 Your Prescription to Prevent Motion Sickness |
|
From the March/April 2004 issue of Alert Diver magazine, reprinted with permission from the Divers Alert Network. Scopace Tablets
Here's An Alternative to "The Patch" By Renée Duncan, Editor
I'm one of those unfortunates who, given a good whiff of diesel and a quick view of a rolling horizon, will be feeding the fish off almost any boat unlucky enough to have me. Actually, I usually take it in stride, but my involuntary actions have dismayed some of my fellow dive travelers at times. Unhappily, "the patch" is just too strong for me. I'm on the small side, 5 feet 2 inches (1.57 meters) tall, maybe 110 pounds (49.5 kilograms) without my gear. And putting on a patch practically guarantees I won't recall much of my dive, flight or boat ride (short-term memory loss is one of the side effects). It doesn't have this effect on all small persons; and, by the same token, it may affect larger persons just as intensely - or it may not be enough. As with many medications, it simply works on each of us individually, and some days (and dosages) can be tougher than others. What to do? Well, I've pondered. Fed some fish. Postponed dives. Or gone diving off the other side of the boat after a good spew. Then I heard about a pill I could take for motion sickness. The best thing about it is that I can keep my dosages low rather than enduring the fixed dosage of a patch. And although, I haven't had motion sickness in a while, I almost wish I could get sick again, just to try it. Divers and travelers who suffer from motion sickness, you have a choice: you can use the scopolamine patch or take it in pill form. For many folks, the pill is welcome news. Scopace, a medication for motion sickness, is available through your doctor - in 0.4 mg tablets. Scopace contains scopolamine hydrobromide, described by the American Hospital Formulary Service (a drug information reference from the American Society of Health-System Pharmacists) as the "single most effective medicine to prevent nausea and vomiting induced by motion." So, how do these tablets compare to the patch? To begin with, both have scopolamine, a drug well known for its ability to ease motion sickness. Dosing Flexibility The patch and the pill differ, however, in dosing flexibility. The patch delivers a fixed dose to all persons who don it. And therein lies the problem. Because a fixed dose is formulated for individuals of average weight, it may be excessive for smaller individuals and not enough for larger persons. This means a small person could encounter side effects from absorbing too much of the drug, while larger individuals may still get motion sickness because they're getting insufficient amounts. With tablets, you can adjust the dosage to the lowest level you find effective. Granted, this may mean a couple of trial-and-error runs, but it beats the dizziness and blurring of vision if you're sensitive to the patch. Skin Considerations Then, there's the issue of skin. Topical absorption of a medication - such as what you find in a scopolamine patch - is dependent on certain skin characteristics. These factors include skin thickness, patch adhesion (that's why instructions tell you to apply the patch to clean skin) and blood circulation within the skin. If the skin is too thick, the medication may penetrate too slowly. With hairy or sweaty skin, the patch may not adhere properly. If circulation is poor or if blood flow is shunted away from the skin (this can happens in cold conditions or during episodes of extreme nausea), drug levels may remain diminished because of reduced drug passage into the blood. Ingesting the Tablets Next, there's speed: in order to work, tablets have to melt. If you wait until you're already ill, you may get quicker relief with the patch. Quality guidelines published by the United States Pharmacopoeia, an organization that works closely with the Food and Drug Administration (FDA), the pharmaceutical industry, and the health professions to establish authoritative drug standards, specify that scopolamine tablets must disintegrate within 15 minutes. According to Craig R. Sherman, M.D., Medical Director, Hope Pharmaceuticals (the manufacturer of Scopace), ongoing testing confirms that Scopace tablets meet or exceed this standard. Whichever method you prefer, remember to dose yourself at least an hour before you dive, travel or go boating. Side Effects The incidence of side effects associated with the two dosage forms of scopolamine can differ. If you have experienced any negative effects with the patch, you may want to give the pills a try, or vice versa. The primary side effect of scopolamine tablets at the intended doses is reduced salivation, says the manufacturer. That's dry mouth in diving terms, and it's not fun. But it's not dangerous, either. More serious side effects can always happen with any medication. The manufacturer points out, however, that the more serious side effects with the tablets tend to be infrequent because you can adjust your dose to the lowest level you need. Another consideration is the duration of possible side effects. If a side effect occurs after you ingest a tablet, you can suspend subsequent doses while your body metabolizes the pill. In contrast, side effects associated with topically applied medicine may be prolonged after it is removed because of continued absorption into the blood from the skin. To reinforce the drug's safety, Hope Pharmaceuticals also provided this study result for the scopolamine tablet: A study conducted for NASA evaluated whether oral scopolamine impacted operational proficiency. Scopolamine was tested in two doses - 0.25 mg and 0.5 mg. The researchers concluded that neither dose produced any loss of proficiency performing selected tasks. Furthermore, the incidence of drowsiness and blurred vision associated with the drug did not exceed that associated with placebo. Just like the scopolamine patch, Scopace can cause inability to urinate in men with enlarged prostate glands, and can exacerbate certain types of glaucoma (excessive pressure in the eye). It can also cause drowsiness, which could be dangerous while performing certain activities such as driving a car. It's Your Trip No one wants motion sickness to spoil a trip. At the same time, you don't want to over-medicate yourself: it's just as bad. If you have a tried-and-true method of dealing with motion sickness, stick with it. If you're not happy with your present solution, perhaps you'd like to discuss a prescription for Scopace with your doctor. For other, non-medical ways to prevent motion sickness, see Dan Orr's July / August 2003 Incident Insights report on "Mal de Mer." Pay attention to what your body's telling you about motion sickness or drugs.
-- With reports from Dr. Craig Sherman, Copyright © DAN - Alert Diver Magazine, March/April 2004 |
