this medication with caution because they may be more sensitive to its effects (e.g., reduced sweating). Hyoscyamine should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your health care provider. This drug may pass into breast milk. If you are breastfeeding, consult your health care provider before using this medication.

DRUG INTERACTIONS: Tell your health care provider of all the medicines you may use (both prescription and non-prescription), especially of: antacids, digoxin, psychiatric drugs (e.g., phenothiazines such as chlorpromazine, and butyrophenones such as haloperidol), ketoconazole or itraconazole, potassium supplements, drugs for Parkinson's disease, certain heart medicines (e.g., disopyramide, procainamide, quinidine), tricyclic antidepressants (e.g., amitriptyline), amantadine, MAO inhibitors (e.g., furazolidone, linezolid, moclobemide, phenelzine, procarbazine, selegiline), other anticholinergics (e.g., atropine). Also report use of drowsiness-causing drugs, including: sleep medications, tranquilizers, sedatives, narcotic pain relievers (e.g., codeine), muscle relaxants. Antihistamines are found in many non-prescription and prescription medications. Check your medication labels carefully, and ask your pharmacist about the safe use of these products. Do not start or stop any medicine without health care provider or pharmacist approval.

OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly. Symptoms of overdose may include unusually dry mouth; excessive thirst; nausea; vomiting; difficulty breathing; blurred vision; dilated pupils; flushed, hot, dry skin; muscle weakness; unusual dizziness or drowsiness; restlessness; disorientation; and seizures.

NOTES: Management of digestive disorders may often include lifestyle changes such as increased exercise, change in diet, stop smoking and reduction of stress. Discuss the benefits of lifestyle changes with your health care provider.

MISSED DOSE: If you miss a dose, take as soon as remembered; do not take if it is almost time for the next dose, instead, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

STORAGE: Store at room temperature away from sunlight and moisture.

MEDICAL ALERT: Your condition can cause complications in a medical emergency. For enrollment information call MedicAlert at 1-800-854-1166 (USA), or 1-800-668-1507 (Canada).

HYOSCYAMINE - ORAL

Generic Name: Hyoscyamine (oral) Brand Name(s): Anaspaz, Cystospaz, Donnamar, Levsin

USES: Hyoscyamine is used to treat a variety of stomach and intestinal tract disorders such as peptic ulcers, diarrhea, irritable bowel syndrome, diverticulitis, colitis, or pancreatitis. It is also used to control bed-wetting and frequent urination, prevent motion sickness, treat alcohol withdrawal symptoms, Parkinson's disease or poisonings due to certain insecticides and plants.

HOW TO USE: Take this medication 30 to 60 minutes before meals. Take this medication as prescribed. Do not increase the dose or take it more frequently without consulting your health care provider. Antacids interfere with the absorption of hyoscyamine. If you use antacids, take them one hour after taking hyoscyamine. Drink plenty of fluids while taking this medication unless your health care provider directs you otherwise.

SIDE EFFECTS: This medication may cause flushing of the face, problems sleeping, headache, blurred vision, drowsiness, increased sensitivity to light, constipation, dry mouth, reduced sweating or thirst. If these symptoms persist or become severe, inform your health care provider. Notify your health care provider if you develop: confusion, tremors, fast/irregular heartbeat, difficulty urinating. In the unlikely event you have an allergic reaction to this drug, seek immediate medical attention. Symptoms of an allergic reaction include: rash, itching, swelling, dizziness, trouble breathing. If you notice other effects not listed above, contact your health care provider or pharmacist.

PRECAUTIONS: Tell your health care provider your medical history, especially of: heart problems, glaucoma, stomach/abdominal/intestinal problems, prostate or urinary problems, contact lens wear, any allergies. Contact lens wearers may need to use appropriate lubricating solutions if this medication causes dry eyes. Because this medication may cause drowsiness, use caution when driving or performing tasks requiring alertness. This medication can reduce sweating, leading to heatstroke in hot weather. Avoid strenuous activity in hot weather. Elderly patients should use this medication with caution because they may be more sensitive to its effects. Children should use this medication with caution because they may be more sensitive to its effects. Hyoscyamine should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your health care provider. This drug may be excreted into breast milk. If you are breastfeeding, consult your health care provider before taking this medication.

DRUG INTERACTIONS: Tell your health care provider of all the medicines you may use (both prescription and non-prescription), especially of: antacids, digoxin, psychiatric drugs (e.g., phenothiazines such as chlorpromazine, and butyrophenones such as haloperidol), ketoconazole or itraconazole, potassium supplements, drugs for Parkinson's disease, certain heart medicines (e.g., disopyramide, procainamide, quinidine), tricyclic antidepressants (e.g., amitriptyline), amantadine, MAO inhibitors (e.g., furazolidone, linezolid, moclobemide, phenelzine, procarbazine, selegiline), other anticholinergics (e.g., atropine). Also report use of drowsiness-causing drugs, including: sleep medications, tranquilizers, sedatives, narcotic pain relievers (e.g., codeine), muscle relaxants. Antihistamines are found in many non-prescription and prescription medications. Check your medication labels carefully, and ask your pharmacist about the safe use of these products. Do not start or stop any medicine without health care provider or pharmacist approval.

OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly. Symptoms of overdose may include unusually dry mouth; excessive thirst; nausea; vomiting; difficulty breathing; blurred vision; dilated pupils; flushed, hot, dry skin; muscle weakness; unusual dizziness or drowsiness; restlessness; disorientation; and seizures.

NOTES: Management of digestive disorders may often include lifestyle changes such as increased exercise, change in diet, stop smoking and reduction of stress. Discuss the benefits of lifestyle changes with your health care provider.

MISSED DOSE: If you miss a dose, take as soon as remembered; do not take if it is almost time for the next dose, instead, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

STORAGE: Store at room temperature away from sunlight and moisture.

MEDICAL ALERT: Your condition can cause complications in a medical emergency. For enrollment information call MedicAlert at 1-800-854-1166 (USA), or 1-800-668-1507 (Canada).

MECLIZINE

Generic Name: Meclizine Brand Name(s): Antivert, Bonine

DRUG CLASS AND MECHANISM: Meclizine is classified as a histamine receptor blocker medication.

PRESCRIPTION: yes

GENERIC AVAILABLE: no

PREPARATIONS: Tablets: 12.5 mg (Antivert), 25 mg, 50 mg (Antivert).

STORAGE: Meclizine should be stored between 36-86°F.

PRESCRIBED FOR: It is used for the treatment of nausea, vomiting, and dizziness associated with motion sickness. Meclizine is also possibly effective in the treatment of vertigo (balance disorder) related to diseases of the body's balance (vestibular) system.

DOSING: In treating symptoms of motion sickness, meclizine should be taken initially one hour prior to travel. Bonine is available as a chewable tablet.

DRUG INTERACTIONS: Meclizine can cause drowsiness. Alcohol, sedatives, and tranquilizers can increase the drowsiness of meclizine and should be avoided while taking it and only after consulting the health care provider. Meclizine is not recommended for children under 12 years of age.

PREGNANCY: Usage in pregnancy should be discussed with the health care provider.

SIDE EFFECTS: Side effects include drowsiness. Meclizine can also cause dry mouth and, rarely, blurred vision.

MECLIZINE, CYCLIZINE - ORAL

Generic Name: Meclizine, Cyclizine (oral)
Brand Name(s): Antivert, Bonine, Dramamine II, Marezine

USES: This medication is used to prevent or treat nausea, vomiting and dizziness caused by motion sickness or middle ear infections.

HOW TO USE: For motion sickness, take the first dose 30 minutes before traveling. For other conditions, take exactly as directed by your health care provider. Chewable tablets must be chewed thoroughly before swallowing.

SIDE EFFECTS: May cause drowsiness, blurred vision, stomach upset, headache or dry mouth. These effects should subside as your body adjusts to the medication. If they persist or become bothersome, inform your health care provider. Since this medication may cause drowsiness, use caution engaging in activities requiring alertness. If you notice other effects not listed above, contact your health care provider or pharmacist.

PRECAUTIONS: Tell your health care provider your medical history, especially of: glaucoma, prostate problems, urinary problems, asthma, any allergies you have. Alcohol may intensify the drowsiness effect of this drug. Limit alcohol intake and use caution performing tasks that require alertness such as driving and operating machinery. Do not give meclizine to a child under 12 years of age without a health care provider's permission. Before using this medication, inform your health care provider if you are pregnant. It is not known if this medication is excreted into breast milk. If you are breastfeeding, consult your health care provider before using this medication.

DRUG INTERACTIONS: Tell your health care provider of all prescription and non-prescription drugs you may use, especially of drugs that have a drowsiness effect such as: medications for cough/colds and allergies, drugs used for sleep, anti-seizure medications, narcotic pain drugs (e.g., codeine), barbiturates (e.g., phenobarbital), tranquilizers. Do not start or stop any medicine without health care provider or pharmacist approval.

OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly. Symptoms of overdose may include unusual excitability, drowsiness, hallucinations, very slow or shallow breathing, and seizures.

NOTES: Do not share this medication with others.

MISSED DOSE: If you miss a dose, take as soon as remembered; do not take if it is almost time for the next dose, instead, skip the missed dose and resume your usual dosing schedule. Do not "double-up" the dose to catch up.

STORAGE: Store at room temperature away from sunlight and moisture.

PROMETHAZINE - ORAL Generic Name: Promethazine (Oral)
Brand Name(s): Phen-Tuss, Phenergan

USES: Promethazine is used to prevent nausea and vomiting. It is also used for sedation, allergy symptoms (runny nose, itchy eyes) and motion sickness (prevention and treatment). Use is not recommended in children less than 2 years old.

HOW TO USE: May be taken with food or milk to lessen stomach irritation. Do not take more medication than is prescribed. For motion sickness, medication should be taken 30-60 minutes before travel.

SIDE EFFECTS: Constipation, drowsiness, vision changes or dry mouth may occur. If any of these effects persist or worsen, notify your health care provider. Unlikely to occur but report promptly: restlessness, muscle stiffness, weakness, difficulty speaking, loss of balance, mask- like facial expression, trembling or shaking, dizziness, lip smacking or other uncontrollable movements, difficulty urinating, skin rash/discoloration. Very unlikely to occur but report promptly: persistent sore throat or fever, unusual bleeding or bruising, stomach pain, yellowing of eyes or skin, dark urine, hot dry skin, vomiting. This drug may infrequently cause a very serious (rarely fatal) nervous system disorder (neuroleptic malignant syndrome). If you notice any of the following unlikely but very serious side effects, seek immediate medical attention: severe muscle stiffness, mental/mood changes, fever, seizures, irregular/fast heartbeat, increased sweating. Males - in the unlikely event you have a painful, prolonged erection, stop using this drug and seek immediate medical attention or permanent problems could occur. In the unlikely event you have a serious allergic reaction to this drug, seek immediate medical attention. Symptoms of a serious allergic reaction include: rash, itching, swelling, severe dizziness, trouble breathing. If you notice other effects not listed above, contact your health care provider or pharmacist.

PRECAUTIONS: This medication should not be given to a patient who is in a coma. This medication should not be used if you have certain medical conditions. Before using this medicine, consult your health care provider or pharmacist if you have: certain lung/breathing problems (e.g., COPD, sleep apnea). Tell your health care provider your medical history, especially of: very high or very low blood pressure, liver or heart disease, Reye's syndrome, alcohol or drug dependencies, nervous system problems, blood or immune system disorders (e.g., bone marrow depression), seizures, glaucoma (narrow angle), urinary problems (e.g., enlarged prostate), stomach/bowel problems, allergies (especially drug allergies). This drug may make you dizzy or drowsy; use caution engaging in activities requiring alertness such as driving or using machinery. Use of alcohol can cause extreme drowsiness. Avoid alcohol use. This medication may increase sensitivity to sunlight. Avoid prolonged sun exposure and wear a sunscreen and protective clothing when you are exposed to the sun. This medication can reduce sweating making you more susceptible to heat stroke. Avoid strenuous work or exercise in hot weather. Caution is advised when using this drug in the elderly because they may be more sensitive to the effects of the drug, especially the drowsiness effect. Caution is advised when using this drug in children because they may be more sensitive to the effects of the drug, especially the slowed breathing effect. This medication should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your health care provider. Certain drugs closely related to promethazine (a phenothiazine) are excreted into breast milk and may have undesirable effects on a nursing infant. Therefore breast-feeding while using this medication is not recommended. If you are breastfeeding, consult your health care provider before using this medication.

DRUG INTERACTIONS: Inform your health care provider of all the medications you may use (both prescription and non-prescription), especially of: sparfloxacin, grepafloxacin, guanethidine, guanadrel, lithium, metrizamide, cabergoline, barbiturates, epinephrine, MAO inhibitors (e.g., furazolidone, isocarboxazid, linezolid, moclobemide, phenelzine, procarbazine, selegiline, tranylcypromine), drugs which are potentially toxic to the blood or immune systems (e.g., cancer chemotherapy). Tell your health care provider or pharmacist if you also take drugs that cause drowsiness such as: antihistamines that cause drowsiness (e.g., diphenhydramine), anti-anxiety drugs (e.g., diazepam), anti-seizure drugs (e.g., carbamazepine), medicine for sleep (e.g., sedatives), muscle relaxants, narcotic pain relievers (e.g., codeine), psychiatric medicines (e.g., phenothiazines such as chlorpromazine, or tricyclic anti-depressants such as amitriptyline), tranquilizers. Many cough-and-cold products contain ingredients that may add a drowsiness effect. Before you use cough-and-cold medications, ask your health care provider or pharmacist about the safe use of those products. Also report the use of drugs which might increase seizure risk (decrease seizure threshold) when combined with promethazine such as: isoniazid (INH), other phenothiazines (e.g., thioridazine), theophylline, or tricyclic antidepressants (e.g., amitriptyline) among others. Consult your health care provider or pharmacist for details. Promethazine can affect the results of certain lab tests, including certain pregnancy and blood sugar tests. Make sure laboratory personnel and your health care providers know you use this drug. Do not start or stop any medicine without health care provider or pharmacist approval.

OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly. Symptoms of overdose may include shortness of breath, trouble breathing, dry mouth, unusual drowsiness or restlessness, flushing, nightmares, loss of consciousness, and seizures.

NOTES: Do not share this medication with others.

MISSED DOSE: If you miss a dose, take it as soon as remembered; do not take if it is almost time for the next dose, instead, skip the missed dose and resume your usual dosing schedule. Do not "double-up" the dose to catch up.

STORAGE: Store at room temperature away from sunlight and moisture. Do not store in the bathroom. Keep all medicines away from children and pets.

SCOPLAMINE

Generic Name: Scopolamine
Brand Name(s): Transderm-Scop

Scopolamine is an oral, intravenous, ophthalmic or topical drug with many uses including the prevention of motion sickness. Transderm-Scop is scopolamine administered topically (through the skin or transdermal) via a special delivery system that gradually releases scopolamine onto the skin over a period of three days. The scopolamine is absorbed into the body through the skin. It is not clear how scopolamine prevents nausea and vomiting due to motion sickness. The vestibular part of the ear is very important for balance. When a person becomes disoriented due to motion, the vestibule sends a signal through nerves to the vomiting center in the brain, and vomiting occurs. Acetylcholine is a chemical that nerves use to transmit messages to each other. Scientists believe that scopolamine prevents communication between the nerves of the vestibule and the vomiting center in the brain by blocking the action of acetylcholine. Scopolamine also may work directly on the vomiting center. Scopolamine must be taken before the onset of motion sickness to be effective.

USES: This skin patch is used to prevent nausea, vomiting and dizziness caused by motion sickness.

HOW TO USE: Place one patch in a dry area behind the ear at least 4 hours before the effect is required. The patch will slowly release the medication into your system over a period of 3 days. If the patch becomes dislodged or another patch is needed, place the new patch on a clean, dry area behind the ear. Use only one patch at a time. Wash hands thoroughly with soap and water after handling a patch. If the medication comes in contact with the eyes, blurred vision and pupil dilation can occur.

SIDE EFFECTS: This drug may cause drowsiness, headache or dry mouth. These effects should subside as your body adjusts to the medication. If they persist or worsen, inform your health care provider. Dizziness, stomach upset and loss of balance have been reported in a few patients after the patches were removed. This occurred most often in persons using the patches for longer than 3 days. In the unlikely event you have an allergic reaction to this drug, seek immediate medical attention. Symptoms of an allergic reaction include: rash, itching, swelling, dizziness, trouble breathing. If you notice other effects not listed above, contact your health care provider or pharmacist.

PRECAUTIONS: Tell your health care provider your medical history, especially of: heart disease, glaucoma, ulcers, difficulty urinating or urinary tract disorders, high blood pressure, an overactive thyroid, any allergies (including allergies to adhesives). Caution is advised when performing tasks requiring alertness (e.g., driving) since this drug may cause drowsiness. Limit alcohol intake; it may intensify drug side effects. Children are very sensitive to the effects of this medication. Use of these patches is not recommended in children. This drug should be used only if clearly needed during pregnancy. Discuss the risks and benefits with your health care provider. It is not known if this medication appears in breast milk. If you are breastfeeding, consult your health care provider before using this medication.

DRUG INTERACTIONS: Tell your health care provider of all over-the-counter and prescription medication you may use, including medications for: depression, heartbeat irregularities, Parkinson's disease. Also report any drugs which may cause drowsiness such as: antihistamines (e.g., diphenhydramine and others found in many cough/cold products), narcotic pain relievers, sleep medicines, anti-anxiety drugs, anti-seizure drugs, tranquilizers/psychiatric medicines. Do not start or stop any medicine without health care provider or pharmacist approval.

OVERDOSE: If overdose is suspected, remove the patch. Contact your local poison control center or emergency room immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly. Symptoms of overdose may include disorientation, memory disturbances, dizziness, restlessness, hallucinations, and confusion. Remove patch immediately if these symptoms occur.

NOTES: Do not share this medication with others.

MISSED DOSE: Skin patches offer the convenience of continuous dosing. If you should forget to replace a patch at the scheduled time, replace it as soon as you remember. Do not "double-up" the dose to catch up.

STORAGE: Store at room temperature between 59-86°F (between 15-30°C) away from moisture and heat. Do not store in the bathroom.

MEDICAL ALERT: Your condition can cause complications in a medical emergency. For enrollment information call MedicAlert at 1-800-854-1166 (USA), or 1-800-668-1507 (Canada).

A NOTE ABOUT TRAVELING BY COMMERCIAL AIRLINES & CARRY-ON BAGGAGE

The imposition of stricter security measures for commercial airline passengers following the Aug. 10, 2006, arrests of individuals engaged in a terrorist plot to bomb U.S.-bound planes from Britain has left many travelers wondering how to manage their health conditions while traveling. The following tips may help those who are concerned about health issues when traveling by air:

• Remember that prescription medications are allowed in carry-on bags, with some restrictions. Prescriptions must be in their original pharmacy container labeled with the name of the passenger. Be sure that the name is the same as on your ticket. Do NOT combine your medications into one bottle; take each type of medication in its own labeled bottle. Place all medications in a plastic bag for ease during security screening.



• Non-prescription medications are also allowed, but remember to take these in their original containers, too. Take small packages containing the amount of medication you might reasonably expect to need while traveling-family-size bottles containing 500 tablets may be even considered suspicious.



• Liquids, gels, and aerosol preparations are allowed as long as these are in 3-ounce or smaller containers. Larger containers that are partially full are not permitted. All liquids, gels, and aerosols must be placed in a single, quart-size, zip-top, clear plastic bag. Each traveler can use only one plastic bag. These bags must be removed from carry-on baggage and placed in a bin or on the conveyor belt for x-ray screening. While these items may have a volume greater than 3 ounces, they must be kept separate from the liquids, gels, and aerosols in your quart-size and zip-top bag. You must declare you have the items to a security officer at the security checkpoint. They are subject to additional screening.



• If you have diabetes, you may bring your insulin on board. Inspection will be smoother if you remember to have a copy of your prescription with you. You are also allowed to take treatments for low blood sugar, including gels to treat low blood sugar. Again, any medically necessary products of more than 3 ounces must be kept separate and declared to the security officer at the time of passenger screening.



• Infant formula and breast milk are allowed in carry-on luggage if you are traveling with an infant. Canned, jarred, or processed baby food is permitted in your carry-on baggage. Liquids including water, juice, or liquid nutrition or gels for passengers with a disability or medical condition are permitted "in the absence of suspicious activity." You (or your child) will not be required to taste these items at the security checkpoint, but like all carry-on items, these must be screened.



• Inhalers to treat asthma or breathing problems are also allowed on board after they have been screened at the security checkpoint.



• Items used to augment the body for medical or cosmetic reasons, such as mastectomy products, prosthetic breasts, bras or shells containing gels, saline solution, or other liquids, are also allowed.



• Contact your airline if you need special assistance with transportation or other medical needs prior to boarding. Airlines are still responsible for offering assistance to passengers with extra needs. The TSA security officer's job is limited to assistance with security screening. Ask the airline for a gate pass so that your companion or caretaker can accompany you to the gate if necessary.



• If you need special help during the security screening, speak up. Explain the situation to the security officer, including telling the officer your level of ability (for example, if you are not able to walk through the metal detector or unable to hold your arms upright). Security officers can examine motility aids such as wheelchairs while you are still seated in them if necessary, and they can help you with shoe removal and putting your shoes back on.



• Finally, remain patient and calm. The enhanced security requirements are stressful for everyone, and keeping your frustration in check can make everyone's experience easier. Arrive early at the airport and always allow yourself extra time for going through security

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CONSIDERATIONS

There are numerous over-the counter products available that may help to prevent motion sickness, including cyclizine (Marezine), dimenhydrinate (Dramamine), and meclizine (Antivert, Bonine). These drugs are not always effective, however, and can cause side effects, especially drowsiness (see Medications above). Motion sickness medication should not be taken with alcohol, sleep aids, or any type of tranquilizers. It is important to use extreme caution and carefully follow the dosage instructions for children.

If motion sickness is debilitating, and herbal, homeopathic, and over-the-counter medications do not bring relief, a health care provider can prescribe scopolamine (which is a component of the herb Belladonna) to be applied in a patch (Transderm-Scop) that delivers the drug through the skin for up to 3 days. Possible side effects of scopolamine include dry mouth, drowsiness, blurred vision, and a dilated pupil on the side the patch is worn. This drug should not be used by anyone with glaucoma, as it raises pressure within the eye. If you are pregnant or nursing, talk to your health care provider before using scopolamine. It is not recommended for use by children.

Symptoms of nausea may indicate that the liver needs attention. Gallbladder disease can also result in bouts of nausea and vomiting. Consult your health care provider if you have or suspect liver or gallbladder disease.

A homeopathic liver remedy may help reduce nausea.

Chewable papaya tablets can be helpful.

To a certain extent, motion sickness is psychological. In many cases it can be prevented if you consciously tell yourself that you will not get sick. If you travel frequently and are prone to motions sickness, you may benefit from psychotherapy or counseling.

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HERBAL & HOLISTIC RECOMMENDATIONS

Natural remedies have been used with great success for motion sickness. Prevention is the key since motion sickness is easier to prevent than it is to cure. Once excessive salivation and nausea set in, it is often too late to do anything but wait for the trip to be over so recovery can begin.

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HERBS

Black Horehound (Ballota Nigra) can reduce nausea and should not be confused with White Horehound. Black horehound has antispasmodic and anti-emetic properties. It is used as an emmenagogue, astringent and vermifuge substance. Black Horehound is an excellent remedy for the settling of nausea and vomiting. Black horehound is traditionally used as a tea or tincture. Approximately 2 teaspoons of the leaves are added to 1 cup hot water and allowed to steep for 10 to 15 minutes.6 One cup is drunk three times per day. If a tincture is preferred, 1 to 2 ml may be taken three times per day. Black horehound is rarely used alone, and is frequently combined with meadowsweet, chamomile, or ginger for relief of nausea. There are no reports of adverse effects from use of black horehound when taken in the amounts listed above. Black horehound was traditionally used to treat nausea during pregnancy, though no scientific evaluation of the safety or efficacy of this practice has been conducted. Some sources report that black horehound could induce miscarriage when taken in large amounts. Consult with a practitioner who is trained in botanical medicine before using horehound during pregnancy. There were no well-known drug interactions with black horehound.

MotherBloom: Black Horehound (Ballota Nigra) Tincture

Butcher's Broom, Kudzu, and Motherwort help to relieve vertigo.

Ginger (Zingiber officinale) has been used for stomach upset, motion sickness and nausea by suppressing nausea. It is an excellent treatment and preventive for nausea and upset stomach. Ginger is one of the more popular natural remedies for motion sickness. It has been used for centuries in cooking and medicinally. The Food and Drug Administration classifies ginger as "generally recognized as safe". Studies conducted so far suggest that it may help reduce motion sickness, but it does not appear to be help if the nausea is severe. Studies have shown that it may be more effective than dimehydrinate (Dramamine) without the side effects. For example, one study involving 1,489 people on a ship compared ginger to medications and found that ginger was as effective as the medications for motion sickness. A Swedish study involving 79 naval cadets found that one gram of ginger could reduce vomiting and cold sweats. There was no significant reduction in nausea or vertigo. Two small studies, including one funded by NASA, found that ginger was not more effective than placebo at reducing simulated motion sickness. Larger, well-designed studies are needed before we can conclude that ginger is effective for motion sickness. Take 2 ginger capsules (approximately 1,000 mg) every 3-4 hours, starting one hour before the beginning of the trip and while traveling. Ginger tea can be prepared and sipped while traveling. Ginger can be found in health food stores and Asian markets as candied pieces for chewing. If you have problems with stomach upset or heartburn, discontinue using ginger. If you have allergies to ginger, heart problems, gallbladder or gallstone problems, consult your health care provider before using ginger. Ginger products may contain aristolochic acid, which can cause serious kidney/urinary system disease (e.g., renal fibrosis or urinary tract cancer). Symptoms include an unusual change in the amount of urine, or blood in the urine. Consult your pharmacist for more details regarding the contents of this ginger product. Liquid preparations of this product may contain sugar and/or alcohol. Caution is advised if you have diabetes, alcohol dependence or liver disease. Ginger should not be used within two weeks before or after surgery or by people taking "blood-thinning" medication such as warfarin (Coumadin) because it may interfere with blood clotting and prolong bleeding time. In addition, some sources say there is not enough information about the safety of ginger in pregnant women, saying that ginger inhibits an enzyme called thromboxane synthetase and may possibly influence sex steroid differentiation in the fetal brain. Studies have not confirmed this.

Peppermint tea soothes and calms the stomach. A drop of Peppermint Oil on the tongue provides excellent relief from nausea and motion sickness. Peppermint can also be taken in lozenge form.

FLOWER REMEDY & ESSENCE THERAPY

The flower remedy Scleranthus can help motion sickness. Using the Bach Flower Remedies, place two to four drops under the tongue and holding them in your mouth for a moment before swallowing. You can apply the remedy topically, putting it on the temples and inside the belly button. Flower remedies are available in some health food stores, online and through mail order. For information on preparing and administering flower remedies, see:

MoonDragon's Alternative Health Therapy: Bach Flower Remedies

Herbal Remedies: Scleranthus Bach Flower Remedies Tincture, Bach Flower Essence, 20 ml

HOMEOPATHY

If you feel like your surroundings are spinning, feel nauseated from motion in a car or boat and feel better when you close your eyes, try a 6C or 12C dose of Cocculus. Taking Cocculus 30 to 60 minutes prior to your trip may also be a good preventive measure if it has relieved your motion sickness in the past.

Another option for motion sickness is a 30C dose of Tabacum. Tabacum is recommended if you feel better in the open air with your eyes closed with nausea and a sensation of dizziness associated with motion.

Herbal Remedies: Hyland's Motion Sickness, 50 Quick Dissolving Tabacum 6X & Cocculus Indicus 30X HPUS Tablets

If you do not know which remedy to use (Cocculus or Tabacum) and what is best for you, carry both with you on your trip and take them one at a time. Try one, and if it works, great. If it does not, then you have the option of trying the next one. You will know within 30 minutes of taking it if one of these remedies is going to work. Cocculus and Tabacum are available in many health food stores and online or from a homeopathic practitioner.



JUICE THERAPY

Make a juice blend about an hour before a trip using ginger as the active ingredient. To prepare, juice a slice of fresh ginger (about 1/4 inch thick) with an apple and four carrots. See recipes and juicing information below at these links:

MoonDragon's Nutritional Therapy: Juicing

MoonDragon's Nutritional Therapy: Ginger-Berry Fizz

MoonDragon's Nutritional Therapy: Ginger Fizz

MoonDragon's Nutritional Therapy: Ginger Hopper

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ACUPRESSURE

According to traditional Chinese medicine, firmly pressing on an acupuncture points called "pericardium 5 and 6" (P5 and P6) may relieve nausea and motion sickness. To find P5, place your right thumb on the inside of your left forearm, three finger-widths from the center of your wrist crease. Breathing deeply, apply firm pressure with your thumb for one minute. Then move your thumb about half of a finger-width closer to the wrist crease to point P6. The P6 point is located on the inside of the forearm, about two inches above the crease of the wrist. Apply pressure for one more minute, then repeat the procedure on your right forearm. A person can press on the point using the index finger of the opposite hand. Alternatively, acupressure wrist bands, often marketed as "sea bands", stimulate the point. The bands are worn on the forearm. They have a plastic button or bead that puts pressure on the P6 point. The person wearing the band can also press on the bead for additional stimulation. Acupressure bands cost less than $10 for a pair and can be found online or in some health food stores and online.



REFLEXOLOGY

To help prevent motion sickness, or to help control it once it has started, work the diaphragm, pituitary gland, ear, neck and spine reflexes on your hands or feet.

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RECOMMENDATIONS

When traveling, take whole-grain crackers with you on trips. Olives can help ward off nausea because they have the effect of decreasing salivation.

Try sipping green or ginger tea during long trips. Sucking on a fresh lemon may also calm the stomach.

Pay special attention to your diet. If a certain food or dish disagrees with you at home, it will most certainly disagree with you on the road.

Do not eat spicy, salty, sugary, heavy, or fatty foods, especially fried foods, before or during travel. Also avoid dairy products and processed and junk foods. These can contribute to nausea or cause digestive imbalances.

Avoid large meals when traveling. Instead, eat smaller, more frequent meals so that your stomach is never empty.

Avoid alcohol. Alcohol disrupts the delicate operations that occur in the inner ear. If you are prone to motion sickness, alcohol consumption will only aggravate the problem by further disrupting communication between the eyes, the inner ear, and the brain.

Avoid odors and aromas that can bring about nausea. Aside from the obvious things such as smoke and engine exhaust, certain food odors can make you ill, as can pain fumes, nail polish, or animal waste. Even otherwise pleasant smells, such as those from perfume or aftershave, can cause a problem if you are prone to motion sickness.

Sit still and breathe deeply. Your brain is already thoroughly confused without extra motion on your part. Especially try to keep your head still. Rest in a reclined position in an area where there is the least amount of motion (in the center of the ship or in the wing area of an airplane. Focus your eyes on a distant object and try not to allow your eyes to drift to either side. Or close your eyes and take deep breaths. If possible, lie down in a dark place with a cool damp cloth over your eyes.

Stay cool, if possible. Fresh air can assist in battling motion sickness. If in a car, roll down a window. If on a ship, standing on deck and taking in the sea breeze may help. In an airplane, open the overhead vent.

When you begin to feel sick, rub or press on your wrist about 3 fingers width down from the line that separates the hand from the arm. Massaging this acupressure point often stops motion sickness (see Acupressure above).

Do not read while traveling. Limit or eliminate visual input. This will cut down on the conflicting information assaulting your brain. Traveling at night helps many people, simply because visual acuity is diminished, so that they do not perceive motion to the same degree as during the day.

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NUTRITIONAL SUPPLEMENTS

Unless otherwise specified, the dosages recommended here are for adults. For a child between the ages of 12 and 17 years, reduce the dose to 3/4 the recommended amount. For a child between the ages of 6 and 12, use 1/2 the recommended dose, and for a child under the age of 6, use 1/4 the recommended amount.

NUTRIENTS
Supplement	Suggested Dosage	Comments
Very Important
Charcoal Tablets	5 tablets 1 hour before travel. Take separately from other medications and supplements.	A detoxifier. Activated Charcoal Supplement, Nature's Way, 260 mg, 100 Caps
Magnesium	500 mg daily 1 hour before trip.	Acts as a nerve tonic. Magnesium Ionic Mineral Supplement, Fully Absorbable, 350 +/- ppm, 16 fl. oz., Natural Calm Magnesium Supplement, Peter Gillham's Natural Vitality, 8 oz., Mama Calm, Powder Magnesium Supplement, Peter Gillham's Natural Vitality, 8 oz., Magnesium Citrate, 100% Pure, Vegetarian, NOW Foods, 200 mg, 250 Tabs, Magnesium Ascorbate Powder, NOW Foods, 100% Pure, 8 oz.
Vitamin B-6 (Pyridoxine)	100 mg daily 1 hour before trip, then 100 mg 2 hours later.	Helps relieve nausea. Vitamin B-6 (Pyridoxine), 100 mg, 100 Caps

MOTION SICKNESS SUPPLEMENTS

Information, supplements and products for motion sickness, feeling of nausea and vomiting that occurs when traveling in a car, airplane, boat, train or amusement park rides (especially roller coasters).

Buchu Herb, Urinary / Kidney Herb, African Red Tea Imports, 2 fl. oz. Buchu herb has traditionally been claimed to treat a wide variety of disorders, some of which include stomach complaints and urinary tract infections.

Crystallized Ginger Slices, NOW Foods, 12 oz. NOW Foods crystallized Ginger Slices are prepared from fresh, natural ginger roots / rhizomes and excellent for use in baking as well as candy making.

Ginger Honey Crystals, 10 Packets Per Box Ginger Honey Crystals can help to relieve motion sickness, aids digestion and temporary nausea.

Ginger Root, Nature's Way, 550 mg, 180 Caps Ginger root is especially useful for bowel disorders including indigestion, morning sickness, motion sickness and nausea.

Ginger Root (Zingiber Officinale) Powder, 4 oz. Bulk Ginger is used medically to help expel gas from the intestines and treat nausea from morning sickness, upset stomach, seasickness, and motion sickness. It is also used to help reduce fevers and lessen the symptoms of colds. Ginger's ability to prevent vomiting has been verified by clinical trial, and it has been shown to stimulate the intestines and promote production of saliva, digestive juices, and bile. It also tends to boost the pumping action of the heart.

Ginger Root Tincture, 100% Organic, 2 fl. oz. Ginger root has also been recommended as a treatment for atherosclerosis, migraine headaches, rheumatoid arthritis, high cholesterol, burns, ulcers, depression, impotence, and liver toxicity.

Ginger Tea, 20 Tea Bags Caffeine Free Ginger Tea is used in Chinese medicine to remove toxins, warm the stomach, maintain good health, especially in changing weather conditions, and to prevent sea sickness.

Ginger Tea, Yogi Tea, Organic Digestive Aide, 16 Tea Bags This 100% Organic Ginger tea by Yogi Tea has something to offer to anyone who wants to get or stay healthy.

Hyland's Motion Sickness, 50 Quick Dissolving Tabs Hyland's Motion Sickness is a traditional homeopathic formula for the relief of symptoms of nausea and dizziness associated with or aggravated by motion.

Motion Mate Formula With Ginger (Natural Motion Sickness Remedy), Nature's Way, 100 Caps Motion Mate, a natural motion sickness remedy, formula is based on clinical studies that show ginger root is more effective against motion sickness than dimenhydrenate, but exhibits none of the negative side effects.

Motion Sickness For Dogs, Wellness Oil, Nature's Inventory, 2 fl. oz. Even animals are prone to motion sickness. This oil will help both you and your best friend enjoy a car ride.

Natural Pet Calmer, Happy Traveler, Pet Supplement, 500 mg, 30 Caps Ark Naturals, A safe all natural pet supplement, herbal calming formula for stressed, nervous, or anxious pets.

Nausea / Morning & Motion Sickness Tincture, 2 fl. oz. The Nausea / Morning & Motion Sickness Tincture is for upset stomach, nausea, and morning sickness; helps to soothe and calm the stomach.

Nausea Wellness Oil, 2 fl. oz. This Wellness Oil is designed to relieve general nausea as well as morning sickness, motion sickness.

Orange Ginger Mint Tea, Republic of Tea, 36 Tea Bags After a meal, orange ginger mint tea is spicy and soothing to the digestive system. Mint tea has the power to calm a stormy stomach with sweetness.

Pepogest Peppermint Oil, Enteric Coated, Nature's Way, 0.2 ml, 60 Softgels Pepogest peppermint oil is a targeted release peppermint oil supplement that provides natural gastrointestinal comfort. Pepogest peppermint oil is a targeted release peppermint oil supplement that provides natural gastrointestinal comfort.

Peppermint Leaves, Nature's Way, 400 mg, 100 Caps Nature's Way Peppermint leaves are a carefully screened, pure encapsulated powder form of this very well-known member of the mint family. Peppermint leaves calm the stomach, intestinal tract, and the nervous system.

Peppermint Stomach Soother Tea, Yogi Tea, Caffeine Free, Certified Organic, 16 Tea Bags Organic Peppermint tea from Yogi Tea is the perfect way to lift your spirits and quiet your stomach; with a fresh flavor and aroma you'll want to enjoy everyday.

Peppermint Tea With Black Cumin Seed, 20 Tea Bags A unique new way to enjoy the nutritional benefits of Black Cumin Seed in refreshing herbal Peppermint tea.

Scleranthus Bach Flower Remedies Tincture, Bach Flower Essence, 20 ml The Bach Flower Remedy for people who find it difficult to make up their minds which option of two or more they ought to choose.

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HerbalRemedies: Motion Sickness Information

HerbalRemedies: Motion Sickness Supplements & Products

NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...

Most cases of motion sickness are mild and self-treatable. However, very severe cases and those that become progressively worse deserve the attention and care of a health care provider with special skill in diseases of the ear, balance (equilibrium), and the nervous system.

You have any unexpected or unusual symptoms. Some people may have sensitivity, allergies, or other health conditions which would prevent them from using certain herbs or other treatments.

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