Re: Motion Sickness

Paul Harries

On Tue, Jun 15, 2021 at 18:43, CW Bill Rouse
<brouse@...> wrote:
As I reported earlier, our Group member, SM owner, Circumnavigator in a SM and International Space Station, Astronaut, and Professor of Cardiology, responded with the following advice:

Regarding motion-sickness treatments, I checked with my NASA colleagues, who wrote:
Phenergan (promethazine) is still the treatment of choice for Space Motion Sickness/SAS. As you know I first used it to treat a crewmate on an earlier STS flight and it became the treatment. Questions were raised if ondansetron (ZOFRAN) would be better.  Ondansetron was trialed on ISS (the Space Station); it was not as effective as Phenergan. NASA Flight Medicine thinks that Phenergan will remain the treatment for the foreseeable future because it is effective and that the actual side-effects experienced as opposed to what appears in the package insert have not been an issue.

As you are probably aware, Phenergan can be sedating, but the sedative effect can be countered by amphetamines or ephedrine. Because of the abuse potential of amphetamines, they are not used in the military for treatment of side effects, but the last I heard the military does use ephedrine. Typically they use 25mg of Phenergan and 25 of Ephedrine for embarked Marines on a routine basis.

On Revelation, we've tried Stugeron, but did not find it effective, either personally, or for passengers.

NASA, many years ago, made their own "Scope/Dex". It was a large gel capsule with scopolamine and dexedrine tablets inside.  It worked, but not as well as promethazine (PHENERGAN), so Scope/Dex was discontinued.

Studies were done by NASA with Scopolamine patches.  There was a 10-fold variation in Scopolomine blood levels. with the patch. There are multiple determinants for its absorption.  I still remember one of the volunteers, an engineer in our project, who went from being a quiet, shy person to a "drunken, 'life of the party".  She had to be taken home from work...  Trying the patch, on-shore, would be advisable for anyone contemplating its use at sea, although absorption could still be dramatically different "at sea".

We used Phenergan on Day 1 of our flight.  It was highly effective, and in that setting, didn't seem to cause sedation.  Giving it early, before the person is on the verge of vomiting, works best.  At sea, I take it at the first sign of nausea, as it's better to prevent than "treat".  In space, alertness did not seem to be a problem.  I've taken it as a crewmember, doing studies on the NASA KC-135 (aka "The Vomit Comet").  It does make people sleepy, but they can function better than if they were nauseated and vomiting.

There's no question that being in the cockpit, fresh air, focusing on the horizon,  or even letting the person steer the boat all help.  "Steering" helps even if the boat is actually being steered by the autopilot.

Motion-sickness is thought to be caused by a mismatch between the vestibular and ocular system signals, so moving as though steering the boat reduces the mismatch.  

If someone's nausea has proceeded to vomiting, use a suppository.   When a vomiting person takes Phenergan and then vomits again, there's no way to tell how much of the drug was absorbed.  Too much can be toxic. 
CW Bill Rouse Amel Owners Yacht School
Address: 720 Winnie, Galveston Island, Texas 77550 
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Paul Harries
Prospective Amel Buyer

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