{ "schema_version": 1, "kind": "condition", "id": "motion-sickness", "name": "Motion Sickness", "category": "chronic", "sources": "Dramamine Original 50 mg tablets, Directions (DailyMed SetID f9302a5a-295a-4501-9332-e3f5eb387362) · Bonine (meclizine hydrochloride) 25 mg chewable tablets, Directions (DailyMed SetID 0b2ea6b8-b342-4940-8922-898758fbeb31) · Valoid 50 mg Tablets SmPC sections 4.1, 4.2 and 4.4 (eMC product 15294) · Motion Sickness - disease-level clinical article (motion-sickness-full.txt) · Scopolamine transdermal system (Rhodes Pharmaceuticals L.P.) US prescribing information, section 1 Indications and Usage, section 2 Dosage and Administration, section 4 Contraindications and section 8.4 Pediatric Use (DailyMed SetID ba5a1237-4d23-441a-808e-96b97045fbe2)", "review_status": "reviewed", "verified_against": "Dramamine Original 50 mg tablets, Directions (DailyMed SetID f9302a5a-295a-4501-9332-e3f5eb387362) · Bonine (meclizine hydrochloride) 25 mg chewable tablets, Directions (DailyMed SetID 0b2ea6b8-b342-4940-8922-898758fbeb31) · Motion Sickness - disease-level clinical article (motion-sickness-clinical.txt) · Valoid 50 mg Tablets SmPC sections 4.1, 4.2 and 4.4 (eMC product 15294) · Motion Sickness - disease-level clinical article (motion-sickness-full.txt) · Scopolamine transdermal system (Rhodes Pharmaceuticals L.P.) US prescribing information, section 1 Indications and Usage, section 2 Dosage and Administration, section 4 Contraindications and section 8.4 Pediatric Use (DailyMed SetID ba5a1237-4d23-441a-808e-96b97045fbe2)", "verified_date": "2026-08", "treatments": [ { "id": 1219, "generic": "Dimenhydrinate", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 50.0, "adult_dose": "50-100 mg (1-2 tablets) taken 30-60 minutes before travel, then 50-100 mg every 4-6 hours. Maximum 400 mg (8 tablets) in 24 hours", "adult_duration": null, "dose_source": "Dramamine Original 50 mg tablets, Directions (DailyMed SetID f9302a5a-295a-4501-9332-e3f5eb387362)", "rationale": "Antihistamine with anticholinergic activity that dampens vestibular signalling to the vomiting centre, the first-line agent for preventing and treating motion-sickness nausea.", "cautions": [ "Causes significant drowsiness; avoid driving or operating machinery.", "Anticholinergic effects include dry mouth, urinary retention, and blurred vision.", "Avoid alcohol and concurrent CNS depressants.", "Do not give to children under 2 years of age unless directed by a doctor.", "If pregnant or breast-feeding, ask a doctor before use." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Label verbatim, and the 24-hour ceilings matter as much as the doses. \"Children 6 to under 12 years: give ½ to 1 tablet every 6-8 hours\" and \"do not give more than 3 tablets in 24 hours, or as directed by a doctor\". \"Children 2 to under 6 years: give ½ tablet every 6-8 hours\" and \"do not give more than 1 ½ tablets in 24 hours, or as directed by a doctor\". These are halves of the 50 mg tablet; the label gives no dose under 2 years.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": [ { "label": "2 to under 6 years", "age_min_months": 24, "age_max_months": 71, "dose_text": "Half a 50 mg tablet every 6 to 8 hours, and no more than one and a half tablets in 24 hours" }, { "label": "6 to under 12 years", "age_min_months": 72, "age_max_months": 143, "dose_text": "Half to one 50 mg tablet every 6 to 8 hours, and no more than 3 tablets in 24 hours" } ], "peds_doses": null, "brands": [ { "trade_name": "DRAMENEX 50MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA", "price_egp": 28.0, "pack_count": 20, "unit_price": 1.4, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "motion-sickness" }, { "id": 1221, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Motion Sickness - disease-level clinical article (motion-sickness-clinical.txt)", "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.", "cautions": [ "RED FLAG - Basilar artery occlusion is a life-threatening cause that can present as motion sickness or dizziness, especially with diplopia, dysarthria, dysphagia, or drop attacks.", "RED FLAG - New-onset, unexplained motion sickness should prompt consideration of vestibulopathy and referral to a neurologist or vestibular specialist." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "motion-sickness" }, { "id": 1222, "generic": "Cyclizine", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 50.0, "adult_dose": "50 mg by mouth, up to three times a day, started before the journey. SmPC verbatim: \"Adults 50 mg orally, which may be repeated up to three times a day.\" and \"To prevent motion sickness Cyclizine Hydrochloride should be taken about one to two hours before departure.\"", "adult_duration": "For the journey only - repeated up to three times a day while travel continues, not taken between trips.", "dose_source": "Valoid 50 mg Tablets SmPC sections 4.1, 4.2 and 4.4 (eMC product 15294)", "rationale": "The disease article names it and compares it with the drug already on the card, verbatim: \"Cyclizine - First generation antihistamine available orally over the counter. It has shown similar efficacy to diphenhydramine, but with slightly less sedation and more direct action on the stomach in treating gastrointestinal symptoms.\" and \"It is FDA approved for adults and children over 6 years old.\" The SmPC's indication list names motion sickness outright. Egypt registers cyclizine as EMETREX tablets, which are cyclizine with vitamin B6 rather than cyclizine alone, and as plain cyclizine ampoules - so the oral product a patient will actually be handed is a combination, and the dose above is the cyclizine content.", "cautions": [ "Anticholinergic, so it collides with several ordinary conditions. SmPC verbatim: it \"may precipitate incipient glaucoma and it should be used with caution and appropriate monitoring in patients with glaucoma, urinary retention, obstructive disease of the gastrointestinal tract, hepatic disease, phaeochromocytoma, hypertension, epilepsy and in males with possible prostatic hypertrophy.\"", "Caution in heart failure or recent myocardial infarction. SmPC verbatim: \"Cyclizine should be used with caution in patients with severe heart failure or acute myocardial infarction. In such patients, cyclizine may cause a fall in cardiac output associated with increases in heart rate, mean arterial pressure and pulmonary wedge pressure.\"", "Contraindicated with acute alcohol intoxication. SmPC verbatim: \"Cyclizine is contraindicated in the presence of acute alcohol intoxication. The anti-emetic properties of cyclizine may increase the toxicity of alcohol.\"", "It is misused. SmPC verbatim: \"There have been reports of abuse of cyclizine, either oral or intravenous, for its euphoric or hallucinatory effects.\" Repeat requests outside travel deserve a question.", "Sedation is less than with diphenhydramine but not absent - it still affects driving." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "From 6 years, halved. SmPC verbatim: \"Children less than 6 years of age: Cyclizine Hydrochloride tablets are not recommended for children less than 6 years of age.\" \"Children 6 to 12 years of age: 25 mg orally, which may be repeated up to three times a day.\" \"Children over 12 years of age: 50 mg orally, which may be repeated up to three times a day.\"", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": [ { "label": "6 to 12 years", "age_min_months": 72, "age_max_months": 143, "dose_text": "25 mg by mouth, up to three times a day" }, { "label": "Over 12 years", "age_min_months": 144, "age_max_months": 216, "dose_text": "50 mg by mouth, up to three times a day" } ], "peds_doses": null, "brands": [ { "trade_name": "CYCLOLACTAZINE 37.55MG/ML 3 I.M./I.V. AMP.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO B", "price_egp": 15.0, "pack_count": null, "unit_price": null, "strength_mg": 37.55, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "EMETREX-N 37.55MG/ML 3 I.M./I.V. AMP.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMOUN", "price_egp": 27.0, "pack_count": null, "unit_price": null, "strength_mg": 37.55, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "motion-sickness" }, { "id": 1220, "generic": "Meclizine", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 25.0, "adult_dose": "25-50 mg (1-2 chewable tablets) once daily, taken one hour before travel starts", "adult_duration": null, "dose_source": "Bonine (meclizine hydrochloride) 25 mg chewable tablets, Directions (DailyMed SetID 0b2ea6b8-b342-4940-8922-898758fbeb31)", "rationale": "Antihistamine with the same vestibular-suppressing mechanism as dimenhydrinate, chosen instead when a longer-acting, less sedating option is preferred.", "cautions": [ "Less sedating than dimenhydrinate but drowsiness still occurs.", "Caution in glaucoma or prostatic hypertrophy.", "If pregnant or breast-feeding, ask a health professional before use." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "12 years and over: 25-50 mg once daily, one hour before travel - the label dose is the same as for adults. Below 12 years the label gives no dose; ask a doctor.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": [ { "label": "12 years and over", "age_min_months": 144, "age_max_months": 216, "dose_text": "25 to 50 mg once daily, one hour before travel - the same as the adult dose. The label gives no dose below 12 years." } ], "peds_doses": null, "brands": [ { "trade_name": "MECLIZIGO 25 MG 20 ORODISPERSIBLE FILMS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "NERHADOU INTERNATIONAL CO.", "price_egp": 90.0, "pack_count": null, "unit_price": null, "strength_mg": 25.0, "exact_strength": true, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "motion-sickness" }, { "id": 1223, "generic": "Scopolamine", "line": 2, "is_adjunct": false, "form": "topical", "strength_mg": null, "adult_dose": "One patch behind one ear, applied in advance. Per the US label: apply one patch to the hairless skin behind one ear no less than 4 hours ahead of when the antiemetic effect is needed; one patch lasts up to 3 days. If treatment must continue past 3 days, take off the first patch and put a fresh one behind the other ear. Each patch delivers about 1 mg of scopolamine over its 3 days. The label is firm on handling: wear only one patch at a time, never cut it, and after applying it wash and dry the hands thoroughly, using soap and water. The disease article gives the same instruction in its own words - the patch goes on the mastoid area a minimum of 4 hours before travel and lasts 72 hours.", "adult_duration": "Up to three days per patch, then a fresh patch behind the other ear if the journey is longer. It is tied to the travel, not to a course.", "dose_source": "Scopolamine transdermal system (Rhodes Pharmaceuticals L.P.) US prescribing information, section 1 Indications and Usage, section 2 Dosage and Administration, section 4 Contraindications and section 8.4 Pediatric Use (DailyMed SetID ba5a1237-4d23-441a-808e-96b97045fbe2)", "rationale": "The disease article names scopolamine and ranks it top: the most effective agent available, a nonselective antimuscarinic that works by damping the signal reaching the vestibular nuclei, and it causes less sedation than the antihistamines. In the USA it comes as a prescription transdermal patch. The US label's indication section covers the same use in adults - preventing the nausea and vomiting of motion sickness. The card carried three oral antihistamines and nothing else, so the drug the article rates most effective was missing - and with it the advice the article repeats: these medicines work best started ahead of time, or at the very first hint of symptoms. Egypt registers no transdermal scopolamine product, so no brand or price can be shown here. The hyoscine butylbromide sold in Egypt is a different medicine - an oral and injectable antispasmodic for gut cramp, a different salt given by a different route, not this drug.", "cautions": [ "Contraindicated in angle-closure glaucoma. US label verbatim: \"Scopolamine transdermal system is contraindicated in patients with: angle closure glaucoma.\" and, for the open-angle patient, \"Monitor intraocular pressure in patients with open angle glaucoma and adjust glaucoma therapy during scopolamine transdermal system use, as needed.\" Advise the patient to remove the patch and seek help for \"eye pain or discomfort, blurred vision, visual halos or colored images in association with red eyes\".", "Wash the hands, every time. US label verbatim: \"Scopolamine can cause temporary dilation of the pupils resulting in blurred vision if it comes in contact with the eyes. Advise patients to wash their hands thoroughly with soap and water and dry their hands immediately after handling the transdermal system, do not touch the system while wearing it, and wash hands and the application site with soap and water after transdermal system removal.\" A unilateral fixed dilated pupil in someone wearing this patch is usually a finger, not a brain.", "Do not cut it and do not wear two. Cutting a transdermal system destroys the rate control and delivers an unpredictable dose.", "Neuropsychiatric reactions, including in adults. The label carries a separate warnings section for them, and confusion or hallucination in an older traveller wearing a scopolamine patch is the patch until proved otherwise. It is used with caution in the elderly, as the disease article also says.", "It causes blurred vision and dry mouth. Driving, reading a chart and operating machinery are all affected, which matters for the very trip it was applied for.", "Remove it and dispose of it out of a child's reach. US label verbatim: \"Upon removal, fold the used transdermal system in half with the sticky side together, and discard in household trash in a manner that prevents accidental contact or ingestion by children, pets, or others.\" A used patch still contains drug.", "No Egyptian product exists for this route. Do not substitute an oral or injectable hyoscine butylbromide preparation for it - that is a gut antispasmodic and is not what the article or the label describes." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not a paediatric prescription, and the label is unusually specific about why. Safety and effectiveness have not been established in children, who are particularly prone to scopolamine's anticholinergic effects - including neurological and psychiatric reactions and a withdrawal syndrome on stopping it. Reported serious reactions in children include acute psychosis (disorientation, hallucinations), amblyopia, hyperthermia (with one fatal case), and dilated pupils. The disease article agrees and sets its own floor: it is not recommended under 12 years. A child with travel sickness uses one of the oral options on the card instead.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "motion-sickness" } ] }