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Has anyone used Piriton (or similar) to treat travel sickness?

mintymellons · 10/08/2011 09:19

We're travelling down to Somerset from York on Friday (5 hour journey). We plan to travel in the wee small hours so our two DDs can sleep most of the way, but DD2 (17 months) gets travel sickness and I want to take as many precautions as I can. She wears the wristbands and we have Nelson's Travella tablets. With her being so young, regular travel sickness meds are not an option. I heard that Piriton can be used as a travel sickness treatment. Has anyone used this and does it work? Also, any other tips gratefully received! TIA

has worked well for us in the past. Not sure if its just that it sends them to sleep or something more clinical!

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Antihistamines to prevent and treat motion sickness

What is the aim of this review?

Motion sickness, also commonly known as sea sickness or car sickness, is a set of symptoms - usually nausea and vomiting. These symptoms are caused by passive body movement - where your body is moving without you consciously making it move - in response to actual motion (for example, driving in a car or being in a boat), or the illusion of motion when exposed to virtual movement (for example, virtual reality simulations) and moving visual environments (such as looking out of the window of a moving train). Antihistamines are a type of drug that have commonly been given to people to either treat or prevent motion sickness. In this study, we wanted to find out if these drugs actually work for this purpose.

Key message

We found that antihistamines probably do reduce a person's risk of getting motion sickness symptoms under naturally occurring conditions of motion (like a ship or a plane) when compared to placebo (dummy treatment), in adults who are prone to getting motion sickness. We also found that when compared to placebo, antihistamines are more likely to make a person drowsy. We did not find any studies that looked at whether or not antihistamines are effective at treating motion sickness once it has already started and there is very little information on their effect in children under the age of 18. For all the other findings that were investigated, there is uncertainty about the true effects of antihistamines compared to other drugs and non-drugs, or other side effects and effects on body functions (like heart rate or stomach movements).

What was studied in the review?

We looked at studies where people who are known to get motion sickness are given treatment with either an antihistamine or with a placebo (dummy treatment). We also looked at those that have been given an antihistamines compared with other medicines or other types of non-drug therapy.

What are the main results of the review?

Antihistamines versus placebo

The results show that antihistamines are probably more effective than placebo at preventing motion sickness symptoms under natural conditions.

There is uncertainty about whether or not antihistamines are effective at preventing motion sickness, or if they have an effect on gastric tachyarrhythmia (the way the inside of your stomach moves), under experimental conditions (in a laboratory setting) when compared to placebo.

Antihistamines may be more likely to cause sedation (drowsiness) when compared to placebo. There is uncertainty about whether antihistamines cause blurred vision (not being able to see clearly) or impaired cognition (not being able to think clearly) when compared to placebo.

Antihistamines versus scopolamine

There is uncertainty about the effectiveness of antihistamines in the prevention of motion sickness or their ability to make one drowsy when compared to scopolamine under natural conditions.

Antihistamines versus antiemetics

There is uncertainty about the effectiveness of antihistamines in the prevention of motion sickness under natural conditions or laboratory conditions, their effect on stomach movements or their ability to make one drowsy when compared to antiemetics.

Antihistamines versus acupuncture

There is uncertainty about the effectiveness of antihistamines in preventing motion sickness compared to acupuncture under laboratory conditions.

How up‐to‐date is this review?

This review is up-to-date to 7 December 2021.

There is probably a reduction in the risk of developing motion sickness symptoms under naturally occurring conditions of motion when using first-generation antihistamines, in motion sickness-susceptible adults, compared to placebo. Antihistamines may be more likely to cause sedation when compared to placebo. No studies evaluated the treatment of existing motion sickness, and there are few data on the effect of antihistamines in children. The evidence for all other outcomes and comparisons (versus scopolamine, antiemetics and acupuncture) was of low or very low certainty and we are therefore uncertain about these effects of antihistamines.

Motion sickness is a syndrome that occurs as a result of passive body movement in response to actual motion, or the illusion of motion when exposed to virtual and moving visual environments. The most common symptoms are nausea and vomiting. Antihistamines have been used in the management of motion sickness for decades, however studies have shown conflicting results regarding their efficacy.

To assess the effectiveness of antihistamines in the prevention and treatment of motion sickness in adults and children.

The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials; Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 7 December 2021.

Randomised controlled trials (RCTs) in susceptible adults and children in whom motion sickness was induced under natural conditions such as air, sea and land transportation. We also included studies in which motion sickness was induced under experimental conditions (analysed separately). Antihistamines were included regardless of class, route or dosage and compared to no treatment, placebo or any other pharmacological or non-pharmacological interventions.

We used standard Cochrane methods. Our primary outcomes were 1) the proportion of susceptible participants who did not experience any motion sickness symptoms; 2) the proportion of susceptible participants who experienced a reduction or resolution of existing symptoms. Secondary outcomes were 1) physiological measures (heart rate, core temperature and gastric tachyarrhythmia (electrogastrography)) and 2) adverse effects (sedation, impaired cognition, blurred vision). We used GRADE to assess the certainty of the evidence for each outcome.

We included nine RCTs (658 participants). Studies were conducted across seven countries, with an overall age range of 16 to 55 years. Motion sickness was induced naturally in six studies and experimentally in four studies (rotating chair). All the naturally induced studies only evaluated first-generation antihistamines (cinnarizine and dimenhydrinate). Risk of bias across the studies varied, with mostly low risk for random sequence generation and allocation concealment, and mostly high risk for selective reporting. Only the experimentally induced studies measured physiological parameters and only the naturally induced studies evaluated adverse effects. There were no studies that clearly assessed the paediatric population.

Antihistamines versus placebo or no treatment

Antihistamines are probably more effective than placebo at preventing motion sickness symptoms under natural conditions (symptoms prevented: 25% placebo; 40% antihistamines) (risk ratio (RR) 1.81, 95% confidence interval (CI) 1.23 to 2.66; 3 studies; 240 participants) (moderate-certainty). The evidence is very uncertain about the effect of antihistamines on preventing motion sickness under experimental conditions (standardised mean difference (SMD) 0.32, 95% CI -0.18 to 0.83; 2 studies; 62 participants) (very low-certainty). No studies reported results on the resolution of existing motion sickness symptoms.

Antihistamines may result in little or no difference in gastric tachyarrhythmia under experimental conditions (mean difference (MD) -2.2, 95% CI -11.71 to 7.31; 1 study; 42 participants) (low-certainty). No studies reported results for any other physiological measures. When compared to placebo, antihistamines may be more likely to cause sedation (sedation: 44% placebo; 66% antihistamines) (RR 1.51, 95% CI 1.12 to 2.02; 2 studies; 190 participants) (low-certainty); they may result in little or no difference in blurred vision (blurred vision: 12.5% placebo; 14% antihistamines) (RR 1.14, 95% CI 0.53 to 2.48; 2 studies; 190 participants) (low-certainty); and they may result in little or no difference in terms of impaired cognition (impaired cognition: 33% placebo; 29% antihistamines) (RR 0.89, 95% CI 0.58 to 1.38; 2 studies; 190 participants) (low-certainty).

The evidence is very uncertain about the effect of antihistamines on preventing motion sickness under natural conditions when compared to scopolamine (symptoms prevented: 81% scopolamine; 71% antihistamines) (RR 0.89, 95% CI 0.68 to 1.16; 2 studies; 71 participants) (very low-certainty). No studies were performed under experimental conditions. No studies reported results on the resolution of existing motion sickness symptoms.

The evidence is very uncertain about the effect of antihistamines on heart rate under natural conditions (narrative report, 1 study; 20 participants; "No difference in pulse frequency"; very low-certainty). No studies reported results for any other physiological measures. When compared to scopolamine, the evidence is very uncertain about the effect of antihistamines on sedation (sedation: 21% scopolamine; 30% antihistamines) (RR 0.82, 95% CI 0.07 to 9.25; 2 studies; 90 participants) (very low-certainty) and on blurred vision (narrative report: not a significant difference; 1 study; 51 participants; very low-certainty). No studies evaluated impaired cognition.

Antihistamines may result in little or no difference in the prevention of motion sickness under experimental conditions (MD -0.20, 95% CI -10.91 to 10.51; 1 study; 42 participants) (low-certainty). The evidence is of low certainty due to imprecision as the sample size is small and the confidence interval crosses the line of no effect. No studies assessed the effects of antihistamines versus antiemetics under natural conditions. No studies reported results on the resolution of existing motion sickness symptoms.

Antihistamines may result in little or no difference in gastric tachyarrhythmia (MD 4.56, 95% CI -3.49 to 12.61; 1 study; 42 participants) (low-certainty). No studies reported results for any other physiological measures. No studies evaluated sedation, impaired cognition or blurred vision.

One study reported physiological data for this outcome, evaluating gastric tachyarrhythmia specifically. Antihistamines may result in little or no difference in gastric tachyarrhythmia (MD 4.56, 95% CI -3.49 to 12.61; 1 study; 42 participants; low-certainty evidence). This evidence is of low certainty due to imprecision as the sample size is small and the confidence interval crosses the line of no effect.

The evidence is very uncertain about the effects of antihistamines on the prevention of motion sickness under experimental conditions when compared to acupuncture (RR 1.32, 95% CI 1.12 to 1.57; 1 study; 100 participants) (very low-certainty). This study did not assess the prevention of motion sickness under natural conditions, nor the resolution of existing motion sickness symptoms. There was no study performed under natural conditions.

Physiological measures and adverse effects were not reported.

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Antihistamines for motion sickness

Nadine karrim.

University of Kwazulu Natal, Otorhinolaryngology and Head and Neck Surgery, DurbanSouth Africa,

Nombulelo Magula

Nelson R Mandela School of Medicine, DurbanSouth Africa,

Yougan Saman

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:

To assess the effectiveness of antihistamines in the prevention and treatment of motion sickness in adults and children.

Description of the condition

Motion sickness is a syndrome that occurs as a result of passive body movement in response to actual motion, or the illusion of motion when exposed to virtual and moving visual environments. It generally occurs as a physiological response in a healthy person with an intact vestibular system; however, the presentation may be modulated by various pathologies ( Bertolini 2016 ; Murdin 2015 ).

Presentation

The presentation can include nausea, vomiting, loss of appetite, gastric awareness, increased sensitivity to odours, headaches (including migraines), dizziness, sweating, pallor, sensations of bodily warmth, increased salivation, bradycardia, arterial hypotension, general malaise, repetitive yawning and sopite syndrome ( Bertolini 2016 ; Golding 2015 ). Space motion sickness differs from general motion sickness and is characterised by sudden projectile vomiting within minutes of weightlessness ( Thornton 2013 ). Symptoms produced by motion sickness may be severe enough to have a negative impact on cognition and performance ( Matsangas 2014 ).

Epidemiology

Historically, motion sickness was first described in seafarers ( Hippocrates ). A recent study undertaken on expedition ships to Antarctica has shown that motion sickness was the most common reason for consultation, with 150 out of a total of 680 physician consultations for prophylaxis followed by an additional 142 visits (27%, 4.2 per 1000 person‐days) for treatment ( Schutz 2014 ).

Car sickness can affect most people with varying degrees of severity, under the right circumstances ( Wada 2015 ), and is worse in passengers than drivers ( Dong 2011 ). In one study it occurred in 25.9% of experienced rally co‐drivers, while reading and while seated as rear‐seat passengers ( Perrin 2013 ). It may also prove a significant factor in the use of autonomous cars ( Diels 2016 ), and on tilting trains, but can be influenced by compensation strategies ( Förstberg 1998 ). Space motion sickness affects 50% of astronauts within the first 24 to 72 hours of weightlessness ( Thornton 2013 ). Virtual reality has been shown to induce motion sickness ( Nishiike 2013 ), and an incidence of up to 56% has been demonstrated with the use of video games ( Stoffregen 2008 ). Amongst cinema patrons, 54.8% experienced motion sickness after viewing a 3D movie compared to 14.1% after viewing a 2D movie ( Solimini 2013 ).

Motion sickness is rare in children under the age of two, but increases through childhood with a peak incidence at age nine, followed by a progressive decline through adolescence and adulthood ( Henriques 2014 ). There is a slight preponderance in females ( Henriques 2014 ; Paillard 2013 ; Perrin 2013 ).

Ménière’s disease and vestibular migraines are associated with increased motion sensitivity ( Sharon 2014 ). A similar association between patients with vestibular migraines and those with migraines without vestibular symptoms has been shown ( Murdin 2015 ). Benign paroxysmal positional vertigo and vestibular neuritis show no association with motion sickness ( Golding 2015 ). Bilateral vestibular failure has a protective effect against the susceptibility to motion sickness, although this is not seen with unilateral vestibular failure ( Murdin 2015 ).

Aetiology/pathophysiology

The sensory conflict or mismatch theory suggests that conflict arises between one's visual, proprioceptive and vestibular systems when the actual motion experienced differs from the anticipated motion ( Reason 1978 ). Oman 1990 suggested that the difference between all the true sensory input and all the expected sensory information results in the conflict vector. The larger this vector, the greater the likelihood and severity of motion sickness. Bles 1998 further postulated that only vertical input is responsible for motion sickness, suggesting an alternate theory known as the subjective vertical conflict theory, while Holly 1996 expanded this to include all translations. Another hypothesis suggests a link between motion sickness and the time constant of velocity storage ( Cohen 2003 ).

A genetic predisposition showed concordance of 70% in childhood and 50% in adulthood in monozygotic and dizygotic twins ( Reavley 2006 ).

The Reason and Brand Motion Sickness Susceptibility Questionnaire remains the most widely used tool to assess susceptibility to motion sickness ( Golding 1998 ). Once symptoms have been established, Graybiel’s diagnostic criteria may be used to grade the severity of motion sickness ( Graybiel 1968 ). There is no laboratory test that is pathognomonic of motion sickness. Electrogastrography ( Cevette 2014 ), vestibular evoked myogenic potentials ( Tal 2013 ), vestibulo‐ocular reflexes ( Tanguy 2008 ), caloric testing ( Sharon 2014 ), computerised dynamic posturography ( Tal 2010 ), neurochemical markers (ACTH, epinephrine, norepinephrine) ( Kohl 1985 ), and measurements of autonomic activity ( Cowings 1986 ) have all been used to evaluate and study motion sickness.

Habituation is an effective countermeasure to motion sickness ( Cowings 2000 ). It is influenced by the intensity and frequency of exposure to the stimulus, and it is potentiated by controlled breathing ( Yen Pik Sang 2005 ). While playing video games, passive restraint ( Chang 2013 ) and being in control reduce the onset of motion sickness. Reducing passive head movements and postural instability by viewing the horizon and widening one's stance have been shown to be protective ( Stoffregen 2013 ), although the same is not true for artificial horizons ( Tal 2012 ). Optokinetic training reduced sea sickness in 71.4% of participants compared to 12% in the control group ( Ressiot 2013 ). Stroboscopic illumination may also be protective against motion sickness, possibly by reducing retinal slip ( Webb 2013 ). Other methods such as galvanic vestibular stimulation in synchrony with the visual field ( Cevette 2014 ), acupuncture, acupressure, transcutaneous electrical nerve stimulation ( Chu 2012 ), ginger ( Lien 2003 ), and music ( Keshavarz 2014 ) have all been used to control motion sickness.

Pharmacological therapy for the management of motion sickness primarily involves the use of anticholinergics and antihistamines ( Murdin 2011 ). Scopolamine is the most commonly used anticholinergic, and is effective compared to placebo in the prevention of motion sickness; however, there are insufficient data regarding its treatment of established symptoms. The side effects include dry mouth, blurred vision, dilated pupils and bradycardia ( Spinks 2011 ). Other pharmacological agents include antiemetics ( Muth 2007 ), neuroleptics such as phenytoin ( Woodard 1993 ), µ‐opiate receptor agonists ( Otto 2006 ), sympathomimetics ( Weerts 2014a ), and various combinations of all of these drugs.

Current approaches to countering space motion sickness include the combination of pre‐training in an altered gravity environment in combination with the use of promethazine ( Karmali 2016 ).

Future measures to control the incidence of motion sickness may involve engineering the expected stimulus to be less provocative.

Description of the intervention

Antihistamines have been used in the management of motion sickness for decades ( Brand 1967 ), alone or in combination with other interventions ( Weerts 2014a ). H1‐antihistamines are available as over‐the‐counter preparations, as well as by prescription ( Simons 2004 ). For the control of motion sickness, routes of administration and dosages vary depending on the specific drug used ( Zajonc 2006 ).

H1‐antihistamines may be classified according to their functional class (generation), or by their sedative effect. First‐generation H1‐antihistamines are generally sedating, while second and third‐generation antihistamines are non‐sedating. This may be due to the fat soluble nature of first‐generation antihistamines, which allows them to cross the blood–brain barrier, while second and third‐generation antihistamines do not. In addition, first‐generation antihistamines exhibit anticholinergic properties ( Mahdy 2014 ). Wood 1970 suggested this as the reason for their protective effect against motion sickness. Typically, after a single oral dose of an H1‐antihistamine, the onset of action is between two to three hours for first‐generation antihistamines, and one to two hours for second‐generation antihistamines. The duration of action may be up to 24 hours ( Simons 2004 ).

Side effects that limit the use of H1‐antihistamines in certain professions (such as astronauts) include drowsiness, fatigue, dizziness and impairment of cognitive function, memory and psychomotor performance ( Weerts 2014b ). Other reported adverse effects include dystonia, dyskinesia, agitation, confusion, hallucinations and cardiac toxicity. Additionally, first‐generation antihistamines may produce side effects related to their anticholinergic activity, such as blurred vision, dry mouth, dilated pupils and urinary retention. Second‐generation H1‐antihistamines have been relatively free of adverse effects. However, two early second‐generation antihistamines, astemizole and terfenadine, have been withdrawn due to cardiac toxicity ( Simons 2004 ).

Antihistamines have been compared to scopolamine ( Gil 2012 ; Pingree 1994 ); however, the comparative effectiveness in the management of motion sickness was found to be inconclusive in a Cochrane review ( Spinks 2011 ).

How the intervention might work

Acetylcholine (ACh) is a vestibular neurotransmitter and has been identified in all vestibular nuclei. Histamine may be a vestibular neurotransmitter or neuromodulator, acting on histamine receptors (H1‐H3 are expressed in the vestibular system), but this remains unclear ( Soto 2010 ). First‐generation antihistamines are ACh and H1 receptor antagonists, thus inhibiting their effects on the vestibular system. Second‐generation antihistamines do not possess any anticholinergic properties but inhibit histaminergic activity only ( Mahdy 2014 ). Cheung 2003 concluded that second‐generation agents are not effective in the management of motion sickness and suggested that the anticholinergic and sedative effects of first‐generation agents may be the reason for their apparent success.

Why it is important to do this review

When motion sickness was first described by Hippocrates in 400 BC, land and sea travel were the main sources of passive motion. Now, for the general population, this includes motor vehicles, trains, buses, cruise liners and other smaller vessels, and passenger aircraft. Additionally, in this age of rapid technological advancement, new sources of motion sickness inducing stimuli have emerged, including virtual reality, 3D visual effects, 4D experiences, video games, driverless cars and commercial space flight. Apart from the daily life and recreational aspects, occupational exposure to motion sickness inducing stimuli has increased over time. This includes but is not limited to paramedics in helicopters and ambulances, military personnel on naval vessels and in the air force, pilots, seafarers, and astronauts during space flight and training.

While habituation is effective and has no side effects, it lacks immediacy. Antihistamines have been the most commonly used pharmacological therapy ( Weerts 2014b ), however studies reveal conflicting results regarding their efficacy in the management of motion sickness ( Buckey 2004 ; Cheung 2003 ). This review aims to potentially resolve this conflict and to facilitate advancement of future research in the field of motion sickness.

Criteria for considering studies for this review

Types of studies.

We will include all published and unpublished randomised controlled trials (RCTs), including cluster‐randomised trials. We will exclude cross‐over studies. There will be no time or language limitations on included studies.

Types of participants

Participants will include susceptible adults and children (the age limit to define children will be 18 years and under), of any gender and ethnicity, who have no vestibular, visual or neurological co‐morbidities.

We will include:

  • susceptible participants in whom motion sickness is induced under natural conditions such as air, sea and land transportation.

Susceptibility will be defined as:

  • previous experience of motion sickness; and/or
  • motion sickness susceptibility based on the result of any validated scale.

We will include studies in which motion sickness is induced under experimental conditions but we will analyse data from these studies separately.

Types of interventions

The main intervention will be all antihistamines regardless of:

  • class (first or second‐generation);
  • route of administration; or

Comparison interventions will include:

  • no treatment;
  • any other pharmacological interventions (for example: scopolamine, phenytoin, ondansetron, metoclopramide); and
  • any non‐pharmacological interventions (for example: acupuncture, transcutaneous electrical nerve stimulation, habituation techniques).

The main comparison will be:

  • antihistamine versus no treatment or placebo.

Other possible comparison pairs include:

  • antihistamine versus scopolamine;
  • antihistamine versus antiemetics;
  • antihistamine versus neuroleptics;
  • antihistamine versus µ‐opiate receptor agonists;
  • antihistamine versus sympathomimetics;
  • antihistamine versus acupuncture;
  • antihistamine versus acupressure;
  • antihistamine versus autogenic feedback training exercises;
  • antihistamine versus transcutaneous electrical nerve stimulation.

Concurrent use of other medication will be acceptable if used equally in each group.

Types of outcome measures

We will analyse the following outcomes in the review, but we will not use them as a basis for including or excluding studies.

Primary outcomes

  • Proportion of susceptible participants who did not experience any motion sickness symptoms (based on subjective reporting of nausea and/or vomiting or the use of a validated scale).
  • Proportion of susceptible participants who experienced a reduction or resolution of existing motion sickness symptoms (based on subjective reporting of nausea and/or vomiting or the use of a validated scale).

Secondary outcomes

  • Physiological measures: heart rate, core temperature and electrogastrography.
  • Adverse effects (type, duration and severity): sedation, impaired cognitive function, blurred vision.

We will evaluate outcomes after administration of the antihistamine as short‐term (less than or equal to 24 hours) and long‐term (over 24 hours).

Search methods for identification of studies

The Cochrane ENT Information Specialist will conduct systematic searches for randomised controlled trials and controlled clinical trials. There will be no language, publication year or publication status restrictions. We may contact original authors for clarification and further data if trial reports are unclear and we will arrange translations of papers where necessary.

Electronic searches

Published, unpublished and ongoing studies will be identified by searching the following databases from their inception:

  • the Cochrane Register of Studies ENT Trials Register (search to date);
  • Cochrane Register of Studies Online (search to date);
  • Ovid MEDLINE (In‐Process & Other Non‐Indexed Citations);
  • PubMed (as a top up to searches in Ovid MEDLINE);
  • Ovid EMBASE (1974 to date);
  • EBSCO CINAHL (1982 to date);
  • Ovid CAB abstracts (1910 to date);
  • LILACS (search to date);
  • KoreaMed (search to date);
  • IndMed (search to date);
  • PakMediNet (search to date);
  • Web of Knowledge, Web of Science (1945 to date);
  • ClinicalTrials.gov, www.clinicaltrials.gov (search via the Cochrane Register of Studies to date);
  • World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (search to date);
  • ISRCTN, www.isrctn.com (search to date);
  • Google Scholar (search to date);
  • Google (search to date).

The subject strategies for databases will be modelled on the search strategy designed for CENTRAL ( Appendix 1 ). Where appropriate, these will be combined with subject strategy adaptations of the highly sensitive search strategy designed by Cochrane for identifying randomised controlled trials and controlled clinical trials (as described in the Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0, Box 6.4.b. ( Higgins 2011 )).

Searching other resources

We will scan the reference lists of identified publications for additional trials and contact trial authors if necessary. In addition, the Information Specialist will search Ovid MEDLINE, the Cochrane Library and Google to retrieve existing systematic reviews relevant to this systematic review, so that we can scan their reference lists for additional trials.

Data collection and analysis

Selection of studies.

Two review authors (NK and YS) will independently sift through the initial search results and identify studies that appear to meet our inclusion criteria. We will then obtain full‐text articles for the studies on this preliminary list. We will independently examine these studies and select those that meet our inclusion criteria. If there are any discrepancies, we will resolve this by reviewing the original study. We will consult the third review author (NM) where necessary.

Data extraction and management

Two review authors (NK and YS) will independently extract data using standardised forms. If there are any missing or incomplete data, we will contact the study author. If there are any discrepancies, we will consult the third review author (NM).

We will extract the following:

  • Study design features (double‐/single‐/non‐blinded; cluster/parallel‐group)
  • Sample size
  • Participant (baseline) characteristics (age, gender, susceptibility to motion sickness and how this was assessed, co‐morbidities)
  • Inclusion criteria
  • Exclusion criteria
  • Method of induction of motion sickness
  • Duration of motion
  • Type of antihistamine used (name, class, route, dosage)
  • Comparison intervention
  • Funding sources
  • Study author declarations of interest

See Appendix 2 .

Assessment of risk of bias in included studies

NK and YS will independently assess the risk of bias of the included studies. This will be determined using Cochrane's tool for assessing the risk of bias as outlined in the Cochrane Handbook for Systematic Reviews of Interventions ( Higgins 2011 ).

We will consider the following domains and assign a judgement based on the following criteria:

Random sequence generation

  • Low risk: Study authors describe a random component in the sequence generation process such as referring to a random number table, using a computerised random number generation, coin tossing, shuffling cards or envelopes, throwing dice or drawing of lots.
  • High risk: Study authors describe a non‐random component in the sequence generation process (such as allocation based on geographic location, hospital number, date of birth).
  • Unclear risk: Study authors have not specified the sequence generation process.

Concealment of allocation prior to assignment

  • Low risk: Participants and/or investigators could not foresee drug allocation due to concealed allocation (such as the use of central allocation, or sequentially numbered, opaque envelopes or drug containers).
  • High risk: Participants and/or investigators could foresee drug allocation due to an inadequate concealment process.
  • Unclear risk: Insufficient information is given on the allocation concealment process.

Blinding of provider, participant and outcome assessor

  • Low risk: Blinding of treatment provider, participant or outcome assessor undertaken.
  • High risk: Blinding not undertaken.
  • Unclear risk: Study does not state whether blinding was undertaken or not.

Incomplete outcome data

  • Low risk: No incomplete outcome information, or the reason for incomplete outcome data is unrelated to the study's outcomes (for example: a participant dropped out of the study due to relocating to a new geographic location).
  • High risk: Incompleteness of outcome data is related to the study's outcomes (for example: a participant dropped out of the study due to severe nausea).
  • Unclear risk: Reason for missing data unspecified.

Selective outcome reporting

  • Low risk: The study protocol is available and all of the study's pre‐specified outcomes have been reported in the pre‐specified manner.
  • High risk: Not all the primary outcomes have been reported, or one or more of the primary outcomes were reported using methods of analysis that were not pre‐specified, or one or more of the primary outcomes were not pre‐specified, or one or more of the primary outcomes were reported incompletely.
  • Unclear risk: Insufficient information available to assign a judgement.
  • Low risk: Study appears free of other sources of bias.
  • High risk: Other source of bias noted by review authors.

We will classify studies that have been categorised as high risk on the basis of random sequence generation and/or concealment of allocation of treatment and/or incomplete outcome data as having a high overall risk of bias. We will not consider studies that have been categorised as high risk in one or more of the other domains to have a high overall risk of bias.

We will include a description of the risk of bias of our included studies in our Discussion.

Measures of treatment effect

For dichotomous data, we will calculate individual and pooled statistics as risk ratios (RR) with 95% confidence intervals (95% CI). We will assess continuous data (for example, heart rate) using the mean difference (MD) for outcomes measured on the same scale and/or the standardised mean difference (SMD) for outcomes measured on different scales. We will use a change from baseline for this analysis. We will complete an intention‐to‐treat analysis, assuming that the relevant data are available in the included studies.

Unit of analysis issues

For multi‐arm studies, we will establish which comparisons are relevant to this review and include data from the respective arms. We will not include cross‐over studies.

Dealing with missing data

If we identify missing data, we will attempt to contact the trial author by email. If we are unable to contact the author and/or if the author is unable to provide the relevant information, we will assume the missing data to be 'missing at random' and we will conduct the data analysis using only the available data.

Assessment of heterogeneity

We will assess clinical, methodological and statistical heterogeneity. We will measure statistical heterogeneity using the Chi² test and the I² statistic. For the latter, according to the Cochrane Handbook for Systematic Reviews of Interventions ( Higgins 2011 ), a value of > 50% suggests substantial heterogeneity.

Assessment of reporting biases

We will address publication bias (between‐study reporting bias) by searching for published, unpublished and ongoing trials in the specified trial databases. We will ensure data from all the available outcomes across all papers are recorded, taking care not to duplicate results. Where potentially eligible but unpublished trials are identified, we will contact the authors to acquire the full study results and/or to find out the reasons why these results have not been published. For ongoing trials, we will include results available until the date of publication of this review. We will address language bias by including studies in any language and we will obtain an English translation where possible. We will address outcome (within‐study) reporting bias by ensuring results are presented as indicated in the protocol, which will have been published beforehand. We will assess between‐study reporting bias as outlined in the Cochrane Handbook for Systematic Reviews of Interventions ( Higgins 2011 ) .

Data synthesis

If data are comparable, we will combine data to give a summary measure of effect using the methods set out in Measures of treatment effect . If data are missing, we will use the available data to perform a meta‐analysis using Review Manger 5.3 ( RevMan 2014 ), in the absence of significant clinical or statistical heterogeneity. We will test for heterogeneity using the I 2 statistic and we will assume significant heterogeneity if the I 2 is greater than 50% (i.e. more than 50% of the variability in outcome between trials could not be explained by sampling variation) ( Higgins 2011 ). We will use a fixed‐effect model in the absence of statistical heterogeneity and a random‐effects model if heterogeneity is present. For key outcomes presented in the 'Summary of findings' table, we will also convey the pooled results as absolute numbers (as number needed to treat).

Subgroup analysis and investigation of heterogeneity

If there are sufficient studies available we will conduct the following subgroup analyses in RevMan, using the formal test for subgroup differences ( RevMan 2014 ):

  • age (adults versus children); and
  • motion sickness that has been induced under experimental conditions versus natural conditions (such as air, sea and land transportation).

Adults and children may report symptoms differently and antihistamines may have differing effects on each group (for example, children may be more susceptible to the side effects of antihistamines). The subjective experience of motion sickness symptoms may differ when motion sickness is induced under experimental conditions compared to naturally occurring conditions.

Therefore these subgroups have been selected as variability in these conditions may affect the outcome.

Sensitivity analysis

Two review authors (NK and YS) will independently conduct a sensitivity analysis by identifying studies with a high risk of bias using the Cochrane 'Risk of bias' tool and excluding these studies from the analysis.

GRADE and 'Summary of findings' table

We will use the GRADE approach to rate the overall quality of evidence. The quality of evidence reflects the extent to which we are confident that an estimate of effect is correct and we will apply this in the interpretation of results. There are four possible ratings: high, moderate, low and very low. A rating of high quality of evidence implies that we are confident in our estimate of effect and that further research is very unlikely to change our confidence in the estimate of effect. A rating of very low quality implies that any estimate of effect obtained is very uncertain.

The GRADE approach rates evidence from RCTs that do not have serious limitations as high quality. However, several factors can lead to the downgrading of the evidence to moderate, low or very low. The degree of downgrading is determined by the seriousness of these factors:

  • study limitations (risk of bias);
  • inconsistency;
  • indirectness of evidence;
  • imprecision; and
  • publication bias.

We will include a 'Summary of findings' table for the comparison antihistamine versus placebo ( Appendix 3 ), constructed according to the recommendations described in Chapter 11 of the Cochrane Handbook for Systematic Reviews of Interventions ( Higgins 2011 ).

The 'Summary of findings' table will include the following primary outcomes:

  • proportion of susceptible participants who did not experience any motion sickness symptoms; and
  • proportion of susceptible participants who experienced a reduction or resolution of existing motion sickness symptoms.

It will also include the following secondary outcomes:

  • physiological measures; and
  • adverse effects.

Acknowledgements

This project was supported by the National Institute for Health Research, via Cochrane Infrastructure, Cochrane Programme Grant or Cochrane Incentive funding to Cochrane ENT. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, NHS or the Department of Health.

We would also like to acknowledge Samantha Faulkner for assisting with the search strategy and Jenny Bellorini for copy editing and reviewing the protocol.

Appendix 1. CENTRAL search strategy

#1 MeSH descriptor: [Motion Sickness] explode all trees #2 ((motion or car or air* or travel* or sea or space or auto* or aviat* or flight or simulator or vehicle or passenger* or train or trains or bus or coach or ship or (virtual next reality) or (computer next simulat*)) near (sick* or nausea or vomit*)):ti,ab,kw #3 ((video or computer) next game* near (sick* or nausea or vomit*)):ti,ab,kw #4 ((3D or ((three or 3) next dimensional)) near (film* or movie* or image*) near (sick* or nausea or vomit*)):ti,ab,kw #5 (carsick* or airsick* or seasick* or motionsick* or travelsick* or spacesick*):ti,ab,kw #6 kinetosis:ti,ab,kw #7 #1 or #2 or #3 or #4 or #5 or #6 #8 MeSH descriptor: [Histamine Antagonists] explode all trees #9 MeSH descriptor: [Anti‐Allergic Agents] explode all trees #10 MeSH descriptor: [Promethazine] explode all trees #11 MeSH descriptor: [Diphenhydramine] explode all trees #12 MeSH descriptor: [Meclizine] explode all trees #13 MeSH descriptor: [Cinnarizine] explode all trees #14 MeSH descriptor: [Cyclizine] explode all trees #15 MeSH descriptor: [Chlorpheniramine] explode all trees #16 MeSH descriptor: [Cetirizine] explode all trees #17 MeSH descriptor: [Loratadine] explode all trees #18 MeSH descriptor: [Doxepin] explode all trees #19 ((antihistam* or antiallerg*) or (anti next (histam* or alerg*))):ti,ab,kw #20 ((histamine* or H1) near (antagonist* or block*)):ti,ab,kw #21 (acrivastine* or astemizole* or azelastine* or azatadine* or brompheniramine* or carbinoxamine* or cetirizine* or chlorpheniramine* or chlorphenamine* or clemastine* or cinnarizin* or cyclizine* or cyproheptadine* or dexchlorpheniramine* or dimenhydrinate* or dexbrompheniramine* or desloratadine* or diphenhydramine* or doxylamine* or dimetapp* or drixoral* or dimethindene* or diphenylpyraline* or ebastine* or fexofenadine* or flunarizine* or hydroxyzine* or ketotifen* or levocetirizine* or levocabastine* or loratadine* or methapyrilene* or mequitazine* or methdilazine* or mizolastine* or meclizine* or mepyramine* or oxatomide* or pheniramine* or phenyltoloxamine* or pyrilamine* or promethazine* or terfenadin* or tripelennamine* or triprolidine* or tritoqualine* or dimotane* or zirtek* or clarityn* or neoclarityn* or telfast* or xyzal* or mistamine* or mizollen* or alimemazine* or vallergan* or optimine* or piriton* or tavegil* or periactin* or phenergan* or piriton* or piriteze*):ti,ab,kw #22 (carebastine or alcaftadine or Antazoline or Astemizole or bamipine or benzonitrile or chloropyramine or dibenzheptropine or embramine or emedastine or epinastine or fonazine or histabudifen or histapendife or Mianserin or mirtazapine or Olopatadine or picumast or protopine or proxicromil or temelastine or tranilast or trimeprazine or Virlix or Zetir or Zyrtec or Reactine or Voltric or Alerlisin or Cetalerg or Ceterifug or Cetiderm or Cetidura or CetiLich or Cetirigamma or Cetirlan or Cinazière or Cinna or Cinnipirine or Cisaken or Dimitronal or Stugeron or Prometazin or Proazamine or Rumergan or Diprazin or Isopromethazine or Phen?rgan or Phensedyl or Pipolfen or Pipolphen or Promet or Prothazin or Pyrethia or Remsed or Atosil or Diphergan or Chlorphenamine or Antihistaminico or chlor or Trimeton or Chlorpro or Chlorspan or chlortab or Efidac or Kloromin or Piriton or Teldrin or doxepi* or Dramamine or Marezine or Aviomarin or Biodramina or "calm X" or Cinfamar or Contramareo or dimen or Dimetabs or dinate or DMH or Dramanate or gravol or Wehamine or "motion aid" or Nausicalm or Reisegold or Reisetabletten or Rodovan or RubieMen or Superpep or "travel well" or triptone or vomex or Vomacur or omisin or Marmine or Benzhydramine or Benhydramin or Benadryl or Benylin or Dormin or Allerdryl or Dimedrol or Parachloramine or Meclozine or Antivert or Bonamine or Bonine or Chiclida or Histametizyn or RuVertM or Agyrax or "d vert" or dvert or Deptran or Desidox or Doneurin or Espadox or Mareen or Prudoxin or Quitaxon or Sin?quan or Zonalon or Xepin or Aponal or ApoDoxepin or Claritin or Clarium or alavert):ti,ab,kw #23 #8 or #9 or #10 or #11 or #12 or #13 or #14 or #15 or #16 or #17 or #19 or #20 or #21 or #22 #24 #7 and #23

Appendix 2. Template 'Characteristics of included studies' table

Appendix 3. template 'summary of findings' table, contributions of authors.

Nadine Karrim: drafted the protocol; will contribute as a primary review author, obtain copies of studies, select studies for inclusion, extract data, enter data into RevMan 5, perform the data analysis and interpretation of data, and draft and approve the final document.

Nombulelo Magula: reviewed and edited the protocol, and provided a methodological perspective; will assist with data analysis and interpretation of data, and review, edit and approve the final document.

Yougan Saman: reviewed and edited the protocol, and provided a clinical perspective; will select studies for inclusion, extract data and review, edit and approve the final document.

Sources of support

Internal sources.

  • No sources of support supplied

External sources

Infrastructure funding for Cochrane ENT

Declarations of interest

Nadine Karrim: none known.

Nombulelo Magula: none known.

Yougan Saman: none known.

Additional references

  • Bertolini G, Straumann D. Moving in a moving world: a review on vestibular motion sickness . Frontiers in Neurology 2016; 7 :14. [ PMC free article ] [ PubMed ] [ Google Scholar ]
  • Bles W, Bos JE, Graaf B, Groen E, Wertheim AH. Motion sickness: only one provocative conflict? . Brain Research Bulletin 1998; 47 ( 5 ):481‐7. [ PubMed ] [ Google Scholar ]
  • Brand JJ, Colquhoun WP, Gould AH, Perry WL. Hyoscine and cyclizine as motion sickness remedies . British Journal of Pharmacology and Chemotherapy 1967; 30 ( 3 ):463‐9. [ PMC free article ] [ PubMed ] [ Google Scholar ]
  • Buckey JC, Alvarenga D, Cole B, Rigas JR. Chlorpheniramine for motion sickness . Journal of Vestibular Research 2004; 14 ( 1 ):53‐61. [ PubMed ] [ Google Scholar ]
  • Cevette MJ, Pradhan GN, Cocco D, Crowell MD, Galea AM, Bartlett J, et al. Electrogastrographic and autonomic responses during oculovestibular recoupling in flight simulation . Aviation, Space, and Environmental Medicine 2014; 85 ( 1 ):15‐24. [ PubMed ] [ Google Scholar ]
  • Chang CH, Pan WW, Chen FC, Stoffregen TA. Console video games, postural activity, and motion sickness during passive restraint . Experimental Brain Research 2013; 229 ( 2 ):235. [ PubMed ] [ Google Scholar ]
  • Cheung BS, Heskin R, Hofer KD. Failure of cetirizine and fexofenadine to prevent motion sickness . Annals of Pharmacotherapy 2003; 37 ( 2 ):173‐7. [ PubMed ] [ Google Scholar ]
  • Chu H, Li MH, Juan SH, Chiou WY. Effects of transcutaneous electrical nerve stimulation on motion sickness induced by rotary chair: a crossover study . Journal of Alternative and Complementary Medicine 2012; 18 ( 5 ):494‐500. [ PubMed ] [ Google Scholar ]
  • Cohen B, Dai M, Raphan T. The critical role of velocity storage in production of motion sickness . Annals of the New York Academy of Sciences 2003; 1004 :359‐76. [ PubMed ] [ Google Scholar ]
  • Cowings PS, Suter S, Toscano WB, Kamiya J, Naifeh K. General autonomic components of motion sickness . Psychophysiology 1986; 23 ( 5 ):542‐51. [ PubMed ] [ Google Scholar ]
  • Cowings PS, Toscano WB. Autogenic‐feedback training exercise is superior to promethazine for control of motion sickness symptoms . Journal of Clinical Pharmacology 2000; 40 ( 10 ):1154‐65. [ PubMed ] [ Google Scholar ]
  • Diels C, Bos JE. Self‐driving carsickness . Applied Ergonomics 2016; 53 Pt B :374‐82. [ PubMed ] [ Google Scholar ]
  • Dong X, Yoshida K, Stoffregen TA. Control of a virtual vehicle influences postural activity and motion sickness . Journal of Experimental Psychology: Applied 2011; 17 ( 2 ):128. [ PubMed ] [ Google Scholar ]
  • Förstberg J, Andersson E, Ledin T. Influence of different conditions for tilt compensation on symptoms of motion sickness in tilting trains . Brain Research Bulletin 1998; 47 ( 5 ):525‐35. [ PubMed ] [ Google Scholar ]
  • Gil A, Nachum Z, Tal D, Shupak A. A comparison of cinnarizine and transdermal scopolamine for the prevention of seasickness in naval crew: a double‐blind, randomized, crossover study . Clinical Neuropharmacology2012; Vol. 35, issue 1:37‐9. [ PubMed ]
  • Golding JF. Motion sickness susceptibility questionnaire revised and its relationship to other forms of sickness . Brain Research Bulletin 1998; 47 ( 5 ):507‐16. [ PubMed ] [ Google Scholar ]
  • Golding JF, Gresty MA. Pathophysiology and treatment of motion sickness . Current Opinion in Neurology 2015; 28 ( 1 ):83‐8. [ PubMed ] [ Google Scholar ]
  • Graybiel A, Wood CD, Miller EF, Cramer DB. Diagnostic criteria for grading the severity of acute motion sickness . Aerospace Medicine 1968; 39 ( 5 ):453‐5. [ PubMed ] [ Google Scholar ]
  • Henriques IF, Douglas de Oliveira DW, Oliveira‐Ferreira F, Andrade PM. Motion sickness prevalence in school children . European Journal of Pediatrics 2014; 173 ( 11 ):1473‐82. [ PubMed ] [ Google Scholar ]
  • Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011 . Available from www.cochrane‐handbook.org.
  • Aphorisms By Hippocrates Written 400 B.C.E (Translated by Francis Adams), Section IV, 14 . http://classics.mit.edu/Hippocrates/aphorisms.html (accessed 10 July 2016).
  • Holly JE, McCollum G. The shape of self‐motion perception—II. Framework and principles for simple and complex motion . Neuroscience 1996; 70 ( 2 ):487‐513. [ PubMed ] [ Google Scholar ]
  • Karmali F, Clark TK, Artiles AD, Sherwood DP, Garza G, Young LR. Development of a countermeasure to enhance sensorimotor adaptation to altered gravity levels . 2016 IEEE Aerospace Conference . IEEE, 2016:1‐7. [ Google Scholar ]
  • Keshavarz B, Hecht H. Pleasant music as a countermeasure against visually induced motion sickness . Applied Ergonomics 2014; 45 ( 3 ):521‐7. [ PubMed ] [ Google Scholar ]
  • Kohl RL. Endocrine correlates of susceptibility to motion sickness . Aviation, Space, and Environmental Medicine 1985; 56 ( 12 ):1158‐65. [ PubMed ] [ Google Scholar ]
  • Lien HC, Sun WM, Chen YH, Kim H, Hasler W, Owyang C. Effects of ginger on motion sickness and gastric slow‐wave dysrhythmias induced by circular vection . American Journal of Physiology‐Gastrointestinal and Liver Physiology 2003; 284 ( 3 ):G481‐9. [ PubMed ] [ Google Scholar ]
  • Mahdy AM, Webster NR. Histamine and antihistamines . Anaesthesia & Intensive Care Medicine 2014; 15 ( 5 ):250‐5. [ Google Scholar ]
  • Matsangas P, McCauley ME, Becker W. The effect of mild motion sickness and sopite syndrome on multitasking cognitive performance . Human Factors 2014; 56 ( 6 ):1124‐35. [ PubMed ] [ Google Scholar ]
  • Murdin L, Golding J, Bronstein A. Managing motion sickness . BMJ 2011; 343 :d7430. [ PubMed ] [ Google Scholar ]
  • Murdin L, Chamberlain F, Cheema S, Arshad Q, Gresty MA, Golding JF, et al. Motion sickness in migraine and vestibular disorders . Journal of Neurology, Neurosurgery & Psychiatry 2015; 86 ( 5 ):585‐7. [ PMC free article ] [ PubMed ] [ Google Scholar ]
  • Muth ER, Elkins AN. High dose ondansetron for reducing motion sickness in highly susceptible subjects . Aviation, Space, and Environmental Medicine 2007; 78 ( 7 ):686‐92. [ PubMed ] [ Google Scholar ]
  • Nishiike S, Okazaki S, Watanabe H, Akizuki H, Imai T, Uno A, et al. The effect of visual‐vestibulosomatosensory conflict induced by virtual reality on postural stability in humans . Journal of Medical Investigation 2013; 60 ( 3‐4 ):236‐9. [ PubMed ] [ Google Scholar ]
  • Oman CM. Motion sickness: a synthesis and evaluation of the sensory conflict theory . Canadian Journal of Physiology and Pharmacology 1990; 68 ( 2 ):294‐303. [ PubMed ] [ Google Scholar ]
  • Otto B, Riepl RL, Otto C, Klose J, Enck P, Klosterhalfen S. µ‐Opiate receptor agonists – a new pharmacological approach to prevent motion sickness? . British Journal of Clinical Pharmacology 2006; 61 ( 1 ):27‐30. [ PMC free article ] [ PubMed ] [ Google Scholar ]
  • Paillard AC, Quarck G, Paolino F, Denise P, Paolino M, Golding JF, et al. Motion sickness susceptibility in healthy subjects and vestibular patients: effects of gender, age and trait‐anxiety . Journal of Vestibular Research 2013; 23 ( 4, 5 ):203‐9. [ PubMed ] [ Google Scholar ]
  • Perrin P, Lion A, Bosser G, Gauchard G, Meistelman C. Motion sickness in rally car co‐drivers . Aviation, Space, and Environmental Medicine 2013; 84 ( 5 ):473‐7. [ PubMed ] [ Google Scholar ]
  • Pingree BJ, Pethybridge RJ. A comparison of the efficacy of cinnarizine with scopolamine in the treatment of seasickness . Aviation, Space, and Environmental Medicine 1994; 65 ( 7 ):597‐605. [ PubMed ] [ Google Scholar ]
  • Reason JT. Motion sickness adaptation: a neural mismatch model . Journal of the Royal Society of Medicine 1978; 71 ( 11 ):819. [ PMC free article ] [ PubMed ] [ Google Scholar ]
  • Reavley CM, Golding JF, Cherkas LF, Spector TD, MacGregor AJ. Genetic influences on motion sickness susceptibility in adult women: a classical twin study . Aviation, Space, and Environmental Medicine 2006; 77 ( 11 ):1148‐52. [ PubMed ] [ Google Scholar ]
  • Ressiot E, Dolz M, Bonne L, Marianowski R. Prospective study on the efficacy of optokinetic training in the treatment of seasickness . European Annals of Otorhinolaryngology, Head and Neck Diseases 2013; 130 ( 5 ):263‐8. [ PubMed ] [ Google Scholar ]
  • The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan) . Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
  • Schutz L, Zak D, Holmes JF. Pattern of passenger injury and illness on expedition cruise ships to Antarctica . Journal of Travel Medicine 2014; 21 ( 4 ):228‐34. [ PubMed ] [ Google Scholar ]
  • Sharon JD, Hullar TE. Motion sensitivity and caloric responsiveness in vestibular migraine and Meniere's disease . Laryngoscope 2014; 124 ( 4 ):969‐73. [ PMC free article ] [ PubMed ] [ Google Scholar ]
  • Simons F Estelle R. Advances in H1‐antihistamines . New England Journal of Medicine 2004; 351 ( 21 ):2203‐17. [ PubMed ] [ Google Scholar ]
  • Solimini AG. Are there side effects to watching 3D movies? A prospective crossover observational study on visually induced motion sickness . PloS One 2013; 8 ( 2 ):e56160. [ PMC free article ] [ PubMed ] [ Google Scholar ]
  • Soto E, Vega R. Neuropharmacology of vestibular system disorders . Current Neuropharmacology 2010; 8 ( 1 ):26‐40. [ PMC free article ] [ PubMed ] [ Google Scholar ]
  • Spinks A, Wasiak J. Scopolamine (hyoscine) for preventing and treating motion sickness . Cochrane Database of Systematic Reviews 2011, Issue 6 . [DOI: 10.1002/14651858.CD002851.pub4] [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
  • Stoffregen TA, Faugloire E, Yoshida K, Flanagan MB, Merhi O. Motion sickness and postural sway in console video games . Human Factors 2008; 50 ( 2 ):322‐31. [ PubMed ] [ Google Scholar ]
  • Stoffregen TA, Chen FC, Varlet M, Alcantara C, Bardy BG. Getting your sea legs . PloS One 2013; 8 ( 6 ):e66949. [ PMC free article ] [ PubMed ] [ Google Scholar ]
  • Tal D, Bar R, Nachum Z, Gil A, Shupak A. Postural dynamics and habituation to seasickness . Neuroscience Letters 2010; 479 ( 2 ):134‐7. [ PubMed ] [ Google Scholar ]
  • Tal D, Gonen A, Wiener G, Bar R, Gil A, Nachum Z, et al. Artificial horizon effects on motion sickness and performance . Otology & Neurotology 2012; 33 :878Y885. [ PubMed ] [ Google Scholar ]
  • Tal D, Hershkovitz D, Kaminski‐Graif G, Wiener G, Samuel O, Shupak A. Vestibular evoked myogenic potentials and habituation to seasickness . Clinical Neurophysiology 2013; 124 ( 12 ):2445‐9. [ PubMed ] [ Google Scholar ]
  • Tanguy S, Quarck G, Etard O, Gauthier A, Denise P. Vestibulo‐ocular reflex and motion sickness in figure skaters . European Journal of Applied Physiology 2008; 104 ( 6 ):1031‐7. [ PubMed ] [ Google Scholar ]
  • Thornton WE, Bonato F. Space motion sickness and motion sickness: symptoms and etiology . Aviation, Space, and Environmental Medicine 2013; 84 ( 7 ):716‐21. [ PubMed ] [ Google Scholar ]
  • Wada T, Yoshida K. Effect of passengers’ active head tilt and opening/closure of eyes on motion sickness in lateral acceleration environment of cars . Ergonomics 2015 Dec 23 [Epub ahead of print]. [ PubMed ]
  • Webb CM, Estrada A, Athy JR. Motion sickness prevention by an 8‐Hz stroboscopic environment during air transport . Aviation, Space, and Environmental Medicine 2013; 84 ( 3 ):177‐83. [ PubMed ] [ Google Scholar ]
  • Weerts AP, Vanspauwen R, Fransen E, Jorens PG, Heyning PH, Wuyts FL. Space motion sickness countermeasures: a pharmacological double‐blind, placebo‐controlled study . Aviation, Space, and Environmental Medicine 2014; 85 ( 6 ):638‐44. [ PubMed ] [ Google Scholar ]
  • Weerts AP, Pattyn N, Heyning PH, Wuyts FL. Evaluation of the effects of anti‐motion sickness drugs on subjective sleepiness and cognitive performance of healthy males . Journal of Psychopharmacology 2014; 28 ( 7 ):655‐64. [ PubMed ] [ Google Scholar ]
  • Wood CD, Graybiel A. A theory of motion sickness based on pharmacological reactions . Clinical Pharmacology & Therapeutics 1970; 11 ( 5 ):621‐9. [ PubMed ] [ Google Scholar ]
  • Woodard D, Knox G, Myers KJ, Chelen W, Ferguson B. Phenytoin as a countermeasure for motion sickness in NASA maritime operations . Aviation, Space, and Environmental Medicine 1993; 64 ( 5 ):363‐6. [ PubMed ] [ Google Scholar ]
  • Yen Pik Sang F, Billar J, Gresty MA, Golding JF. Effect of a novel motion desensitization training regime and controlled breathing on habituation to motion sickness . Perceptual and Motor Skills 2005; 101 ( 1 ):244‐56. [ PubMed ] [ Google Scholar ]
  • Zajonc TP, Roland PS. Vertigo and motion sickness. Part II: Pharmacologic treatment . Ear, Nose, & Throat Journal 2006; 85 ( 1 ):25. [ PubMed ] [ Google Scholar ]

Sharing health evidence you can trust

Cochrane UK logo

Treatments to prevent travel sickness: a quick look

In this short blog, Dr Robert Walton looks at the evidence on treatments to prevent travel sickness (motion sickness).

Take-home points

Take-home points: Effective preventative treatments are available for travel sickness The choice is between hyoscine and older ‘first generation’ antihistamines New Cochrane evidence shows that some antihistamines are likely to reduce the risk of travel sickness in adults. They may cause drowsiness

The new evidence on antihistamines comes from the Cochrane Review Antihistamines for motion sickness (published in October 2022) and is relevant to adults.

Travel sickness (motion sickness) is a common problem, and many people experience nausea for example on boats, planes or in the car. Lots of treatments which aim to prevent travel sickness are available to buy in UK pharmacies, including medicines. Here is the evidence on these medicines and some things you may want to think about when making your choices.

Making a choice? Think BRAIN!

It can be helpful to think BRAIN : What are the B enefits, R isks, A lternatives, what do I want and what if I do N othing? These can be good questions to talk about with a health professional when making a health decision.

Medicines to prevent travel sickness

The choice is between hyoscine (or scopolamine as it is sometimes called) and antihistamines such as cinnarizine.

Most of the Cochrane evidence Cochrane Reviews are systematic reviews. In systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. is focused on hyoscine which is probably better than placebo An intervention that appears to be the same as that which is being assessed but does not have the active component. For example, a placebo could be a tablet made of sugar, compared with a tablet containing a medicine. (dummy treatment Something done with the aim of improving health or relieving suffering. For example, medicines, surgery, psychological and physical therapies, diet and exercise changes. ) at preventing travel sickness.  It comes from the Cochrane Review Scopolamine (hyoscine) for preventing and treating motion sicknes s (published June 2011).

The new Cochrane evidence about antihistamines, from the Cochrane Review Antihistamines for motion sickness (published October 2022) finds that they are likely to reduce the risk A way of expressing the chance of an event taking place, expressed as the number of events divided by the total number of observations or people. It can be stated as ‘the chance of falling were one in four’ (1/4 = 25%). This measure is good no matter the incidence of events i.e. common or infrequent. of travel sickness in adults who tend to get it, compared with taking a placebo.

It’s worth bearing in mind that there is evidence to support using older or ‘first generation’ antihistamines but none for the newer medicines such as loratadine and cetirizine which are more commonly used now for hay fever now.  These newer antihistamines are not used to prevent or treat motion sickness and are unlikely to be effective.

There are few studies comparing the two types of medicines.  There is little information about whether either are useful for treating motion sickness after it has started so prevention may be better than cure.

What are the risks?

Hyoscine and antihistamines both work in the same way for preventing travel sickness and they also share the same side effects which include drowsiness in some people.

What are the other options?

Many other options are available but there is no Cochrane evidence about their potential benefits and harms.

What do I want?

What matters (most) to you, and past experiences of a problem – and of treatments, is important when making treatment choices. If you usually get travel sickness and want to prevent it then there are medicines that can help and are backed up by Cochrane evidence. But it may be important to you to avoid the risk of side effects (such as drowsiness, if you have to drive for example). You could discuss your options and experience of treatments with a pharmacist.

What if I do nothing?

Travel sickness is usually not usually a big problem although some people can be quite severely affected.  If you have had it once in a particular situation then you are likely to get it again.

Find out more

NHS pages on motion sickness

The Cochrane Reviews Cochrane Reviews are systematic reviews. In systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. :

Karrim N, Byrne R, Magula N, Saman Y. Antihistamines for motion sickness. Cochrane Database of Systematic Reviews In systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. 2022, Issue 10. Art. No.: CD012715. DOI: 10.1002/14651858.CD012715.pub2.

Spinks A, Wasiak J. Scopolamine (hyoscine) for preventing and treating motion sickness. Cochrane Database of Systematic Reviews 2011, Issue 6. Art. No.: CD002851. DOI: 10.1002/14651858.CD002851.pub4.

Why you can trust this information

Join in the conversation on Twitter with  @CochraneUK   @rtwalton123  or leave a comment on the blog. 

Please note, we cannot give specific medical advice and do not publish comments that link to individual pages requesting donations or to commercial sites, or appear to endorse commercial products. We welcome diverse views and encourage discussion but we ask that comments are respectful and reserve the right to not publish any we consider offensive. Cochrane UK does not fact-check – or endorse – readers’ comments, including any treatments mentioned.

Robert Walton has nothing to disclose.

AUKCAR_Rob-Walton-Portrait-1_resized-for-new-site

About Robert Walton

Robert Walton is a Cochrane UK Senior Fellow in General Practice. Robert qualified in medicine in London in 1983, having taken an intercalated degree in human pharmacology and immunology. He trained at St Georges Hospital, London and became a member of the Royal College of Physicians in 1986. His work applying computerised decision support to prescribing drugs in the Department of Public Health and Primary care in Oxford led to a doctoral thesis in 1998. Robert was elected a Fellow of the Royal College of General Practitioners in 1999 and the Royal College of Physicians in 2001. He became a Senior Investigator in the National Institute for Health Research (NIHR) in 2016. Robert is Clinical Professor of Primary Medical Care at Queen Mary and was joint lead of the NIHR Research Design Service east London team. His research interests are in primary care, genetics, clinical trials and personalised medicine. Robert led a five-year NIHR funded programme developing a novel training intervention to promote smoking cessation in pharmacies in east London which included a substantive Cochrane review and meta analysis on behaviour change interventions in community pharmacies and a large scale cluster-randomised clinical trial. His research team is also developing a smartphone game to promote smoking cessation and researching a personalised/stratified medicine approach to tobacco dependence using computerised decision support. He sat on the NIHR Programme Grants for Applied Research sub panel A and worked as an evaluator for the European Union Horizon 2020 programmes Global Alliance for Chronic Diseases and New Therapies for Rare Diseases and as a monitor for EU projects. Robert contributes to UK national guidance, and has served on the National Institute for Health and Care Excellence (NICE) Outcome Indicator and Technology Appraisals Committees.

is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International

1 Comments on this post

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Dr. Walton, thank you for sharing your review. For children and those children with epilepsy, I have looked at their sensory processing to help prevent some of their motion sickness. There is a book “Understanding your Child’s Sensory Signals” by Angie Voss, OTR that helps families. I can also share with you my poster from the British Paediatric Neurology Association event in 2020 titled ” What are the perspectives and understanding of healthcare professionals including occupational therapists on treatment and care of babies with infantile spasms and early onset epilepsy- A qualitative design” if I have your email address.

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Evidently Cochrane

Chlorpheniramine for motion sickness

Affiliation.

  • 1 Department of Medicine, Dartmouth Medical School, One Medical Center Dr., Lebanon, New Hampshire 03756, USA. [email protected]
  • PMID: 15156097

Background: Motion sickness remains a significant problem for travelers and for those involved in naval, aviation and space operations. Many motion sickness remedies are also sedating, making them undesirable in many settings.

Methods: We studied chlorpheniramine as a potential motion sickness treatment. A placebo-controlled, double-blind, dose-ranging trial was performed to establish the most effective dose and the drug's effects on cognition. Eighteen normal, motion sickness susceptible subjects received placebo, low dose (4 mg) or high dose (12 mg) chlorpheniramine 3.5 hours before off-axis vertical rotation. Cognitive testing included a battery of objective and subjective tests performed before drug ingestion, at peak drug effect and following rotation.

Results: Chlorpheniramine significantly increased the time in the chair compared to placebo at high dose (7.2 minutes to 11.7 minutes) and low dose (7.2 minutes to 10.2 minutes). Chlorpheniramine did not affect performance on objective cognitive tests. Subjects reported significantly more sleepiness and less alertness with high-dose chlorpheniramine, although they could not reliably determine when they had received active drug.

Conclusion: Chlorpheniramine is effective and could be considered for use against motion sickness. Chlorpheniramine also has the potential to be administered transdermally.

Publication types

  • Clinical Trial
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  • Research Support, U.S. Gov't, Non-P.H.S.
  • Anti-Allergic Agents / adverse effects
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  • Chlorpheniramine / adverse effects
  • Chlorpheniramine / therapeutic use*
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  • Dose-Response Relationship, Drug
  • Double-Blind Method
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Managing motion sickness

  • Related content
  • Peer review
  • Louisa Murdin , academic clinical fellow in audiovestibular medicine 1 ,
  • John Golding , professor of applied psychology 2 ,
  • Adolfo Bronstein , professor of neuro-otology 3
  • 1 Department of Neuro-otology, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
  • 2 Department of Psychology, University of Westminster, London
  • 3 Centre for Neuroscience (Neuro-otology), Imperial College, London
  • Correspondence to: L Murdin louisa{at}murdin.com
  • Accepted 14 November 2011

Summary points

Motion sickness is a common and potentially disabling problem, thought to be due to sensory conflict or “mismatch” involving the vestibular system

Management using behavioural methods such as habituation can be effective and has few adverse effects, but can be unpleasant and time consuming

Hyoscine is an effective preventive medication for which oral preparations and transdermal patches are established in clinical practice, and emerging evidence suggests that hyoscine nasal spray is effective in preventing motion sickness

Evidence to support the use of other drugs, taking into account the trade off between efficacy and adverse effects, is weaker.

Management of motion sickness with traditional remedies such as ginger and acupressure bands has not been shown to be effective.

Motion sickness is a syndrome of nausea and vomiting, pallor, sweating, headache, dizziness, malaise, increased salivation, apathy, drowsiness, belching, hyperventilation, and stomach awareness. Symptoms can be provoked by externally imposed motion, or implied self motion from a moving visual field, such as in a cinema. The condition has been recognised from the early days of sea travel and the word for sickness, “nausea,” derives from the Greek word νανς, meaning “ship.”

Travel by car, train, or other transport is part of everyday life for most people, and motion sickness is a common problem. Estimating its prevalence is complex because reported symptoms depend on variables such as previous avoidance and exposure, as well as presumed inherent susceptibility. Some estimates are presented in table 1 ⇓ . Motion sickness may have an important effect on occupational activity for some people, such as airline pilots, those in the armed forces, and emergency services staff. General practitioners may frequently encounter patients who report difficulties in work or daily life related to motion sickness, or those seeking advice about prevention before a forthcoming journey. We review the management of patients with motion sickness for the generalist. This article is based on evidence obtained largely from controlled studies in patients and in healthy volunteers.

 Estimates of motion sickness by mode of transport

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Sources and selection criteria

We searched Clinical Evidence, PubMed, Medline, and Embase for articles using the keywords “motion sickness.” Articles were limited to studies in people published in the past 10 years (2000-11), focusing on clinical trials and review articles. We consulted a Cochrane Review on prevention and treatment of motion sickness. We also consulted personal reference collections.

Why do people get motion sickness?

There is no universally accepted explanation about why people get motion sickness. One commonly held view is that motion sickness originates from a mismatch between sensory inputs, especially between the visual and vestibular systems. For example, when travelling in a vehicle with limited outside visibility, the vestibular system reports motion to the central nervous system, but information from the visual system suggests the individual is not moving. Other forms of mismatch, such as visual motion without actual motion—for example, in a large cinema—can have the same effect. Motion sickness itself could have evolved from a system designed to protect from potential ingestion of neurotoxins by inducing vomiting when unexpected central nervous system inputs are detected (the “toxin detector” hypothesis). This system would then be activated by modern methods of transport that cause mismatch.

Less popular alternatives to the toxin detector hypothesis propose that motion sickness could be the result of aberrant activation of vestibular-cardiovascular reflexes 1 ; or that it might originate from a warning system that evolved to discourage development of perceptual motor programmes that are inefficient or cause spatial disorientation 2 or that motion sickness is a unfortunate consequence of the physical proximity of the motion detector (vestibular) and vomiting circuitry in the brainstem. 3

Who is most susceptible to motion sickness?

Experimental evidence supports the theory that, with varying thresholds of susceptibility, almost all healthy unmedicated individuals can get motion sickness in the right conditions. Some people may be more troubled by the condition than others, and reports of motion sickness depend on lifestyles and situations. For example, a professional pilot will be more troubled by new symptoms of air sickness than someone who never needs or wants to travel by aeroplane. Bearing these difficulties in mind, various large prospective surveys have estimated the frequency of symptoms of motion sickness (table 1).

Babies and young children under 2 do not usually get motion sickness. w1 However, motion sickness is more common in children under 15 than in adults, perhaps because of habituation—that is, reduction in symptom severity with repeated exposure. It is also more commonly reported in women than in men, although a number of potentially confounding variables related to social roles may account for this observation. Evidence from twin studies has shown that a large proportion of individual variation in susceptibility is due to genetic factors, with heritability estimates in the range 55-70%. w2

Some groups of patients are particularly susceptible. Self reported motion sickness is higher in people who have migraines than in those who have other types of headache. Furthermore, migraineurs characteristically report heightened sensitivity of all senses 7 —for example, phonophobia and photophobia—including vestibular and visual-vestibular inputs. 8 Many symptoms of motion sickness are reminiscent of a migraine attack. One large observational study of female yacht racers found that that individuals with migraine are more susceptible to motion sickness, and are prone to develop migraine headaches during provocative motion exposure. 9 Patients with vestibular migraine, in which vestibular symptoms and migraine are strongly associated, w3 report greater susceptibility than those with other forms of migraine (see “A patient’s story”). 10

Many patients with vestibular disorders also report symptoms during external motion. 11 By contrast, patients with absent vestibular function do not normally become motion sick, 12 although they are still partially susceptible to visually induced motion sickness. w4

How should the patient with motion sickness be assessed?

The diagnosis of motion sickness is made on the basis of reported symptoms in externally imposed motion. It is rare for motion sickness to be the presenting symptom of serious disease. Vestibular disease (peripheral or central) can present with motion sickness, but dizziness or vertigo will usually exist between exposures. Unilateral vestibular disease can be suggested by a positive head thrust test or positional manoeuvre. w5 Central vestibular disease can present with cerebellar symptoms and signs, so an eye movement and gait examination is essential. Mal de debarquement is a distinct presentation, which is discussed later in this article.

How can motion sickness be treated?

Behavioural counter measures.

Simple behavioural counter measures can be effective treatments for patients who experience motion sickness. A within person comparison showed that sickness was reduced when a stable visual reference point, such as the horizon, was provided, minimising visual-vestibular conflict during sea travel 13 (fig ⇓ ). Forward visibility is particularly helpful in coach or bus travel. 6 Alternatively, laboratory based observations showed that lying supine, where practical, reduces symptoms of motion sickness and is preferable to an upright seated posture. 14 Controlled studies have shown that deliberate restriction of head movements is helpful, as is avoidance of tasks that enhance visual-vestibular conflict, such as reading when travelling.

Fig 1 Visual-vestibular conflict. As the bus turns, the passenger on the left has a fixed external visual reference and has no visual-vestibular conflict. The passenger on the right, who is reading the paper, experiences a conflict because the visual input is still but the vestibular system is sensing motion (modified from Bronstein and Lempert w6 )

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Prospective controlled studies have shown that repeated exposure to the nauseogenic stimulus (habituation) is an effective treatment for motion sickness. 15 16 Habituation programmes pioneered by the military are effective but time consuming. For maximum efficacy, the exposure to the stimuli needs to be frequent and graded. The exposure is initially gentle, and is then increased by gradual increments to maximise acceptability and speed up recovery between sessions, and to avoid the undesirable effect of sensitisation to the stimulus. Habituation is specific to a particular stimulus: tolerance to car travel may have no effect on susceptibility to seasickness.

A prospective controlled study of healthy volunteers has shown that coping strategies such as controlled regular breathing or listening to music are more effective than placebo in reducing nausea. However the effect size was small, with provocative stimuli tolerated for around 10% longer. 17 A small but well designed prospective placebo controlled study showed no benefit of acupressure bands over control, w7 although a small trial showed Korean hand pressure to be more effective than sham pressure in reducing subjective nausea for emergency patients transported in ambulances. w8

Motion sickness is increasingly reported in the context of virtual environments, with head mounted or large field of view displays, when it is known as cybersickness or visually induced motion sickness. These devices are potentially useful tools for various research, health, training, and leisure activities. Cybersickness can be treated with habituation. 18

Antiemetic drugs

Most drugs in common use for motion sickness have been used for more than 30 years. Some of these drugs have been examined in small but well designed studies. However, most data have been obtained in studies involving healthy adults, usually men. Data on the effectiveness of these drugs for treating motion sickness in women and children are scarce, although these groups are generally more susceptible than men. Many of the drugs cause drowsiness and other adverse effects. Also, evidence suggests that some (for example, hyoscine) may delay habituation either directly or indirectly via sedative effects. 19 Consider drug treatment carefully in patients who could benefit from using habituation methods to overcome motion sickness, and discuss this disadvantage of using drugs with them before embarking on treatment. Some drugs in common use are shown in table 2 ⇓ .

 Common anti-motion sickness drugs (adapted from Benson, 2002 36 )

Gastric stasis occurs with motion sickness before the vomiting phase, so non-oral routes of administration, such as transdermal patches, are advantageous. Medication is most effective when taken before exposure rather than after the onset of symptoms. Drugs are useful in situations where habituation is impractical, such as solitary or infrequent journeys.

Antimuscarinics

Hyoscine (scopolamine) is available as tablets or liquid for oral ingestion, intravenous and subcutaneous injection, and transdermal patches. Its potential adverse effects include drowsiness, blurred vision, dry mouth, and dizziness, which reflect its muscarinic anticholinergic properties. However, many studies have reported that it is safe and well tolerated.

Patches are applied to the mastoid area 6-8 hours before exposure. Patch users should wash their hands thoroughly both before and after touching the patch, since hyoscine can be spread to the eyes by hand, which can cause blurred vision and pupil dilatation. Patches should never be cut into pieces, as this interferes with the drug release mechanism. One small randomised, crossover, double blind study in healthy young men reported on double dose hyoscine patch therapy as a potential treatment for those in whom a single patch is ineffective, and concluded that two patches were safe and well tolerated in this group. 20 Faster onset of action may be obtained through administration as a nasal spray. 21 A small randomised, placebo controlled, double blind crossover trial using experimentally induced motion sickness in young adults showed the nasal preparation to be effective, with no significant decrease in alertness. 22 A Cochrane systematic review concluded that hyoscine is more effective than placebo in treating the symptoms of motion sickness, but that its effectiveness compared with other treatments for the condition is unclear. 23 Selective M3 or M5 muscarinic receptor antagonists may also be effective against motion sickness. 24

Antihistamines

Antihistamines—including cinnarizine, meclozine, dimenhydrinate, cyclizine, chlorphenamine, and promethazine—are the other main group of drugs frequently used to treat motion sickness. These are available as prescribed and over the counter preparations. Cinnarizine at a dose of 50 mg was more effective than placebo at reducing symptoms in a double blind placebo controlled study, although 25 mg was not. 25 According to a small placebo controlled study of healthy young men, promethazine is effective given as a 50 mg intramuscular injection, but at the cost of considerable sedative effects. 16 Dimenhydrinate was found to be no more effective than placebo in another study of susceptible individuals. 26 Cetirizine and fexofenadine are ineffective, probably owing to a lack of central nervous system effects.

Central nervous system stimulants

Sympathomimetics such as dextroamphetamine have been documented to have efficacy in the prevention of motion sickness, either alone or in combination with other drugs, but their usefulness is limited by the potential for abuse and legal problems. Amphetamine has been discontinued as an anti-motion sickness treatment, apart from some limited use in special circumstances for the military. Modafinil, an alternative central nervous system stimulant, was recently evaluated as a potential treatment for motion sickness, but was not found to be effective alone in a double blind, placebo controlled study. w9

Ondansetron

Individuals with a history of motion sickness are at higher risk for postoperative and chemotherapy induced nausea and vomiting. Because 5-HT3 receptor antagonists such as ondansetron have revolutionised the management of nausea and vomiting, experts hoped they would be efficacious in the management of motion sickness. However, initial results of placebo controlled studies have not shown ondansetron to be effective among small groups of healthy volunteers w10 or larger groups of people with a history of high susceptibility to motion sickness. 26

Non drug remedies

Ginger is a popular traditional remedy for nausea. One small trial suggested that ginger was better than placebo in treating motion sickness 27 but another has shown it to be ineffective compared with hyoscine. 28 Supplemental oxygen may reduce motion sickness in patients being transported by ambulance, but does not alleviate the problem in individuals who are otherwise healthy. 29 This apparent paradox is perhaps explained by the suggestion that supplemental oxygen may work by ameliorating internal states that sensitise for motion sickness.

Combination treatments

Combinations of agents have also been selected with the aim of increasing efficacy and others to increase tolerability. One small study examined the combination of chlorpheniramine with ephedrine to combat the drowsiness which is so frequently a problem in managing motion sickness. A modest reduction in drowsiness was reported. 30 In another study of the prevention of air sickness, the combination of promethazine with caffeine was more effective than placebo, meclizine, or hyoscine and had fewer adverse effects. 31 Although no longer available for legal reasons, combinations of hyoscine or promethazine with amphetamine are highly effective.

Other drugs

5-ht receptor agonists.

Given the well known connections between migraine and motion sickness, w11 and the revolution in migraine management that has taken place thanks to the advent of 5-HT 1B/1D receptor agonists (triptans), experts hoped that these drugs might be useful in motion sickness, both in migraineurs and in non-migraineurs. Rizatriptan has been evaluated for efficacy in motion sickness in migraineurs in a double blind randomised placebo controlled study. Although the majority of participants with complete data reported a reduction in symptoms, the effect was small and not repeatable. 32

A number of small placebo controlled double blind studies have evaluated the effectiveness of phenytoin for treating motion sickness and found it to be effective on some, but not all, measures. 33 At the dose that is appropriate for treatment of epilepsy (approx 4-7 mg/kg daily for adults) the adverse effects of phenytoin are well known, including nausea, dizziness, constipation, mood changes, and blood dyscrasias. However, the doses required to prevent motion sickness would be smaller (previous studies used from 200 mg up to levels used for anticonvulsant treatment) and less frequent, which may be more tolerable.

Loperamide, a µ-opiate receptor antagonist known for its role in managing diarrhoea, has been evaluated in a small study of motion sickness. A statistically significant reduction in nausea was found, although in clinical terms the effect size was small. 34

What is mal de debarquement?

Mal de debarquement (from the French for “sickness of disembarkment”) is the persistence of imbalance or a rocking sensation after exposure to passive motion, especially a sea voyage. A transient sensation of this kind is normal, but some individuals report persistent and troublesome symptoms. 35 Mal de debarquement is usually managed along the same principles as other vestibular disorders, using customised vestibular rehabilitation exercises, but no studies have prospectively evaluated the efficacy of this approach. Consider referring patients with symptoms extending beyond one month to an audiovestibular physician or other specialist in vestibular disorders.

A patient’s story

I had mild motion sickness when travelling by car as a child, but my symptoms dramatically worsened when I developed acute labyrinthitis about 10 years ago. Since then I have become much more sensitive to motion, especially when travelling by bus. It’s best for me to be the driver, but the next best option is to sit in the passenger seat, and the back seat is worst of all. I’ve also developed troublesome vestibular migraine, and have noticed that travel and motion sickness can trigger a bad migraine attack a few hours after the journey. My migraines are managed with amitriptyline, and although they are still fairly frequent (a few episodes a week) I have learnt to manage them. They are less severe than they were. There is a definite relation between the migraine and the motion sickness, and the motion sickness is better when the migraines are under better control. I’ve had some physiotherapy, which has been helpful at times when the migraines have been well treated. It’s also been really helpful for me to see a specialist who has an interest in these problems, as I have found that some professionals haven’t appreciated the connections between my motion sickness, vertigo, and migraines.

Tips for non-specialists

Exclude central and peripheral vestibular disease in patients who report marked motion sickness

Motion sickness is linked to migraine. It is worth asking specifically about migraine symptoms in patients who present with motion sickness, since uncontrolled migraine can be treated prophylactically as well as acutely.

Habituation is a highly effective treatment when exposures are specific, graded, and frequent

Drug treatments can be selected according to factors such as desirability of sedation and duration of expected exposure

The most effective treatments for motion sickness are used in advance of an expected exposure

Gastric stasis occurs with motion sickness before the vomiting phase, so non-oral routes of administration, such as transdermal patches, are advantageous

Questions for future research

Are selective M5 muscarinic receptor antagonists effective treatments?

Can motion sickness be alleviated pharmacologically after symptoms are established, perhaps by using faster routes of administration?

Can the addition of alternative stimulant drugs to proved agents such as antihistamines and anticholinergics improve tolerability, especially with respect to drowsiness?

How can the known link between migraine, vestibular migraine, and motion sickness be exploited to better manage patients?

How do vestibular disorders contribute to motion sickness?

How can virtual reality technologies be adapted to avoid cybersickness, and do they have a role in preventing motion sickness in other settings?

Additional educational resources

For healthcare professionals.

Motion Sickness Susceptibility Questionnaire Short-form ( www.westminster.ac.uk/__data/assets/pdf_file/0010/47539/MSSQ-short.pdf )—questionnaire useful for quantifying susceptibility to motion sickness

Medical Aspects Of Harsh Environments: Motion Sickness ( www.bordeninstitute.army.mil/published_volumes/harshEnv2/HE2ch35.pdf )— a more detailed review of the topic 36

For patients

NHS Choices ( www.nhs.uk/Conditions/Motion-sickness/Pages/Introduction.aspx )—information for patients about motion sickness

Vestibular Disorders Association ( www.vestibular.org )—support for patients with vestibular disorders and doctors treating them

Travel Sickness ( www.bbc.co.uk/health/physical_health/conditions/travelsickness1.shtml )—overview and advice on BBC Health site

Cite this as: BMJ 2011;343:d7430

Contributors: LM drafted and critically revised the manuscript, AB and JG critically revised the manuscript, all authors have approved the final version.

Competing interests: All authors have completed the All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Provenance and peer review: Commissioned, externally peer reviewed.

  • ↵ Golding JF. Motion sickness susceptibility. Auton Neurosci 2006 ; 129 : 67 -76. OpenUrl CrossRef PubMed
  • ↵ Guedry FE, Rupert AR, Reschke MF. Motion sickness and development of synergy within the spatial orientation system. A hypothetical unifying concept. Brain Res Bull 1998 ; 47 : 475 -80. OpenUrl CrossRef PubMed Web of Science
  • ↵ Balaban CD. Vestibular autonomic regulation (including motion sickness and the mechanism of vomiting). Curr Opin Neurol 1999 ; 12 : 29 -33. OpenUrl CrossRef PubMed Web of Science
  • Turner M, Griffin MJ, Holland I. Airsickness and aircraft motion during short-haul flights. Aviat Space Environ Med 2000 ; 71 : 1181 -9. OpenUrl PubMed Web of Science
  • Lawther A, Griffin MJ. A survey of the occurrence of motion sickness amongst passengers at sea. Aviat Space Environ Med 1988 ; 59 : 399 -406. OpenUrl PubMed Web of Science
  • ↵ Turner M, Griffin MJ. Motion sickness in public road transport: the relative importance of motion, vision and individual differences. Br J Psychol 1999 ; 90 : 519 -30. OpenUrl CrossRef PubMed
  • ↵ .Afridi SK, Goadsby PJ. Neuroimaging of migraine. Curr Pain Headache Rep 2006 ; 10 : 221 -4. OpenUrl CrossRef PubMed
  • ↵ Murdin L, DaviesRA, Bronstein AM. Vertigo as a migraine trigger. Neurology 2009 ; 73 : 638 -42. OpenUrl Abstract / FREE Full Text
  • ↵ Grunfeld E, Gresty MA. Relationship between motion sickness, migraine and menstruation in crew members of a “round the world” yacht race. Brain Res Bull 1998 ; 47 : 433 -6. OpenUrl CrossRef PubMed Web of Science
  • ↵ Boldingh MI, Ljostad U, Mygland A, Monstad P.Vestibular sensitivity in vestibular migraine: VEMPs and motion sickness susceptibility. Cephalalgia 2011 ; 31 : 1211 -9. OpenUrl Abstract / FREE Full Text
  • ↵ Yardley L, Masson E, Verschuur C, Haacke N, Luxon L. Symptoms, anxiety and handicap in dizzy patients—development of the vertigo symptom scale. J Psychosomat Res 1992 ; 36 : 731 -41. OpenUrl CrossRef PubMed Web of Science
  • ↵ Cheung BS, Howard IP, Money KE. Visually-induced sickness in normal and bilaterally labyrinthine-defective subjects. Aviat Space Environ Med 1991 ; 62 : 527 -3. OpenUrl PubMed Web of Science
  • ↵ Bos JE, MacKinnon SN, Patterson A. Motion sickness symptoms in a ship motion simulator: effects of inside, outside,and no view. Aviat Space Environ Med 2005 ; 76 : 1111 -8. OpenUrl PubMed Web of Science
  • ↵ Golding JF, Markey HM, Stott JR. The effects of motion direction, body axis, and posture on motion sickness induced by low frequency linear oscillation. Aviat Space Environ Med 1995 ; 66 : 1046 -51. OpenUrl PubMed Web of Science
  • ↵ Yen Pik SF, Billar J, Gresty MA, Golding JF. Effect of a novel motion desensitization training regime and controlled breathing on habituation to motion sickness. Percept Mot Skills 2005 ; 101 : 244 -56. OpenUrl PubMed Web of Science
  • ↵ Cowings PS, Toscano WB, DeRoshia C, Miller NE. Promethazine as a motion sickness treatment: impact on human performance and mood states. Aviat Space Environ Med 2000 ; 71 : 1013 -22. OpenUrl PubMed Web of Science
  • ↵ Yen Pik Sang FD, Billar JP, Golding JF, Gresty MA. Behavioral methods of alleviating motion sickness: effectiveness of controlled breathing and a music audiotape. J Travel Med 2003 ; 10 : 108 -11. OpenUrl PubMed Web of Science
  • ↵ Howarth P, Hodder S. Characteristics of habituation tomotion in a virtual environment. Displays 2008 ; 29 : 117 -23. OpenUrl CrossRef Web of Science
  • ↵ van Marion WF, Bongaerts MC, Christiaanse JC, Hofkamp HG, van OW. Influence of transdermal scopolamine on motion sickness during 7 days’ exposure to heavy seas. Clin Pharmacol Ther 1985 ; 38 : 301 -5. OpenUrl CrossRef PubMed
  • ↵ Bar R, Gil A, Tal D. Safety of double-dose transdermal scopolamine. Pharmacotherapy 2009 ; 29 : 1082 -8. OpenUrl CrossRef PubMed Web of Science
  • ↵ Klocker N, Hanschke W, Toussaint S, Verse T. Scopolamine nasal spray in motion sickness: a randomised, controlled, and crossover study for the comparison of two scopolamine nasal sprays with oral dimenhydrinate and placebo. Eur J Pharm Sci 2001 ; 13 : 227 -32. OpenUrl CrossRef PubMed
  • ↵ Simmons RG, Phillips JB, Lojewski RA, Wang Z, Boyd JL, Putcha L. The efficacy of low-dose intranasal scopolamine for motion sickness. Aviat Space Environ Med 2010 ; 81 : 405 -12. OpenUrl CrossRef PubMed Web of Science
  • ↵ Spinks A, Wasiak J. Scopolamine (hyoscine) for preventing and treating motion sickness. Cochrane Database Syst Rev 2011 ; 6 : CD002851 . OpenUrl PubMed
  • ↵ Golding JF, Stott JR. Comparison of the effects of a selective muscarinic receptor antagonist and hyoscine (scopolamine) on motion sickness, skin conductance and heart rate. Br J Clin Pharmacol 1997 ; 43 : 633 -7. OpenUrl CrossRef PubMed
  • ↵ Doweck I, Gordon CR, Spitzer O, Melamed Y, Shupak A. Effect of cinnarizine in the prevention of seasickness. Aviat Space Environ Med 1994 ; 65 : 606 -9. OpenUrl PubMed
  • ↵ Muth ER, Elkins AN. High dose ondansetron for reducing motion sickness in highly susceptible subjects. Aviat Space Environ Med 2007 ; 78 : 686 -92. OpenUrl PubMed Web of Science
  • ↵ Lien HC, Sun WM, Chen YH, Kim H, Hasler W, Owyang C. Effects of ginger on motion sickness and gastric slow-wave dysrhythmias induced by circular vection. Am J Physiol Gastrointest Liver Physiol 2003 ; 284 : G481 -9. OpenUrl Abstract / FREE Full Text
  • ↵ Stewart JJ, Wood MJ, Wood CD, Mims ME. Effects of ginger on motion sickness susceptibility and gastric function. Pharmacology 1991 ; 42 : 111 -20. OpenUrl CrossRef PubMed Web of Science
  • ↵ Ziavra NV, Yen Pik Sang FD, Golding JF, Bronstein AM, Gresty MA. Effect of breathing supplemental oxygen on motion sickness in healthy adults. Mayo Clin Proc 2003 ; 78 : 574 -8. OpenUrl CrossRef PubMed Web of Science
  • ↵ Buckey JC Jr, Alvarenga DL, MacKenzie TA. Chlorpheniramine and ephedrine in combination for motion sickness. J Vestib Res 2007 ; 17 : 301 -11. OpenUrl PubMed
  • ↵ Estrada A, LeDuc PA, Curry IP, Phelps SE, Fuller DR. Airsickness prevention in helicopter passengers. Aviat Space Environ Med 2007 ; 78 : 408 -13. OpenUrl PubMed Web of Science
  • ↵ Furman JM, Marcus DA, Balaban CD. Rizatriptan reduces vestibular-induced motion sickness in migraineurs. J Headache Pain 2011 ; 12 : 81 -8. OpenUrl CrossRef PubMed Web of Science
  • ↵ Albert EG. Phenytoin for the prevention of motion sickness. Med J Aust 2003 ; 178 : 575 -6. OpenUrl PubMed Web of Science
  • ↵ Otto B, Riepl RL, Otto C, Klose J, Enck P, Klosterhalfen S. mu-Opiate receptor agonists—a new pharmacological approach to prevent motion sickness? Br J Clin Pharmacol 2006 ; 61 : 27 -30. OpenUrl CrossRef PubMed
  • ↵ Cha YH. Mal de debarquement. Semin Neurol 2009 ; 29 : 520 -7. OpenUrl CrossRef PubMed
  • ↵ Benson AJ. Motion sickness. In: Pandolf K, Burr R, eds. Medical aspects of harsh environments vol 2. Walter Reed Army Medical Center; 2002.

can piriton help travel sickness

Breastfeeding and Medication

Wendy’s Support on Breastfeeding and Medication

Home » Fact Sheet » Travel Sickness and Breastfeeding

Travel Sickness and Breastfeeding

Copy of this information is available as a pdf

https://breastfeeding-and-medication.co.uk/wp-content/uploads/2023/05/travel-sicknes-and-breastfeeding.pdf

As the summer season and travels begin, my mind has turned to travel sickness and breastfeeding. I suffer badly personally!

I hope this helps you enjoy your travels rather than dread them

can piriton help travel sickness

Causes of travel sickness

Travel sickness or motion sickness happens when the body, the inner ear, and the eyes send conflicting signals to the brain. This most often happens when you are in a car, boat, or airplane, but it may also happen on flight simulators or amusement park rides.

It is more common in children and in women. Sitting in the back of the car can also be a trigger for many people or a on a coach. I personally find the new trains which are faster much harder to deal with as they seem to sway much more.

It is difficult as a breastfeeding mother to deal  with your own travel sickness as well as a baby or children. You may be able to drive rather than be a passenger. If not ,then there are medications which you can take which wont reduce your supply (because only being used short term) or affect your baby. Some temporary drowsiness is possible with any medicine which makes you drowsy.

Symptoms of travel sickness

Symptoms can come on very suddenly but rapidly escalate:

  • Nausea and vomiting
  • Cold sweats
  • Increased salivation
  • Difficulty concentrating
  • Rapid breathing

These are symptoms not dissimilar to panic.

  • If you are breastfeeding and need to care for a baby you  may prefer one that is less likely to cause drowsiness – e.g.  cinnarizine (Stugeron™)
  • Hyoscine (Kwells ™, Joy Rides™) is usually regarded as the most effective medicine for motion sickness taken 30-60 minutes before the journey.
  • Prochlorperazine (Buccastem™, Stemetil™)
  • Cyclizine might be prescribed for you but is no longer available over the counter.
  • Hyoscine patch can be prescribed. These are applied behind the ear 5-6 hours before travelling.
  • Metoclopramide and domperidone may be useful to slow gastric emptying but are generally not prescribed for travel sickness.
  • Homeopathic remedies e.g. Nelson’s Travella has limited research but is not harmful to the breastfed infant if it is a remedy which the mother finds useful.
  • Antihistamines which cause drowsiness e.g. promethazine (Phenergan™, chlorpheniramine (Piriton ™) may be useful for children who struggle with travel sickness although it is rare before the age of 2 years.

Acupressure Bands

Some studies suggest that acupressure may help reduce symptoms of motion sickness in the same way as acupuncture. Acupressure bands are available commercially to help prevent motion sickness. Studies suggest these bands may help delay the onset of symptoms.

Traditionally, the acupuncture point known as Pericardium 6 is said to help relieve nausea. It is on the inside of the wrist, about the length of 2 fingernails up the arm from the centre of the wrist crease.

To reduce risk of travel sickness without medication

https://www.nhs.uk/conditions/motion-sickness/

  • sit in the front of a car or in the middle of a boat.
  • look straight ahead at a fixed point, such as the horizon rather than at a book, phone screen or portable device.
  • fresh air e.g.  open a car window
  • close your eyes and breathe slowly while focusing on your breathing.
  • distract children by talking, listening to music or singing songs.
  • break up long journeys to get some fresh air, drink water or take a walk.
  • some people recommend ginger, as a tablet, biscuit or tea but if you have had significant sickness in pregnancy this may bring back memories!
  • Avoid heavy or fatty meals.

Fear of flying

One of the questions I have had frequently at this time of year has been about supporting the breastfeeding mother who has a fear of flying. I know this feeling myself so can empathise. I have always wanted to keep my headphones on and focus on breathing and listening to my music/relaxation most just when you are coming in to land and are told to take them off. I resort to counting backwards from a thousand.

However, diazepam as one or two low doses can be prescribed during breastfeeding. At worst the baby may temporarily be a little drowsy, but in practice this doesn’t seem to happen ( they are often too busy looking round and being social!)

Don’t forget to pack plastic bags or bowls ( just in case), wipes and cold water if the worst happens.

can piriton help travel sickness

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Nausea medicine

Peer reviewed by Dr Colin Tidy, MRCGP Last updated by Dr Doug McKechnie, MRCGP Last updated 20 Jun 2024

Meets Patient’s editorial guidelines

In this series: Nausea and vomiting Dehydration

Various medicines are available to treat nausea . They work in different ways to one another. These medicines are not usually started until your doctor is sure what has caused your nausea. This is because knowing the cause helps your doctor to choose the right medicine for you. If they are required then any medicine usually only needs to be taken for a few days. Most people are able to take these medicines.

In this article :

Types of nausea medicine, when is nausea medicine prescribed, which medicine is usually prescribed for nausea, side-effects of nausea medicine.

Continue reading below

The medicines for nausea used are sometimes called antiemetics. Some of these medicines work on the gut and speed up how quickly food moves through it. Other medicines work on the brain and block signals to the vomiting centre. Listed below are some of the more commonly prescribed medicines:

Cinnarizine , cyclizine , promethazine - these medicines belong to a group of medicines called antihistamines . The exact way that they work is not fully understood. It is thought that antihistamines block histamine 1 (H1) receptors in the area of the brain which creates nausea in response to chemicals in the body. They are thought to work well for nausea caused by a number of conditions including ear problems and motion (travel) sickness.

Hyoscine - this medicine works by blocking a chemical in the brain called acetylcholine. It is a type of medicine called an antimuscarinic (or anticholinergic). It works well for nausea caused by ear problems and motion sickness.

Chlorpromazine , haloperidol , perphenazine, prochlorperazine , levomepromazine - these medicines work by blocking a chemical in the brain called dopamine. They are useful for nausea that is caused by some cancers, radiation and opiate medicines such as morphine and codeine. Prochlorperazine (or brand name Stemetil®) is one of the most used medicines for nausea. It works for many common causes of nausea, including vertigo, ear problems and sickness in pregnancy.

Metoclopramide - this medicine works directly on your gut. It eases the feelings of sickness by helping to empty the stomach and speed up how quickly food moves through the gut. It is often used for people with sickness due to gut problems or migraine. It is not usually used for more than a few days.

Domperidone - this medicine works on an area of the brain called the chemoreceptor trigger zone (CTZ). It also speeds up the emptying of the gut. It is not usually used for more than a few days. The use of domperidone is strictly regulated following a 2014 warning about the risk of cardiac (heart) side-effects. It is no longer available over the counter and should only be used at the lowest effective dose for the shortest possible time.

Dexamethasone - this is a steroid medicine. It is a man-made version of a natural hormone produced by your own body. Dexamethasone has a wide range of actions on many parts of the body. The reason why it reduces nausea is not clear. It is often used to prevent nausea and vomiting after an anaesthetic, or during chemotherapy.

Granisetron , ondansetron , and palonosetron - these medicines work by blocking a chemical called serotonin (5-HT) in the gut, and the brain. Serotonin (5-HT) has an action in the gut and the brain to cause nausea. These medicines are useful for controlling nausea and vomiting caused by chemotherapy. Ondansetron is also sometimes used to treat nausea and vomiting from gastroenteritis .

Aprepitant and fosaprepitant - these are newer medicines and work by blocking a chemical that acts on neurokinin receptors in the body to cause nausea. They are sometimes called neurokinin-1 receptor antagonists. They are usually given to people on a certain type of chemotherapy.

Nabilone - it is still not clear how this medicine works to control nausea. It is normally prescribed for people who are having chemotherapy.

Medicines for nausea are usually only prescribed once your doctor is sure what is causing your feeling of sickness (nausea). This is because, in a lot of cases, if you treat the condition causing your nausea, it will go away. For example, if your nausea is caused by taking too much of a particular medicine, your doctor will reduce the dose and your nausea will often go away.

If the cause of your nausea is not known, your doctor can still prescribe a medicine for you but it is much better to know what the cause is so the right medicine can be chosen.

Nausea medicine is also commonly prescribed when doctors are giving a drug that is likely to cause nausea and vomiting as a side-effect, such as chemotherapy, or general anaesthetic for an operation. This aims to stop the nausea from happening, or at least reduce it significantly.

The choice of medicine depends on various factors, including:

What is causing your feeling of sickness (nausea).

Whether you have any other medical conditions.

Whether you are pregnant.

Possible side-effects of the medicines.

It is not possible to list all the conditions that can cause nausea and which treatments are usually prescribed. However, some examples include:

Motion (travel) sickness

Hyoscine is the most effective medicine for motion sickness. Promethazine, cyclizine, or cinnarizine also work well. See the separate leaflet called Motion sickness (Travel sickness) for more detail .

Nausea and vomiting affects women differently in pregnancy. If the symptoms are severe, medications can help to control them.

Preferred medication choices in pregnancy include promethazine, cyclizine, prochlorperazine, doxylamine and pyridoxine (Xonvea ®) and metoclopramide may be prescribed. This is because they are not thought to harm the unborn baby.

Ondansetron can also be used, although it is possibly linked to a very small increase in the risk of the baby developing cleft palate and certain heart defects. It's usually kept as a second- or third-line option for women with severe nausea and vomiting in pregnancy.

Steroid tablets are sometimes used for severe nausea and vomiting in pregnancy that has not responded to several other treatments.

See the separate leaflet called Nausea and vomiting in pregnancy for more detail .

Both metoclopramide and domperidone work well for nausea caused by a migraine. See the separate leaflet called Migraine treatment for more detail .

Chemotherapy

It is not unusual to take a combination of different medicines to control nausea and vomiting if you have chemotherapy. Some chemotherapy medicines are more likely than others to cause nausea and vomiting.

If you have chemotherapy that has a low risk of nausea, your doctor will usually prescribe metoclopramide or domperidone. If you have chemotherapy that has a high risk of nausea, three medicines that work in a different way to each other may be prescribed - for example, ondansetron, dexamethasone and aprepitant. See the separate leaflet called Chemotherapy for more detail.

It is not possible to list all the possible side-effects of each of these medicines in this leaflet. However, as with all medicines, there are a number of side-effects that have been reported. To see the side-effects specific to your medicine, see the information leaflet that came with your medicine.

Common side-effects may include:

Constipation .

Headaches .

Drowsiness or tiredness.

Trouble with sleeping ( insomnia ).

Indigestion .

However, the side-effects are different with each different medicine. Most side-effects are not serious and each person may react differently to these medicines. Usually most people do not get the side-effects listed; however, they can happen to some people.

Further reading and references

  • British National Formulary (BNF) ; NICE Evidence Services (UK access only)
  • Flake ZA, Linn BS, Hornecker JR ; Practical selection of antiemetics in the ambulatory setting. Am Fam Physician. 2015 Mar 1;91(5):293-6.
  • Becker DE ; Nausea, vomiting, and hiccups: a review of mechanisms and treatment. Anesth Prog. 2010 Winter;57(4):150-6; quiz 157. doi: 10.2344/0003-3006-57.4.150.
  • Domperidone: risks of cardiac side effects. MHRA ; 2014

Article history

The information on this page is written and peer reviewed by qualified clinicians.

Next review due: 19 Jun 2027

20 jun 2024 | latest version.

Last updated by

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Nausea and labyrinth disorders

Drug treatment.

Antiemetics are generally only prescribed when the cause of vomiting is known because otherwise, they may delay diagnosis, particularly in children. If antiemetic drug treatment is indicated, the drug is chosen according to the aetiology of vomiting.

Antihistamines (e.g. cinnarizine , cyclizine , promethazine hydrochloride , promethazine teoclate ) are effective against nausea and vomiting resulting from many underlying conditions. The duration of action and incidence of adverse effects, such as drowsiness and antimuscarinic effects, differ between antihistamines.

The phenothiazines (e.g. chlorpromazine hydrochloride , prochlorperazine , trifluoperazine ) are dopamine antagonists and act centrally by blocking the chemoreceptor trigger zone. Severe dystonic reactions sometimes occur with phenothiazines, especially in children. Prochlorperazine is less sedating and available as a buccal tablet for children aged 12 years and over, which can be useful in patients with persistent vomiting or with severe nausea.

Other antipsychotic drugs including haloperidol [unlicensed use] and levomepromazine are used for the relief of nausea and vomiting in palliative care. A Strength of recommendation: High For information on the use of antiemetics in palliative care, see Prescribing in palliative care .

Metoclopramide hydrochloride is an effective antiemetic and its activity closely resembles that of the phenothiazines. Metoclopramide hydrochloride also acts directly on the gastric smooth muscle stimulating gastric emptying and it may be superior to the phenothiazines for emesis associated with gastro-intestinal and biliary disease. It is licensed for use in children only as a second-line option for the prevention of delayed chemotherapy-induced nausea and vomiting, and the treatment of established postoperative nausea and vomiting. There is an increased risk of neurological side-effects in children.

Domperidone acts at the chemoreceptor trigger zone. It has the advantage over metoclopramide hydrochloride and the phenothiazines of being less likely to cause central effects, such as sedation and dystonic reactions, because it does not readily cross the blood-brain barrier.

The 5HT 3 -receptor antagonists, granisetron and ondansetron , are used in the management of nausea and vomiting in children receiving cytotoxics. A Strength of recommendation: High

Dexamethasone has antiemetic effects and is used in the management of chemotherapy-induced nausea and vomiting. A Strength of recommendation: High

The neurokinin 1-receptor antagonist, aprepitant , is used to prevent nausea and vomiting associated with chemotherapy. It is usually given in combination with a 5HT 3 -receptor antagonist (with or without a corticosteroid). A Strength of recommendation: High For further information on the prevention of nausea and vomiting caused by chemotherapy, see Cytotoxic drugs .

Nabilone is a synthetic cannabinoid with antiemetic properties. There is limited evidence for nabilone use in children for nausea and vomiting caused by cytotoxic chemotherapy unresponsive to conventional antiemetics.

Nausea and vomiting during pregnancy

Nausea and vomiting in the first trimester of pregnancy is common and will usually resolve spontaneously within 16 to 20 weeks. For pregnant females who have nausea and vomiting, offer appropriate self-care advice (such as rest, oral hydration and dietary changes), and inform them about other available support (e.g. self-help information and support groups) and when to seek urgent medical advice. Take into consideration that a number of interventions may have already been tried. Antiemetics should be considered for females with persistent symptoms where self-care measures have been ineffective. If a non-pharmacological option is preferred, ginger may be helpful for mild to moderate nausea. A Strength of recommendation: High

For females who choose pharmacological treatment, offer an antiemetic considering the advantages and disadvantages of each drug, as well as patient preference, and their experience with treatments in previous pregnancies. Although few drug options are specifically licensed for nausea and vomiting associated with pregnancy, their use is established practice. Antiemetic options include: cyclizine , prochlorperazine , promethazine hydrochloride , promethazine teoclate , and ondansetron . For further information on antiemetic options, see NICE guideline: Antenatal care (available at: https://www.nice.org.uk/guidance/ng201 ). Assess response to treatment after 24 hours; if the response is inadequate, switch to an antiemetic from a different therapeutic class. Reassess after 24 hours and if symptoms have not settled, specialist opinion should be sought. For females who have moderate to severe nausea and vomiting, consider intravenous fluids and adjunctive treatment with acupressure. A Strength of recommendation: High

Hyperemesis gravidarum is a more serious condition, which requires regular antiemetic therapy, intravenous fluid and electrolyte replacement, and sometimes nutritional support. For females with severe or persistent hyperemesis gravidarum, antiemetics given by the parenteral or rectal routes may be more suitable than the oral route. Supplementation with thiamine must be considered in order to reduce the risk of Wernicke’s encephalopathy. A Strength of recommendation: High

Postoperative nausea and vomiting

The incidence of postoperative nausea and vomiting depends on many factors including the anaesthetic used, and the type and duration of surgery. Other risk factors include post-pubertal female sex, over 3 years of age, a history or family history of postoperative nausea and vomiting or motion sickness, and postoperative use of long-acting opioids. Therapy to prevent postoperative nausea and vomiting should be based on the assessed risk of postoperative nausea and vomiting in each patient. A combination of antiemetic drugs that have different mechanisms of action is often indicated in those at moderate and high risk of postoperative nausea and vomiting. When a prophylactic antiemetic drug has failed, postoperative nausea and vomiting should be treated with an antiemetic drug from a different therapeutic class. A Strength of recommendation: High

Drugs used include 5HT 3 -receptor antagonists (e.g. ondansetron ), dexamethasone, and droperidol . A Strength of recommendation: High Cyclizine is licensed for the prevention and treatment of postoperative nausea and vomiting caused by opioids and general anaesthetics. Prochlorperazine is licensed for the prevention and treatment of nausea and vomiting.

Opioid-induced nausea and vomiting

Expert sources advise that cyclizine , ondansetron, and prochlorperazine are used to relieve opioid-induced nausea and vomiting; ondansetron has the advantage of not producing sedation.

Motion sickness

Antiemetics should be given to prevent motion sickness rather than after nausea or vomiting develop. Hyoscine hydrobromide is licensed to prevent motion sickness symptoms such as nausea, vomiting, and vertigo. For children aged 10 years and over, a transdermal hyoscine patch provides prolonged activity but it needs to be applied several hours before travelling. Antihistamine drugs may also be effective; the less sedating antihistamines include cinnarizine and cyclizine , and the more sedating antihistamines include promethazine hydrochloride and promethazine teoclate . Domperidone, metoclopramide hydrochloride, 5HT 3 -receptor antagonists, and the phenothiazines (except promethazine—an antihistamine phenothiazine) are ineffective in motion sickness.

Nausea and vomiting associated with migraine

For information on the use of antiemetics in migraine attacks, see Migraine .

Related drugs

  • Chlorpromazine hydrochloride
  • Cinnarizine
  • Domperidone
  • Granisetron
  • Haloperidol
  • Hyoscine hydrobromide
  • Levomepromazine
  • Metoclopramide hydrochloride
  • Ondansetron
  • Prochlorperazine
  • Promethazine hydrochloride
  • Promethazine teoclate
  • Trifluoperazine

Related treatment summaries

  • Cytotoxic drugs

The content on the NICE BNFC site (BNFC) is the copyright of BMJ Publishing Group Ltd, the Royal Pharmaceutical Society of Great Britain, and RCPCH Publications Ltd. By using BNFC, you agree to the licence set out in the BNF Publications End User Licence Agreement .

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Allergy Pills Can Help Manage Vertigo Symptoms, Study Finds

Grace Cary / Getty Images

Key Takeaways

  • A recent study found allergy pills were better at treating symptoms of vertigo than benzodiazepine. 
  • Antihistamines work by blocking signals to the brain that cause symptoms of vertigo, including dizziness, nausea, and sickness.  
  • Most cases of vertigo are benign and may not require medication.

Vertigo can be debilitating, especially since the dizzy episodes can last anywhere from a few minutes to several hours or even weeks. While some cases of vertigo resolve on their own, others may require medication or therapy.

Healthcare providers sometimes prescribe allergy and anxiety medications as "vestibular suppressants” to treat vertigo symptoms, but their effectiveness was not well-researched.

What Is Vertigo?

Vertigo is a sensation that the environment around you is spinning or tilting. It can make you feel dizzy, off balance, lightheaded, and nauseous. Vertigo is not a disease but a symptom of different conditions. 

A new analysis found that antihistamines , which are used to treat allergies, were better at treating patients who have acute vertigo, compared to benzodiazepines (or tranquilizers).

The researchers found no studies that suggested benzodiazepines offer any benefits for patients with acute vertigo, according to Benton Hunter, MD, FACEP , lead author of the study and professor of clinical emergency medicine at Indiana University School of Medicine. 

Hunter said that providers sometimes prescribe benzodiazepines for vertigo symptoms, but the available evidence suggests that they are ineffective and this class of drugs is highly addictive.

How Are Benzodizepines Used?

Benzodiazepines, also known as Benzos, are primarily used as sedatives to treat anxiety, insomnia, and panic disorder. Long-term use of benzodiazepines can lead to misuse and dependence.

Antihistamines vs. Benzodiazepines

For the analysis, the researchers reviewed data from 17 trials that included 1,586 participants. They found that a single dose of antihistamines resulted in better improvement of vertigo symptoms than a dose of benzodiazepines within two hours.

However, the use of antihistamines did not resolve the symptoms of vertigo entirely after four weeks.

Taking either antihistamines or benzodiazepines daily had no lasting effects on symptom relief either. “It is possible that the body quickly builds tolerance to the vestibular suppressing effect of these medications, or that the medication doesn't truly have a large beneficial effect,” Hunter said. 

The researchers noted that larger randomized trials comparing both antihistamines and benzodiazepines with placebo are needed to better clarify the efficacy of these medications. 

Why Might Antihistamines Help Alleviate Vertigo Symptoms? 

Antihistamines are thought to suppress the vestibular system, which is a sensory system responsible for providing our brain with information about spatial orientation, motion, and head position.

They work by blocking the signals to the brain that cause vertigo-related symptoms, such as nausea, dizziness, or motion sickness.

Amy Sarow, AuD , a clinical audiologist in Michigan, told Verywell in an email that depending on the cause of vertigo, antihistamines may not always provide relief.

For people who have allergies, the pressure from inflammation in the sinuses can affect the eustachian tube , which can disrupt the inner ear balance system and cause a dizzying sensation.

“If this is the source of the dizziness, antihistamines can help by relieving the inflammation caused by the allergies,” Sarow said. “If the source of the dizziness is not related to allergies, this medication is unlikely to provide benefit.” 

What Should You Do If You Have Vertigo? 

There are many causes of vertigo and some are treated differently than others, Hunter said. He recommends seeing a healthcare provider to determine the underlying cause and possible treatment options. In most benign cases, medications are not required.

“Our study looked at options for patients with vertigo in general. But, for example, benign positional vertigo is best treated with head exercises and not necessarily antihistamines or any other medications,” Hunter said. “Vertigo can also be a sign of stroke, so I don’t recommend taking any medication without seeing a doctor to determine the cause of vertigo.”

If you need medications to treat your vertigo symptoms, you could discuss with your provider about taking antihistamines.

“Chronic benzodiazepine use is likely a poor option, while antihistamines may be reasonable to try,” Hunter said. “Based on available evidence, benzodiazepines should not be used for vertigo. We did not find any evidence that they are effective at improving symptoms at all.” 

What This Means For You

If you are experiencing vertigo, speak with your healthcare provider to determine the potential causes and the best treatment plan for the condition.

Casani AP, Gufoni M, Capobianco S.  Current insights into treating vertigo in older adults .  Drugs Aging . 2021;38(8):655-670. doi:10.1007/s40266-021-00877-z

Hunter BR, Wang AZ, Bucca AW, et al. Efficacy of benzodiazepines or antihistamines for patients with acute vertigo: A systematic review and meta-analysis .  JAMA Neurol.  Published online July 18, 2022. doi:10.1001/jamaneurol.2022.1858

National Library of Medicine. Chapter 14: The vestibular system . In Purves D, Augustine GJ, Fitzpatrick D, et al., eds. Neuroscience . 2nd ed. Sinauer Associates; 2001.  

Dyhrfjeld‐Johnsen J, Attali P. Management of peripheral vertigo with antihistamines: New options on the horizon .  Br J Clin Pharmacol . 2019;85(10):2255-2263. doi:10.1111%2Fbcp.14046

Cleveland Clinic. Can allergies make you dizzy?

By Alyssa Hui Hui is a health news writer and former TV news reporter. She was the 2020 recipient of the Midwest Broadcast Journalists Association Jack Shelley Award.

Piriton Uses, Dosage, Side Effects, Food Interaction and all others data.

Piriton is an alkylamine antihistamine. It is one of the most potent H1 blocking agents and is generally effective in relatively low doses. Piriton is not so prone to produce drowsiness, readily absorbed from the gastro-intestinal tract, metabolised in the liver and excreted usually mainly as metabolised in the urine.

In allergic reactions an allergen interacts with and cross-links surface IgE antibodies on mast cells and basophils. Once the mast cell-antibody-antigen complex is formed, a complex series of events occurs that eventually leads to cell-degranulation and the release of histamine (and other chemical mediators) from the mast cell or basophil. Once released, histamine can react with local or widespread tissues through histamine receptors. Histamine, acting on H1-receptors, produces pruritis, vasodilatation, hypotension, flushing, headache, tachycardia, and bronchoconstriction. Histamine also increases vascular permeability and potentiates pain. Piriton, is a histamine H1 antagonist (or more correctly, an inverse histamine agonist) of the alkylamine class. It competes with histamine for the normal H1-receptor sites on effector cells of the gastrointestinal tract, blood vessels and respiratory tract. It provides effective, temporary relief of sneezing, watery and itchy eyes, and runny nose due to hay fever and other upper respiratory allergies.

Table Of contents

  • Side Effect
  • Precautions
  • Interactions
  • Uses during Pregnancy
  • Uses during Breastfeeding
  • Accute Overdose

Food Interaction

  • Volume of Distribution
  • Interaction With other Medicine
  • Contradiction

Piriton

Indicated mainly in allergic conditions including urticaria, sensitivity reactions, angioneurotic oedema, seasonal hay fever, vasomotor rhinitis, cough, common cold, motion sickness.

Piriton is also used to associated treatment for these conditions: Allergic Contact Dermatitis , Allergic Reaction , Allergic Rhinitis (AR) , Allergic cough , Allergies , Allergies caused by Serum , Allergy to House Dust , Allergy to vaccine , Angioneurotic Edema , Asthma , Bronchial Asthma , Bronchitis , Common Cold , Conjunctival congestion , Conjunctivitis , Conjunctivitis allergic , Cough , Cough caused by Common Cold , Coughing caused by Flu caused by Influenza , Drug Allergy , Eye allergy , Fever , Flu caused by Influenza , Food Allergy , Headache , Headache caused by Allergies , Itching of the nose , Itching of the throat , Migraine , Nasal Congestion , Nasal Congestion caused by Common Cold , Pollen Allergy , Productive cough , Pruritus , Rash , Rhinorrhoea , Seasonal Allergic Conjunctivitis , Sinus Congestion , Sinusitis , Sneezing , Transfusion Reactions , Upper Respiratory Tract Infection , Upper respiratory tract hypersensitivity reaction , site unspecified , Urticaria , Vasomotor Rhinitis , Acute Rhinitis , Allergic purpura , Conjunctival hyperemia , Dry cough , Excess mucus or phlegm , Itchy throat , Mild bacterial upper respiratory tract infections , Ocular hyperemia , Throat inflammation , Upper airway congestion , Upper respiratory symptoms , Watery eyes , Watery itchy eyes , Airway secretion clearance therapy

How Piriton works

Piriton binds to the histamine H1 receptor. This blocks the action of endogenous histamine, which subsequently leads to temporary relief of the negative symptoms brought on by histamine.

Piriton dosage

Adults : 4 mg 3-4 times daily.

  • Up to 1( one) year : 1 mg twice daily
  • 1-5 years : 1 mg 3-4 times daily
  • 6-12 years : 2 mg 3-4 times daily or as directed by the physician

Side Effects

Drowsiness, dizziness, headache, psychomotor impairment, urinary retention, dry mouth, blurred vision and gastro intestinal disturbances, paradoxical stimulation may rarely occur, especially in high dosage or in children.

Oral LD50 (rat): 306 mg/kg; Oral LD50 (mice): 130 mg/kg; Oral LD50 (guinea pig): 198 mg/kg [Registry of Toxic Effects of Chemical Substances. Ed. D. Sweet, US Dept. of Health & Human Services: Cincinatti, 2010.] Also a mild reproductive toxin to women of childbearing age.

Piriton may produce mild sedation and it is advised that patients under continuous treatment should avoid operating machinery. Not recommended during pregnancy & lactation.

Interaction

Alcohol, CNS depressants, anticholinergic drugs, MAOIs.

  • Avoid alcohol.
  • Take with food.

[Moderate] GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents.

Use in combination may result in additive central nervous system depression and MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol.

Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

Piriton Drug Interaction

Moderate: diphenhydramine , diphenhydramine , cetirizine , cetirizineUnknown: aspirin , aspirin , omega-3 polyunsaturated fatty acids , omega-3 polyunsaturated fatty acids , fluticasone nasal , fluticasone nasal , acetaminophen , acetaminophen , acetaminophen , acetaminophen , cyanocobalamin , cyanocobalamin , ascorbic acid , ascorbic acid , cholecalciferol , cholecalciferol

Piriton Disease Interaction

Moderate: anticholinergic effects , asthma/COPD , cardiovascular , renal/liver disease

Elimination Route

Well absorbed in the gastrointestinal tract.

21-27 hours

Pregnancy & Breastfeeding use

Pregnancy Category B. Either animal-reproduction studies have not demonstrated a foetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the 1st trimester (and there is no evidence of a risk in later trimesters).

Contraindication

There is no definite contraindication to therapy. It should be used with caution in epilepsy, prostatic hypertrophy, glaucoma and hepatic disease. The ability to drive or operate machinery may be impaired.

Innovators Monograph

You find simplified version here Piriton

Piriton contains Chlorpheniramine see full prescribing information from innovator Piriton Monograph , Piriton MSDS , Piriton FDA label

What is Piriton used for?

Piriton is an antihistamine used to relieve symptoms of allergy, hay fever, and the common cold. These symptoms include rash, watery eyes, itchy eyes/nose/throat/skin, cough, runny nose, and sneezing.

How safe is Piriton?

Piriton is approved by the U.S. Food and Drug Administration and is safe and effective when used according to the Drug Facts label directions.

How does Piriton work?

Piriton works by blocking the action of histamine, a substance in the body that causes allergic symptoms.

What are the common side effects of Piriton?

Common side effects include feeling sick (nausea), sleepy or dizzy. You may also have difficulty concentrating, a dry mouth, headaches or blurred vision.

Is Piriton safe during pregnancy?

To conclude first generation antihistamines such as chlorpheniramine, hydroxyzine, and dexchlorpheniramine are the safest among antihistamines to be used in pregnancy.

Is Piriton safe during breastfeeding?

Small occasional doses of Piriton are acceptable during breastfeeding. Larger doses or more prolonged use might cause effects in the infant or decrease the milk supply, particularly in combination with a sympathomimetic such as pseudoephedrine or before lactation is well established.

Can I drink alcohol with Piriton?

Do not drink alcohol while you're taking Piriton. Alcohol may make you feel sick or more sleepy.

Can I drive after taking Piriton?

After taking Piriton you may feel very tired and sleepy. Do not drive, ride a bike or operate machinery or tools if this happens to you.

When should be taken of Piriton?

The regular capsules of Piriton are usually taken every 4 to 6 hours as needed. The extended-release tablets and capsules are usually taken twice a day in the morning and evening as needed.

Can I take Piriton on an empty stomach?

Piriton may be taken with food or milk if stomach upset occurs.

How long does Piriton take to work?

Piriton usually takes 30 minutes to 1 hour to work.

How long does Piriton stay in my system?

Piriton has a serum half-life of approximately 20 hours in adults, and elimination from the body is primarily by metabolism to monodesmethyl and didesmethyl compounds.

How long can Piriton be taken?

You can buy many different Piritons and forms of antihistamines without a prescription. Some work for only 4 to 6 hours, while others last for 12 to 24 hours. Some are combined with a decongestant, a drug that dries up your nasal passages.

Who should not take Piriton?

Always ask a doctor before giving a cough or cold medicine to a child. Death can occur from the misuse of cough and cold medicines in very young children. You should not use Piriton if you have narrow-angle glaucoma, a blockage in your stomach or intestines, an enlarged prostate, if you are unable to urinate, or if you are having an asthma attack.

What happens if I miss a dose?

Since this medicine is taken when needed, you may not be on a dosing schedule. If you are taking the medication regularly, take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention. Overdose symptoms may include severe forms of some of the side effects listed in this medication guide.

Does Piriton affect liver?

Despite widespread use, the first generation antihistamines such as brompheniramine and Piriton have rarely been linked to liver test abnormalities or to clinically apparent liver injury.

Can Piriton cause kidney problems?

Piriton do not cause kidney problems.

Will Piriton affect my fertility?

Studies have not been done to see if Piriton could affect male fertility or increase the chance of birth defects. In general, exposures that fathers or sperm donors have are unlikely to increase the risks to a pregnancy.

Can I stop taking Piriton?

If you suddenly stop using this medication, you may have withdrawal symptoms (such as restlessness, watering eyes, runny nose, nausea, sweating, muscle aches). To help prevent withdrawal, your doctor may lower your dose slowly.

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Related Content

Antihistamines

Antihistamines are medicines often used to relieve symptoms of allergies, such as  hay fever , hives , conjunctivitis  and reactions to insect bites or stings .

They're also sometimes used to prevent  motion sickness , to treat feeling sick (nausea) or being sick ( vomiting ), and as a short-term treatment for  insomnia .

Most antihistamines can be bought from pharmacies and shops, but some are only available on prescription.

Types of antihistamine

There are many types of antihistamine.

They're usually divided into 2 main groups:

  • antihistamines that make you feel sleepy – such as chlorphenamine (Piriton), cinnarizine , diphenhydramine , hydroxyzine and promethazine
  • non-drowsy antihistamines that are less likely to make you feel sleepy – such as acrivastine ,  cetirizine , fexofenadine and loratadine

They also come in several different forms – including tablets, capsules, liquids, syrups, creams, lotions, gels, eyedrops and nasal sprays.

Which type is best?

There's not much evidence to suggest any particular antihistamine is better than any other at relieving allergy symptoms.

Some people find certain types work well for them and others do not. You may need to try several types to find one that works for you.

Non-drowsy antihistamines are generally the best option, as they're less likely to make you feel sleepy. But types that make you feel sleepy may be better if your symptoms stop you sleeping.

Ask a pharmacist for advice if you're unsure which medicine to try as not all antihistamines are suitable for everyone.

How to take antihistamines

Take your medicine as advised by the pharmacist or doctor, or as described in the leaflet that comes with it.

Before taking an antihistamine, you should know:

  • how to take it – including whether it needs to be taken with water or food, or how to use it correctly (if eyedrops or a nasal spray)
  • how much to take (the dose) – this can vary depending on things such as your age and weight
  • when to take it – including how many times a day you can take it and when to take it (some types should be taken before bedtime)
  • how long to take it for – some types can be used for a long time, but some are only recommended for a few days
  • what to do if you miss a dose or take too much (overdose)

The advice varies depending on the exact medicine you're taking. If you're not sure how to take your medicine, ask a pharmacist.

Side effects of antihistamines

Like all medicines, antihistamines can cause side effects.

Side effects of antihistamines that make you drowsy can include:

  • sleepiness (drowsiness) and reduced co-ordination, reaction speed and judgement – do not drive or use machinery after taking these antihistamines
  • blurred vision
  • difficulty peeing

Side effects of non-drowsy antihistamines can include:

  • feeling sick
  • drowsiness – this is less common with non-drowsy antihistamines but is still possible

Check the leaflet that comes with your medicine for a full list of possible side effects and advice about when to get medical help.

If you think your medicine has caused an unwanted side effect, you can report it through the Yellow Card Scheme .

Taking antihistamines with other medicines, food or alcohol

Speak to a pharmacist or GP before taking antihistamines if you're already taking other medicines.

There may be a risk the medicines do not mix, which could stop either from working properly or increase the risk of side effects.

Examples of medicines that could cause problems if taken with antihistamines include some types of:

  • antidepressants
  • stomach ulcer or indigestion medicines
  • cough and cold remedies that also contain an antihistamine

Try not to drink alcohol while taking an antihistamine, particularly if it's a type that makes you drowsy, as it can increase the chances of it making you feel sleepy.

Food and other drinks do not affect most antihistamines, but check the leaflet that comes with your medicine to make sure.

Who can take antihistamines

Most people can safely take antihistamines.

But speak to a pharmacist or GP for advice if you:

  • are pregnant or breastfeeding
  • are looking for a medicine for a young child
  • are an older person
  • are taking other medicines 
  • have an underlying health condition, such as heart disease ,  liver disease , kidney disease or  epilepsy

Some antihistamines may not be suitable in these cases. A pharmacist or doctor can recommend one that's best for you.

Loratadine is usually recommended if you need to take an antihistamine in pregnancy. Loratadine or cetirizine are usually OK to take while breastfeeding.

Always check the leaflet that comes with your medicine to see if it's safe for you before taking it or giving it to your child.

How antihistamines work

Antihistamines block the effects of a substance called histamine in your body.

Histamine is normally released when your body detects something harmful, such as an infection. It causes blood vessels to expand and the skin to swell, which helps protect the body.

But in people with allergies, the body mistakes something harmless – such as pollen, animal hair or house dust – for a threat and produces histamine. The histamine causes an allergic reaction with unpleasant symptoms including itchy, watering eyes, a running or blocked nose, sneezing and skin rashes.

Antihistamines help stop this happening if you take them before you come into contact with the substance you're allergic to. Or they can reduce the severity of symptoms if you take them afterwards.

Find out more about your medicine

The leaflet that comes in the packet with your medicine will have detailed information about it, including how to take it and what side effects you might get.

If you no longer have the leaflet that came with your medicine, you can search for an online version of it using our medicines A to Z .

You may also find information on individual antihistamines on these websites:

  • Medicines and Healthcare products Regulatory Agency (MHRA): patient information leaflets
  • Electronic Medicines Compendium

Page last reviewed: 16 May 2023 Next review due: 16 May 2026

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COMMENTS

  1. Has anyone used Piriton (or similar) to treat travel sickness?

    Has anyone used Piriton (or similar) to treat travel sickness? 1 reply. mintymellons · 10/08/2011 09:19. We're travelling down to Somerset from York on Friday (5 hour journey). We plan to travel in the wee small hours so our two DDs can sleep most of the way, but DD2 (17 months) gets travel sickness and I want to take as many precautions as I can.

  2. Antihistamines to prevent and treat motion sickness

    Antihistamines are a type of drug that have commonly been given to people to either treat or prevent motion sickness. In this study, we wanted to find out if these drugs actually work for this purpose. Key message. We found that antihistamines probably do reduce a person's risk of getting motion sickness symptoms under naturally occurring ...

  3. Antihistamines for motion sickness

    Epidemiology . Historically, motion sickness was first described in seafarers (Hippocrates).A recent study undertaken on expedition ships to Antarctica has shown that motion sickness was the most common reason for consultation, with 150 out of a total of 680 physician consultations for prophylaxis followed by an additional 142 visits (27%, 4.2 per 1000 person‐days) for treatment (Schutz 2014).

  4. Treatments to prevent travel sickness: a quick look

    In this short blog, Dr Robert Walton looks at the evidence on treatments to prevent travel sickness (motion sickness). Take-home points. The new evidence on antihistamines comes from the Cochrane Review Antihistamines for motion sickness (published in October 2022) and is relevant to adults.. Travel sickness (motion sickness) is a common problem, and many people experience nausea for example ...

  5. Travel and motion sickness: An expert weighs in on Dramamine, ginger

    Nausea literally means "ship-sickness." But it can happen to people traveling by car, bus and plane, too. In one survey of roughly 3,200 bus passengers, 28% felt ill, 13% reported nausea and 2% vomited. Another study highlighted motion sickness experienced by passengers on commercial airline flights, finding that 24% felt ill or nauseated.

  6. Motion Sickness: Prevention and Treatment

    Triggers for motion sickness. Motion sickness can also be triggered by anxiety or strong smells, such as food or petrol. Sometimes trying to read a book or a map can trigger motion sickness. Both in children and adults, playing computer games can sometimes cause motion sickness to occur. Motion sickness is more common in children and also in women.

  7. Chlorpheniramine for motion sickness

    Background: Motion sickness remains a significant problem for travelers and for those involved in naval, aviation and space operations. Many motion sickness remedies are also sedating, making them undesirable in many settings. Methods: We studied chlorpheniramine as a potential motion sickness treatment. A placebo-controlled, double-blind, dose-ranging trial was performed to establish the most ...

  8. Managing motion sickness

    #### Summary points Motion sickness is a syndrome of nausea and vomiting, pallor, sweating, headache, dizziness, malaise, increased salivation, apathy, drowsiness, belching, hyperventilation, and stomach awareness. Symptoms can be provoked by externally imposed motion, or implied self motion from a moving visual field, such as in a cinema. The condition has been recognised from the early days ...

  9. Motion sickness

    Motion sickness is caused by repeated movements when travelling, like going over bumps in a car or moving up and down in a boat, plane or train. The inner ear sends different signals to your brain from those your eyes are seeing. These confusing messages cause you to feel unwell. Find out more about motion sickness, an unpleasant combination of ...

  10. Antihistamines: Types, uses and side-effects

    Your doctor may suggest that you take a sedating antihistamine if itching from an allergy is affecting your sleep. Some of these medicines may help with travel sickness and vertigo. Sedating antihistamines that are available from pharmacies for allergies include: chlorphenamine maleate (eg Piriton) clemastine (eg Tavegil)

  11. Cinnarizine: antihistamine used for travel sickness and vertigo

    Find out how cinnarizine treats travel sickness, vertigo, tinnitus and Ménière's disease, and how to take it. About cinnarizine. Who can and cannot take it. How and when to take it. Side effects. Pregnancy, breastfeeding and fertility. Taking it with other medicines and herbal supplements.

  12. Chlorphenamine: drowsy (sedating) antihistamine

    Chlorphenamine usually takes 30 minutes to 1 hour to work. Common side effects include feeling sick (nausea), sleepy or dizzy. You may also have difficulty concentrating, a dry mouth, headaches or blurred vision. Wait a minimum of 4 hours between taking doses. Do not drink alcohol while you're taking chlorphenamine.

  13. Travel sickness

    Motion sickness is a very common and unpleasant condition thought to be caused by a sensory conflict or a mismatch of the vestibular system (1). Patients may complain of nausea and vomiting, pallor, sweating, headache, dizziness, malaise, increased salivation, apathy, drowsiness, belching, hyperventilation, and stomach awareness. symptoms may ...

  14. Travel Sickness and Breastfeeding

    Antihistamines which cause drowsiness e.g. promethazine (Phenergan™, chlorpheniramine (Piriton ™) may be useful for children who struggle with travel sickness although it is rare before the age of 2 years. Acupressure Bands. Some studies suggest that acupressure may help reduce symptoms of motion sickness in the same way as acupuncture.

  15. Nausea Medicine: Anti-sickness tablets

    Hyoscine is the most effective medicine for motion sickness. Promethazine, cyclizine, or cinnarizine also work well. See the separate leaflet called Motion sickness (Travel sickness) for more detail. Pregnancy. Nausea and vomiting affects women differently in pregnancy. If the symptoms are severe, medications can help to control them.

  16. Nausea and labyrinth disorders

    Antiemetics should be given to prevent motion sickness rather than after nausea or vomiting develop. Hyoscine hydrobromide is licensed to prevent motion sickness symptoms such as nausea, vomiting, and vertigo. For children aged 10 years and over, a transdermal hyoscine patch provides prolonged activity but it needs to be applied several hours before travelling.

  17. PDF 3. How to take Piriton Tablets

    1. What Piriton Tablets do Piriton Tablets are used to treat the allergic symptoms of hayfever and other allergies. The active ingredient is chlorphenamine maleate, an antihistamine which can help to relieve the symptoms of some allergies and itchy skin rashes. It can be used to treat the itchiness, redness, swelling, tenderness and irritation ...

  18. Allergy Pills Can Help Manage Vertigo Symptoms, Study Finds

    A recent study found allergy pills were better at treating symptoms of vertigo than benzodiazepine. Antihistamines work by blocking signals to the brain that cause symptoms of vertigo, including dizziness, nausea, and sickness. Most cases of vertigo are benign and may not require medication. Vertigo can be debilitating, especially since the ...

  19. Is it safe to take Antihistamines and anti ...

    Hi everyone, . I was diagnosed with P B C in June last year after having abnormal blood tests for almost three years. I am going on Holiday to Thailand for Easter, and I am allergic to Mosquito Bites, will be taking all the usual precautions to combat the Bites , but was thinking of taking some Piriton with me as a precaution, also some Travel sickness Tablets as it's such a long flight.

  20. Piriton: Uses, Dosage, Side Effects, FAQ

    Piriton, is a histamine H1 antagonist (or more correctly, an inverse histamine agonist) of the alkylamine class. It competes with histamine for the normal H1-receptor sites on effector cells of the gastrointestinal tract, blood vessels and respiratory tract. It provides effective, temporary relief of sneezing, watery and itchy eyes, and runny ...

  21. Antihistamines

    Antihistamines are medicines often used to relieve symptoms of allergies, such as hay fever, hives, conjunctivitis and reactions to insect bites or stings. They're also sometimes used to prevent motion sickness, to treat feeling sick (nausea) or being sick (), and as a short-term treatment for insomnia. Most antihistamines can be bought from pharmacies and shops, but some are only available on ...

  22. Antihistamines......for anxiety.

    I take it to help me sleep but now you mention it, it really really does make me chill out, so can see how it would be very useful for anxiety. ... I used to use phenergan for travel sickness in my kids. I remember being quite shocked when my GP told me that he and his wife used to use it on their kids just to get them to sleep on occasions ...

  23. Is it okay to use piriton just to make you sleep.?

    Dr. David Miller answered. Short term: Piriton (a uk brand of chlorpheniramine) is an antihistamine that causes drowsiness as a side effect. Benedryl is a common example of this same type of drug, which is used as a sleep aid (in "pm" forms of pain relievers, nyquil, etc). In the short term, they can provide occasional help sleeping but are not ...