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2017 HCHB_digital

Travel Sickness Travel,

Travel Sickness Travel, or motion, sickness is a common problem, especially in young and elderly people. Prevalence varies according to mode of travel but has been estimated at around 50% of children aged two to 12 years travelling in cars or planes, and close to 100% of boat passengers in very rough seas. Although the exact cause is not fully understood, most experts believe that motion sickness arises from either conflicts occurring between the various sensory inputs to the brain, or an overstimulation of balance mechanisms located within the inner ear. Sensory systems involved in monitoring balance include the: • inner ears – semicircular canals within the inner ears contain a fluid which can tell the brain the direction of motion (up, down, side to side, round and round, forward, backward) • eyes – these also help let the brain know if a person is moving and in what direction • skin receptors – these let the brain know what parts of the body are touching the ground • muscles and joint sensors – these tell the brain if a person’s muscles are moving and what position their body is in. When a person is moving, either under their own steam or with the aid of a vehicle, boat or plane, the brain receives a report from these sensory systems and attempts to make sense of what the person is doing. Of the four systems mentioned above, the sensory apparatus in the inner ear seems to be most critical in the development of motion sickness. If this becomes overstimulated or if any of the other sensory reports do not fit together, the brain gets confused and travel sickness occurs. TREATMENT OPTIONS Category Examples Comments Antihistamines Hyoscine (scopolamine) Other products Natural / herbal products / supplements [PHARMACY ONLY MEDICINE] eg, meclozine (Sea-Legs), promethazine (Avomine*) [PHARMACIST ONLY MEDICINE] eg, promethazine (Allersoothe, Phenergan Tablet/Elixir*) [PHARMACY ONLY MEDICINE] eg, hyoscine/scopolamine (Scopoderm TTS Patches) eg, @-ease, 1-Above, No Jet Lag, Trip Ease eg, Nei-Kuan pressure point bands (eg, Sea Band Nausea Relief Adult/Child, Travacalm Travel Band*) eg, Blis K12 Travel Guard eg, ginger (Blackmores Travel Calm Ginger, Lifestream Ginger, Seaband Ginger), pycnogenol (1Above) Sea-Legs are not for use in children under six years. Avomine are not for use in children under 10 years. Ensure packet instructions are followed for the correct dose according to age. Meclozine is generally less sedating than promethazine (although sedation may be an advantage for some people). Warn about the risk of drowsiness and to avoid driving or operating machinery if affected. Refer to the pharmacist people on medications or with certain health conditions since these products may not be suitable for them (see Reference section, OTC Medicines – Precautions). Avoid alcohol. Be wary of the potential for abuse of these medicines and refer any suspicious requests to the pharmacist. Non-sedating antihistamines are ineffective. Not for use in children under 10 years. Apply to the hairless area behind the ear at least four hours before travel (eight hours is best for maximal effect). Remove or replace with a new patch after 72 hours. Do not cut patch in half (although a half patch can be obtained by covering half the patch with an occlusive dressing). Dispose of the patch carefully after use and wash hands after applying to prevent inadvertent transfer to the eye. Warn about the risk of drowsiness and to avoid driving or operating machinery if affected. Avoid alcohol. Homeopathic remedies may help alleviate symptoms associated with travel. Bands that apply constant pressure to the Nei-Kuan pressure points in the wrists may help reduce feelings of nausea. Apply in the middle of the inner wrist, about three finger widths from the crease where the wrist joins the hand. Other products support the body’s natural immune defence system. Ginger may help relieve symptoms such as nausea associated with travel sickness. Pycnogenol may help reduce both the severity and duration of jet lag. Products with an asterisk have a detailed listing in the Travel Sickness section of OTC Products, on page 265. For DRUG-FREE relief of nausea Page 154 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION For example, if a person is travelling in a car, reading a book with their head down, the inner ears and skin receptors tell their brain that their body is moving forward. However, their eyes are looking at a book that isn’t moving and the muscle and joint sensors are telling their brain that they are sitting still. During the early stages of travel sickness, most people start to feel a little tired and dizzy, a bit nauseous, and may begin to salivate. Many people never progress to vomiting, while others are more severely affected and may have to seek medical help at the time. Other symptoms may include yawning, hyperventilation (rapid, deep breathing), sweating and looking pale. Women who are pregnant or menstruating, people who are feeling scared or anxious or who suffer from migraine headaches or conditions that interfere with sensory input are more at risk of motion sickness. In some people, smells, such as those of food or petrol, coupled with the anticipation of travel can also bring it on. People who are subjected to repeated exposure of the same motion develop a tolerance for it after a period of time – often referred to as “gaining your sea legs” if on a boat. Once the motion stops, the feeling of still moving persists for several hours until the body readapts to the lack of movement. Initial assessment Most people buy products in anticipation of future motion sickness. Try to establish what their symptoms are when it happens and run through the Refer to Pharmacist questions and refer anybody with "yes" answers to a pharmacist. Treatment A number of different medicines are effective in treating motion sickness. Most are more successful at alleviating symptoms if taken before the motion occurs, rather than waiting until it has happened. Sedating antihistamines (eg, meclozine, promethazine) and anticholinergics (eg, scopolamine) are most commonly used before travel while antiemetics (antinausea) medicines may be used to control nausea and vomiting after motion sickness has developed. Several of these medicines can cause drowsiness. Natural remedies, such as ginger or peppermint and pressure bracelets that act on the Nei-Kuan pressure point on the anterior wrist may also be effective. Advice for customers • Keep food light and avoid heavy, fatty or spicy meals and alcohol before travelling. Peppermint or ginger taken before travel may help. • Take the recommended medicine at least one to two hours before travelling (or even the night before). • Reduce symptoms by choosing seats with the smoothest ride (eg, front seat of a car, front carriages of a train, seats between the wheels of a bus, centre of a boat and seats over the aircraft wing). • Focus on distant objects or the horizon, do something distracting (eg, listen to music) or keep eyes closed. • Avoid activities, eg, reading, that encourage looking down and require close Refer to PHARMACIST The following questions aim to identify customers who would benefit from further input from a pharmacist. Your initial assessment may have already provided some answers. Decide if any further questions still need to be asked and refer any “yes” answers to a pharmacist. • Does the person have any other health conditions (eg, heart or lung problems, diabetes, is pregnant or breastfeeding)? • Does the person take any other medication or herbal remedy, either prescribed by a doctor or bought from a shop? • Does the person have any pain or oozing from one ear (may indicate an ear infection)? • Is there severe anxiety associated with travelling? • Have travel sickness symptoms become worse over time, not better? • Does the person suffer from prolonged vomiting when they are travelling? • Is the medication intended for: »» a child aged less than six years? »» an elderly person? (Can be sensitive to the side effects of medication.) »» a woman who is pregnant or breastfeeding? • Does the person appear suspicious and may possibly be drug seeking? • Does the person have any allergies to medicines? visual concentration. • Minimise head movement with a head support, or try lying down. • Get plenty of fresh air (open personal air vents on planes). • If a person is feeling car sick, stop in a safe spot and allow them to get out and walk around a bit. » » If it is unsafe to pull over, make sure they have a plastic bag in the car – just in case! Relieves nausea due to motion, pregnancy, anesthesia and chemotherapy Drug-free - Uses the science of acupressure No drowsiness Perfect for both kids and adults Always read the label & follow the instructions. TAPS NA 6962 Page 155

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