# Seasick medication



## jobberone (Jun 24, 2012)

I saw some posts recently about a medication not prescribed in the US that is really good for nausea but I've searched and can't find it. I'm sure it's because I'm not using the search engine properly but help anyway.

I'm familiar with all the US meds and have no problem getting the patch but I personally don't like it much. Inapsine I have but I prefer not to use this if I can. I also have some Zofran but again prefer not to use that for mild nausea.

Is there something out there that's new and not available in the US. PS: not crazy about the idea Salivet although have never used and have no experience.

I don't get seasick often (once since the first time) but the wife gets queasy. But I haven't been in a lot of bad weather either.

Thanks.


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## rockDAWG (Sep 6, 2006)

I think you may be talking about Stugeron (generic name Cinnarizine) which is not available in U.S. However it is the same derivative of piperazine of Bonine or Antivert which is available OTC in U.S. They all work well if it is taking before the voyage. 

Prior to take the seasickness med, try it at home to see if any side effect occurs on land.

Salivette won't work. To prevent excessive over production of saliva, use crystallized ginger root (not the sweet one).


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## Brent Swain (Jan 16, 2012)

Stugeron, available in Mexico and Britain is great stuff. Long shelf life. Take it, then try reading on a moving vehicle,. If it works there it will probably work at sea.
British stuff is 15 mg, Mexican 75 mg. Takes 5 British ones to match a Mexican one.


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## jobberone (Jun 24, 2012)

rockDAWG said:


> I think you may be talking about Stugeron (generic name Cinnarizine) which is not available in U.S. However it is the same derivative of piperazine of Bonine or Antivert which is available OTC in U.S. They all work well if it is taking before the voyage.
> 
> Prior to take the seasickness med, try it at home to see if any side effect occurs on land.
> 
> Salivette won't work. To prevent excessive over production of saliva, use crystallized ginger root (not the sweet one).





Brent Swain said:


> Stugeron, available in Mexico and Britain is great stuff. Long shelf life. Take it, then try reading on a moving vehicle,. If it works there it will probably work at sea.
> British stuff is 15 mg, Mexican 75 mg. Takes 5 British ones to match a Mexican one.


Yeah, that was it. I didn't remember it was an antihistamine type drug so that's no help to me. Salivex is a med that has THC as its antiemetic which is why I wasn't crazy about it. Thanks for the help. We'll take some antihistamine for her and bring some patches if that doesn't work.


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## kellysails (Nov 1, 2008)

My wife bought a "Relief Band" a number of years ago. It is great! No meds and it works well for her. Unfortunately that company went out of business and was taken over by a robber who only sells the bands that are disposable. The original band allowed you to simply replace the battery, like a watch, as needed. This really does work!

Here is how:
Worn on the wrist, the Reletex produces a small neuromodulating current which stops peristalic waves in the stomach, ceasing nausea and vomiting. There are no side effects, no drugs to take and the stimulation sensation is minimal. The Reletex is effective for all types of motion related sickness whether its while flying, boating or riding in a car. Travel can be enjoyable again!

The is the new product from the new company, somewhat of a rip off IMHO. But this technology does work.
https://www.aeromedixrx.com/Reletex-Anti-Nausea-Device.html


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## rockDAWG (Sep 6, 2006)

jobberone said:


> We'll take some antihistamine for her and bring some patches if that doesn't work.


For a day sailing, oral med is better. For an extended long voyage over a few days or more, the patch is preferred. Scopolamine patch lasts for three days. You rarely need more than 2 patches. Once you get your sea legs you don't need it, so you can peel it off from your skin.

Scopolamine causes more dry mouth than others, general speaking. A prolonged use will lead to redraw problem or re-bounced with a sudden redraw. Consult your physician when in doubt.


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## rockDAWG (Sep 6, 2006)

kellysails said:


> My wife bought a "Relief Band" a number of years ago. It is great! No meds and it works well for her. Unfortunately that company went out of business and was taken over by a robber who only sells the bands that are disposable. The original band allowed you to simply replace the battery, like a watch, as needed. This really does work!
> 
> Here is how:
> Worn on the wrist, the Reletex produces a small neuromodulating current which stops peristalic waves in the stomach, ceasing nausea and vomiting. There are no side effects, no drugs to take and the stimulation sensation is minimal. The Reletex is effective for all types of motion related sickness whether its while flying, boating or riding in a car. Travel can be enjoyable again!
> ...


Motion sickness is a central nervous system mediated symtom which is subjected many environmental factor as well as psychological effect. Placebo can play an important role. So if the wristband works, great, keep using it until it fails. I assume if you go off shore with heavy seas, the wristband or ginger will not work.


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## outbound (Dec 3, 2012)

bonine- central antihistaminic/anticholinergic- suppreses output from area postrema in floor of 4th ventricle ( vomit center ) -quite effective. but also blocks central histamine from tubomammillary bodies ( they help maintain alertness). Hence, very good advise to try on land first. Don't want to make nav. or other errors. has long functional 1/2 life
Scop- central anticholinergic. Can block memory consolidation and cause confusion (especially if multiple patches used). Also good idea to try first on land to make sure no cognitive side effects.
given ~1/3 of folks respond to placebo and nocebo good idea to not talk about it.


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## killarney_sailor (May 4, 2006)

I think it makes a great deal of sense to try various methods on shore first. There is no magic bullet for everyone. We have friends who use ginger with good effect, even ginger ale, but strong ginger beer or ginger tea. Obviously no side effects. We had a guest onboard in the Caribbean who put a patch behind each ear, she only has two university degrees so can't expect her to read the instructions and there were two patches in the package. She had an incredible range of the side-effects mentioned in the enclosure. I wonder how half a patch would work for those who only get a bit queasy?


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## rockDAWG (Sep 6, 2006)

Two Scopolamine patches are way too much unless she is a 450 lbs Gal. 

I would not used a half patch becasue it reduces the release rate of the drug by half. The therapeutic concentration of Scopolamine will never be reached. It is better to remote the patch if significant side effects are observed. The first side effect of the drug is dry mouth which is relatively easy to observe. For older folks, it may be difficulty in urination. After three days when the drug reaches at a steady state concentration in the body , one can use half patch as a maintenance dose. 

Of course, your physician has the last words when it comes to your health.


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## copacabana (Oct 1, 2007)

Stugeron is very effective for most people. 75mg is probably overkill. I buy 25mg pills and I've found that taking one a day for the first 3 days at sea is ideal.


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## benesailor (Dec 27, 2012)

Keep your eyes peeled for a new inhaler that will be coming out hopefully in the next year or so. The US Air Force has developed a new sea sickness medication for its pilots. It is supposed to work very rapidly; so as not have to take a couple hours prior. 
During flight training it is quite common for students to get motion sickness. They have to learn how to deal with it without medication. 
Also:


> Sam Puma went to high school during the 50's when America was beginning it's space program. Sam dreamed of becoming an astonaut. His father wanted him to be a doctor. After graduating from Hahnemann Medical School he joined the Air Force and successfully combined the two pursuits, first as a flight surgeon for NASA and later as a jet fighter pilot. Then it happened - the necessity. The T33 training jet Sam was in didn't have airsickness bags. After a series of maneuvers, Sam desperately needed one. Out of necessity, Sam filled one of his gloves. The other pilots had their laughs, but Sam wasn't going to give up his passion for flight because of motion sickness. Again, out of necessity, Sam developed what is now called the Puma Method, a series of conditioning exercises which raise a person's tolerance level to motion sickness-producing activities.


or Air Force Study on Air sickness
http://afspp.afms.mil/idc/groups/public/documents/afms/ctb_100059.pdf


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## capttb (Dec 13, 2003)

> Salivex is a med that has THC as its antiemetic which is why I wasn't crazy about it.


And all this time I thought I was immune to seasickness, I was just pre-medicated.


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## jobberone (Jun 24, 2012)

I assume you meant she would get less drug. The release rate is going to be the same per patch surface area applied to skin. The half life is less than 5 hrs so getting the full affect would take about a day. Elimination half life is about 10hrs.


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## IronSpinnaker (Mar 28, 2011)

NEVER CUT A MEDICATION PATCH IN HALF.

It negates the timed released effects and dumps all the drug on your skin in one dose. Read the directions people!

From the box: DOSAGE AND ADMINISTRATION

Initiation of Therapy: To prevent the nausea and vomiting associated with motion sickness, one Transderm Scōp patch (programmed to deliver approximately 1.0 mg of scopolamine over 3 days) should be applied to the hairless area behind one ear at least 4 hours before the antiemetic effect is required. To prevent post operative nausea and vomiting, the patch should be applied the evening before scheduled surgery. To minimize exposure of the newborn baby to the drug, apply the patch one hour prior to cesarean section. Only one patch should be worn at any time. *Do not cut the patch.*


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## jobberone (Jun 24, 2012)

I think the patch is continuous release so cutting it would not change the release rate of the drug much if at all.


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## IronSpinnaker (Mar 28, 2011)

Well do what you want... it is only scopolamine right? It's only common uses are to treat motion sickness and as a Drug of Choice in End of life Care.

Completely harmless to use it off label


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## jobberone (Jun 24, 2012)

I'm not advocating any use of any medication. I was only clarifying.


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## outbound (Dec 3, 2012)

any of you folks ever get land sick. once did a transport from southwest harbor maine to duxbury ( ended up in situate). got stuck in a storm. trip ended up taking a week ( blew out sails). did not get sick during trip but first night home couldn't lie down in bed without the worse vertigo. exhausted and couldn't sleep cause everytime I closed my eyes felt the world sway and spin. totally miserable experience.
Don't know about details of scop patch but do know engineering of transdermal med patches vary greatly in construction. some are drug in matrix wth semipermiable membranes against skin and delievery rate is dependent on intact patch with membrane totally encasing the drug matrix. would suggest look in PDR before cutting one in half.
Airforce article was of interest. Tx B sailor. most of us don't have access to a Barany chair. Wonder if doing repetitive Dix Hallpike manuvers would do the same thing or the exercises they use in vestibular rehab such as habituation exercises. Knew a lady sailor who believed getting drunk then sleeping on the boat the night before leaving on a passage prevented seasickness. Never tried it. She wasn't that cute and I'm married.


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## SteveInMD (May 11, 2007)

I tried the patch. I'll never use it again. It made me hallucinate. I now just use a little Bonine sometimes if needed. It doesn't put me to sleep like Dramamine.


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## outbound (Dec 3, 2012)

Believe in the "good old days" they gave the ladies scop before childbirth. Didn't help the pain but they had a good trip and didn't remember much of anything.


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## capttb (Dec 13, 2003)

> any of you folks ever get land sick.


Yeah, Also known as "Mal de debarquement" the admiral doesn't get seasick but the first time she had this we went to a large medical center after a couple days. They were baffled except for an ENT doctor who'd read about it but never seen it. They did some Physical therapy for balance etc. but the real cure was 2 Valium and 10 hours sleep.
Turns out the old sailor's cure was to get drunk and go to sleep, the doctor called it "Doing a hard reboot on the semi-circular canals".
I like the idea that getting drunk and sleeping on the boat is medicinal.


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## MedSailor (Mar 30, 2008)

Here you go guys, and gals. Reproduced from my $500/year online medical textbook. Underlining in the text is my emphasis to higlight what I feel are the more salient points. (or is it SAIL-ent points)

Oh, and BTW for those thinking of cutting trans-dermal medications... *DON'T CUT THE PATCH! *

My recommendations are as follows:
1. If you know you get seasick badly and you're going offshore, try scopalamine on land. If it works, use that, but you must start it before you get on the boat and only use it for 3 days. It's what NASA gives its austranauts.
2. If you can't tolerate scopalamine or don't get seasickness really bad, or are only going out for the day, use meclizine or bonine. Take it before you go on the boat, or before a storm, or before offshore, or generally before the situation that makes you get sick.
3. If you don't often get seasick but sometimes get it bad, keep promethazine + caffeine aboard and use it after you get sick. 
4. Accupuncture and ginger are harmless and may be effective but don't rely on them if you have a critical role and know that you're prone to bad seasickness.

MedSailor

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*TREATMENT AND PREVENTION* - A number of interventions can be used to prevent or alleviate motion sickness [34]. Treatments may be more effective when used for prevention rather than after symptoms have developed.

*Environmental modification* - Since conflicting sensory cues are believed to induce the symptoms of motion sickness, a straightforward treatment approach is to minimize the discrepancy between these cues. If visual and vestibular information are congruent, motion sickness is less likely to occur.

Labyrinthine cues cannot be readily manipulated, so this approach is based on providing visual information that contains equivalent motion information to that sensed by the vestibular system. Since the labyrinth senses motion in an inertial (earth-fixed) reference frame, this can be accomplished by viewing an earth-fixed environment during motion rather than a head-fixed environment. As an example, motion sickness on a ship is reduced if passengers view the horizon or land masses from the deck rather than their cabin. Similarly, passengers in a car should sit in the front seat and look through the window rather than sitting in the rear and focusing on an object moving with the interior of the car (such as a book).

Motion sickness does not occur during self-generated movements under normal conditions, so a second way to reduce the susceptibility to these symptoms is to control the motion of the vehicle. The driver of a car is less prone to motion sickness than a passenger, presumably because the driver's brain can utilize the motor commands related to controlling the car to predict in an approximate manner the motion of the head.

*Medication *- Drug therapies can be used to suppress conflicting sensory cues in the brain regions that process afferent signals or to treat nausea. In general, the effectiveness of medications depends upon inhibition of activity in the vestibular nuclei, where labyrinthine and visual sensory cues are combined and synthesized. Drugs that reduce activity in the vestibular nuclei include antihistamines, anticholinergics, and benzodiazepines; other medications that reduce motion sickness include antidopaminergics and sympathomimetics (table 1) [15,35].

In general, medications should be taken before passive motion begins, since they are less effective in relieving symptoms that have already developed.

*Antihistamines* - A number of antihistamines can be used to treat motion sickness, and their effect is probably related to their anticholinergic effects [15]. Medications include dimenhydrinate (Dramamine), diphenhydramine, chlorpheniramine [36], meclizine, cyclizine, and cinnarizine [37]. Dimenhydrinate is available as a chewable tablet. Cinnarizine is not available in the United States, but is widely used in other countries.

Side effects are mainly related to anticholinergic effects and can include sedation, blurred vision, mouth dryness, and, in the elderly, confusion and urinary retention. One small study suggested that cyclizine may be less sedating than dimenhydrinate at a dose that is equally effective for symptoms of motion sickness [38].

Nonsedating antihistamines do not appear to be effective for the treatment of motion sickness [39,40].

*Anticholinergics* - Scopolamine is commonly used for the management of motion sickness. A systematic review of randomized trials concluded that scopolamine is effective for prevention of motion sickness, but that no trials had examined its effectiveness in treating established motion sickness, and that the evidence comparing scopolamine with other treatments was inadequate [32].

At least three randomized trials were performed after the systematic review:

In a trial of experimentally induced motion sickness in 75 patients, scopolamine was more effective in preventing motion sickness than promethazine, meclizine, and lorazepam [41].
In a trial of the prevention of seasickness in 76 naval crew members, scopolamine was more effective than cinnarizine, an antihistamine [42]. Although differences were marginally significant, scopolamine was associated with fewer adverse effects than cinnarizine.
In a trial of preventing motion sickness in 64 helicopter passengers, the combination of promethazine and caffeine appeared to be more effective than scopolamine alone [43].

Scopolamine is most commonly administered as a transdermal patch applied every 72 hours. Side effects include those discussed above (sedation, blurred vision, mouth dryness, and, in older adults, confusion and urinary retention), and scopolamine is contraindicated in people at risk for angle closure glaucoma. Some instances of poor clinical response to scopolamine patches may be due to inadequate transdermal absorption leading to inappropriately low scopolamine levels in the blood [44].

*Antidopaminergics* - Promethazine can be used both for prevention and treatment of motion sickness [15,45]. In two trials of the prevention of motion sickness cited above, promethazine appeared to be less effective than scopolamine but more effective than meclizine or lorazepam [41], and promethazine and caffeine appeared to be more effective than scopolamine [43].

Metoclopramide has also been used for motion sickness, but there is somewhat less evidence for its efficacy than that of promethazine [46,47].

Side effects of antidopaminergics include sedation and extrapyramidal effects.

*Sympathomimetics* - Ephedrine and amphetamines have been used both to treat motion sickness and to counteract the sedating effects of other medications [15]. (See 'Effect on performance' below.) Ephedrine may have some benefit even after symptoms have developed [47]. Amphetamines are controlled substances with potentially significant side effects and the potential for addiction. Although less studied, pseudoephedrine is readily available in the United States including in combination medications with sedating antihistamines.

Caffeine may also be of benefit when used in combination with other medications. A randomized trial in 64 patients examined the effects of promethazine 25 mg plus caffeine 200 mg, meclizine 25 mg, scopolamine patch 1.5 mg, and an acustimulation wristband [43]. Only the combination of promethazine and caffeine produced a significant decrease in symptoms; the combination also improved reaction times.

*Other medications*

Benzodiazepines may be of some benefit for motion sickness, but they are sedating [48].
Standard antiemetics such as prochlorperazine or ondansetron can relieve nausea, which is usually the most prominent symptom of motion sickness [49]. However, in two studies in highly susceptible subjects, one in a laboratory model of simulated rotation and one at sea, ondansetron was ineffective in preventing motion sickness [50,51]. (See "Migrainous vertigo", section on 'Treatment'.)
GABA agonists such as baclofen or gabapentin inhibit the "velocity storage" mechanism in the central vestibular system that may be specifically responsible for producing motion sickness. The utility of these drugs has not been extensively studied to date and their potential usefulness is currently based on results from experiments that use complex movements to induce motion sickness and on case reports [10,11].
Effect on performance - Treating motion sickness can be a particular problem in patients who need to perform tasks such as flying a plane or acting as crew on a ship, since most of the medications used are sedating [52,53].

Dimenhydrinate (Dramamine U.S.) may have particularly negative effects on performance [54]. A controlled trial of medications for experimental motion sickness in 67 adults suggested that, at clinically useful doses, the drugs had the following order from best to worst for cognitive side effects: meclizine, scopolamine, promethazine, lorazepam [55].

One trial found that administering amphetamine, but not pseudoephedrine, with promethazine appeared to prevent the sleepiness and impairment of psychomotor performance seen with promethazine alone [56]. Another trial found that ephedrine decreased sleepiness and improved performance in patients administered chlorpheniramine, although it did not add to the effectiveness of chlorpheniramine in treating motion sickness [57].

*Treatment in pregnancy* - As mentioned above, pregnant women may be particularly susceptible to motion sickness. Medications that are felt to be safe for the treatment of morning sickness can also be used for motion sickness. These include the antihistamines (meclizine, diphenhydramine, and dimenhydrinate), and prochlorperazine, which is listed as category C in pregnancy by the US Food and Drug Administration (FDA) (table 2). (See "Clinical features and evaluation of nausea and vomiting of pregnancy".)

*Other*

*Physical therapy* - As discussed above, the vestibular response to head motion can decline over time (habituate), if a given motion pattern is presented repetitively. For this reason, physical therapy approaches that utilize recurrent head movements and associated visual cues can sometimes reduce the sensitivity to motion sickness in subjects who are particularly prone to this problem.

Ginger - Ginger has been used as an alternative medicine to prevent motion sickness. Randomized trials both in experimental motion sickness and in naval cadets at sea have found benefit with pretreatment with one to two grams of ginger [58,59]. The mechanism of benefit with ginger appears to be related to its effects on gastric motility rather than the vestibular system [60,61].

Acupressure- Pressure at the P6 acupressure point on the anterior wrist (three fingerbreadths proximal to the proximal wrist fold, between the palmaris longus and flexor carpi radialis tendons) (picture 1) either by manual pressure or with a wrist band has been reported to be effective for motion sickness in some [62-64], but not all [65-67], controlled trials. A randomized trial with a device that applies electrical stimulation to the P6 point found no benefit [43].

While these results raise the possibility that acupressure may be of benefit for motion sickness, trials of this sort can be difficult to perform with adequate blinding and allocation concealment. It remains uncertain whether acupressure is effective.

Magnets - Although sometimes promoted for this use, we know of no studies evaluating the efficacy of magnets in the treatment of motion sickness.

Nicotine deprivation - One small observational study found that overnight nicotine deprivation in smokers resulted in a reduction in motion sickness susceptibility [68]. The effect was most pronounced in subjects who were heavy smokers and with mild to moderate susceptibility to motion sickness

*References:*
-Murdin L, Golding J, Bronstein A. Managing motion sickness. BMJ 2011; 343:d7430.
-Brandt T, Dichgans J, Wagner W. Drug effectiveness on experimental optokinetic and vestibular motion sickness. Aerosp Med 1974; 45:1291.
-Buckey JC, Alvarenga D, Cole B, Rigas JR. Chlorpheniramine for motion sickness. J Vestib Res 2004; 14:53.
-Lucertini M, Mirante N, Casagrande M, et al. The effect of cinnarizine and cocculus indicus on simulator sickness. Physiol Behav 2007; 91:180.
-Weinstein SE, Stern RM. Comparison of marezine and dramamine in preventing symptoms of motion sickness. Aviat Space Environ Med 1997; 68:890.
-Kohl RL, Homick JL, Cintron N, Calkins DS. Lack of effects of astemizole on vestibular ocular reflex, motion sickness, and cognitive performance in man. Aviat Space Environ Med 1987; 58:1171.
-Cheung BS, Heskin R, Hofer KD. Failure of cetirizine and fexofenadine to prevent motion sickness. Ann Pharmacother 2003; 37:173.
-Dornhoffer J, Chelonis JJ, Blake D. Stimulation of the semicircular canals via the rotary chair as a means to test pharmacologic countermeasures for space motion sickness. Otol Neurotol 2004; 25:740.
-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. Clin Neuropharmacol 2012; 35:37.
-Estrada A, LeDuc PA, Curry IP, et al. Airsickness prevention in helicopter passengers. Aviat Space Environ Med 2007; 78:408.


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## jobberone (Jun 24, 2012)

I don't know of any adverse reastions using less than a whole patch esp if an entire patch creates side effects. Is there a problem with patch longevity when cutting into one?


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## IronSpinnaker (Mar 28, 2011)

jobberone said:


> Is there a problem with patch longevity when cutting into one?


The patch is like a really small jelly donut. It appears flat to the naked eye but the medication is contained in a small pocket in the middle of the patch. It slowly gets released through the membrane of the patch and onto your skin for absorption. When you cut it, all the medication leaks out the cut end and onto your skin at once. It is a 72 hr patch so even cut in half you are still getting 36 hrs worth of medication in one shot.

It isn't a harmless drug at all. It is used as a date rape drug which is why it is regulated and by RX only. We also use it to accelerate the dying process in terminally ill patients. (what is called a "Comfort Measure" drug) When somebody is within days of death we apply Scopolamine in combination with some other drugs and instead of days they pass in hrs.


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## SteveInMD (May 11, 2007)

For me, Bonine will work even after I start feeling sick. It's a huge benefit not to have to take it continuously on a trip, but I can wait until I know I really need it.


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## distantshores (Jan 24, 2013)

On board Distant Shores II we use Stugeron. On rough ocean passages I (Paul) can get seasick and Stugeron definitely works for me.

I have tried Scopolomine and MUST WARN if you want to use it - try it in advance. It is very potent and had bad hallucinogenic effect on me - also nausea?? Others have even reported temporary blindness.

Paul Shard - Aboard Distant Shores II - St Martin
Distant Shores Home


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## jobberone (Jun 24, 2012)

IronSpinnaker said:


> The patch is like a really small jelly donut. It appears flat to the naked eye but the medication is contained in a small pocket in the middle of the patch. It slowly gets released through the membrane of the patch and onto your skin for absorption. When you cut it, all the medication leaks out the cut end and onto your skin at once. It is a 72 hr patch so even cut in half you are still getting 36 hrs worth of medication in one shot.
> 
> It isn't a harmless drug at all. It is used as a date rape drug which is why it is regulated and by RX only. We also use it to accelerate the dying process in terminally ill patients. (what is called a "Comfort Measure" drug) When somebody is within days of death we apply Scopolamine in combination with some other drugs and instead of days they pass in hrs.


There is a membrane between the skin and the drug which limits the release of scopolamine which has only 1 mg of drug in the entire patch. I'll get a patch and cut it to see if the area with the drug leaks out the side and I'll get back to all.


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## Ferretchaser (Jan 14, 2011)

I like a more natural approach to sea sickness and find that sitting under an old oak tree for just a few minutes hepls a heck of a lot more then any pill I have seen so far. 

ATB

Michael


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## MedSailor (Mar 30, 2008)

jobberone said:


> There is a membrane between the skin and the drug which limits the release of scopolamine which has only 1 mg of drug in the entire patch. I'll get a patch and cut it to see if the area with the drug leaks out the side and I'll get back to all.


*NO NO NO NO NO!* This is a very dangerous thing you are playing with here. Don't cut the patch, not even for an experiment, and if you must, then please wear gloves so you don't give yourself a toxic dose.

Using the words "only 1mg of drug" is very *VERY* concerning to me. You know not what you are doing here. Prescription, and other drugs, are not all equal in their effects at the same number of milligrams. 1mg of tylenol is ineffective, whereas 1mg of thyroid medication will give a heart attack to a healthy person.

1mg of scopalamine, delivered over 1hr with a cut patch is not "just 1 mg" it is 72 times the recommended dose. That could be fatal. If I were having this conversation in my office I would tear up the scopalamine prescription and call the patient's pharmacy and cancel all their other scopalmamine prescriptions.

Please be safe. These medications are safe and effective when taken as directed and dangerous or deadly when abused.

MedSailor

PS Why do you want to decrease the dose so badly? In the article I referenced above they mentioned that it looked like the times scopalamine didn't work were the times when not enough was given. If you really want to tinker with the dose, get the pill or injectable form of scopalamine and take a lesser dose that way.


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## rockDAWG (Sep 6, 2006)

jobberone said:


> I assume you meant she would get less drug. The release rate is going to be the same per patch surface area applied to skin. The half life is less than 5 hrs so getting the full affect would take about a day. Elimination half life is about 10hrs.


Sorry if I have misled you. The release rate/area will always be the same. But she will getting half amount of the drug, and the steady state concentration will be half of what she needed to fight for the motion sickness. Scopolamine half life is about 4.5 in human, but I am not sure where the 10 hour T1/2 comes from.


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## DonScribner (Jan 9, 2011)

Modern medicine grabs at designer drugs that invariably have some adverse affects. To downplay these affects they call them "side affects" as if that description somehow renders them acceptable. The truth is that an affect is an affect, maybe not a desired affect, or an acceptable affect, but nevertheless, it is an affect. So . . . do you want to live with them? I tend to go to the experts, people who have no vested interest but are there to get to the definitive bottom, the truth of truths. I go to . . . The Myth Busters. I'll wait while you roll your eyes . . . OK.

Now, the MBs had a show on motion sickness. They built a chair and stuck the red headed kid, Adam, in it and started him going. Did the same to Grant. They tried everything, Dramamine, Bonine, magnets, bands and the like. Both guys were sick, sick sick, rolling on the floor, yakking stuff up. I really felt bad. Then, came ginger root. Adam, who gets really sick, really fast, took the stuff and hit the chair. Five minutes of spinning (slowly) and he's still saying "Bring it!". Grant had the same experience. Ginger has been used for thousands of years. It's natural (so is death) and it's cheap. You can pick it up at Walmart. Best of all, there's no drug company paying for big advertising, cute bottles to get your attention, high tech research or bribes to the FDA to pass it. I'm not an organic food nut, but I'll stick with the simplest of solutions rather than dumping some exotic compound that will have me coughing up my spleen in a few years.


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## rockDAWG (Sep 6, 2006)

MedSailor said:


> *NO NO NO NO NO!* This is a very dangerous thing you are playing with here. Don't cut the patch, not even for an experiment, and if you must, then please wear gloves so you don't give yourself a toxic dose.
> 
> Using the words "only 1mg of drug" is very *VERY* concerning to me. You know not what you are doing here. Prescription, and other drugs, are not all equal in their effects at the same number of milligrams. 1mg of tylenol is ineffective, whereas 1mg of thyroid medication will give a heart attack to a healthy person.
> 
> ...


i agree that one should not tinker with the finished products especially when the products are designed to cover a long period of time. For example, Scopalamine patch or long action extend tablet. The fear of dose dumping is dangerous, and it was a great concerns of the FDA and drug company in 1980s. Because of there reasons, Drug company would not use drug reservoir approach for their formulation.

In the 80's I worked with NicoDerm patch (CIBA GEIGY) in the clinical trials regarding its efficacy and pharmacokinetics. It uses a propriety zero order release polymer to deliver the drug. There was no dose dumping ever observed. Later, the same system was used for scopalamine patch.


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## rockDAWG (Sep 6, 2006)

DonScribner said:


> Modern medicine grabs at designer drugs that invariably have some adverse affects. To downplay these affects they call them "side affects" as if that description somehow renders them acceptable. The truth is that an affect is an affect, maybe not a desired affect, or an acceptable affect, but nevertheless, it is an affect. So . . . do you want to live with them? I tend to go to the experts, people who have no vested interest but are there to get to the definitive bottom, the truth of truths. I go to . . . The Myth Busters. I'll wait while you roll your eyes . . . OK.
> 
> Now, the MBs had a show on motion sickness. They built a chair and stuck the red headed kid, Adam, in it and started him going. Did the same to Grant. They tried everything, Dramamine, Bonine, magnets, bands and the like. Both guys were sick, sick sick, rolling on the floor, yakking stuff up. I really felt bad. Then, came ginger root. Adam, who gets really sick, really fast, took the stuff and hit the chair. Five minutes of spinning (slowly) and he's still saying "Bring it!". Grant had the same experience. Ginger has been used for thousands of years. It's natural (so is death) and it's cheap. You can pick it up at Walmart. Best of all, there's no drug company paying for big advertising, cute bottles to get your attention, high tech research or bribes to the FDA to pass it. I'm not an organic food nut, but I'll stick with the simplest of solutions rather than dumping some exotic compound that will have me coughing up my spleen in a few years.


MB is for entertainment only. Clinical trials are a serious scientific investigation undertaking. I hope FDA would not use MB result to either approve or disapprove the drug sold in the states.


> bribes to the FDA to pass it.


With this statement, it tells us that you are not very familiar with the drug approval process in the US and you are a layman in regarding in Internal Medicine. 
Although your views are not unique, there are many share your thinking.


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## kellysails (Nov 1, 2008)

rockDAWG said:


> Motion sickness is a central nervous system mediated symtom which is subjected many environmental factor as well as psychological effect. Placebo can play an important role. So if the wristband works, great, keep using it until it fails. I assume if you go off shore with heavy seas, the wristband or ginger will not work.


Well maybe it is the placebo effect. All I know is that while sailing in Greece in following 4m seas (as a result of a Meltimi) my wife never batted an eye. This was a six hour run. That run made me green and I never feel the effects of seasickness. 1m waves used to turn her green prior to the wrist solution.


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## rockDAWG (Sep 6, 2006)

Good to hear that is working for your wife. 

Since the motion sickness is mediated via the CNS, anything that feeds into the brain has some significance. For example:
1. Excessive alcohol consumption the night before
2. The huge greasy dinner and the indigestion the morning after
3. Doing so close work in cabin below for a few minutes during rough sea
4. Once the queasy feeling set in, hard to get rid off. 

Motion sickness in general and things to do to avoid motion sickness
1. Affect more younger children than old people
2. Strong man can get just as sick as woman. Don't be wussy, take your medication when the medical officer or Captain request you the do so. If you get sick, other needs to take care of you and do your job. It is so unfair and will endanger the others and the ship.
3. If you get queasy, be a helmsman for a few hours, it will take the edge off
4. Do not eat cheese, milk or dairy product the day before.
5. Half full stomach is better than full
6. Hydration and plenty sleep
7. Get a few sleeping pills from your doctor, use it the first nite to if you can't fall into sleep easy. OTC does not work.


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## chucklesR (Sep 17, 2007)

The Navy's remedy for sea sickness was scrubbing the floor you puked on. 
Brought the source closer to the landing zone, less collateral damage. 

Serving spaghetti the first meal underway helped, it came out easy. The acid in the sauce kinda hurt (I hear, never had a problem), but helped when cleaning


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## outbound (Dec 3, 2012)

other non pharm tricks that may help
1.lying down ( less stimulation to utricle and saccule lateral semi circular canals not as active) in berth or sette in center of boat. If not puking flat on back (symmetrical input).
2. Sleeping ( this decreases peristalsis- and may reset brainsten structures)
3.standing at centerline of boat with hand on fixed element.i.e standing facing forward holding top of dodger or stand and steer Use legs to absorb lateral motion. This decreases input to vestibular system and allows proprioceptive input to modulate conflict between visual and vestibular input.
If they are still sick I put a harness on them and lie them down in the cockpit. Much easier to clean up. I keep them out of the head. The confined space with little visual reference just makes them puke all the more. Find most people can live for days in a storm on Coke and snicker bars. The caffeine sugar and hydration keeps them functional and on watch.


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## sparrowe (Nov 29, 2010)

kellysails said:


> Well maybe it is the placebo effect. All I know is that while sailing in Greece in following 4m seas (as a result of a Meltimi) my wife never batted an eye. This was a six hour run. That run made me green and I never feel the effects of seasickness. 1m waves used to turn her green prior to the wrist solution.


My wife uses the band and finds it gives immediate relief. I can't rule out a placebo effect, but it is a FDA approved device for post-operative nausea. It is very annoying that the band no longer is available with replaceable batteries - the new units have a shelf life of less than a year, and so if you aren't in rough or rolling water a lot it is a heavy price to pay.


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## IronSpinnaker (Mar 28, 2011)

I also use Ginger root with good effect. I find that eating something light when you start to feel sick helps. I drink Gatoraid when in rough seas. I try and stay out of the head, because the enclosed space does me in every time. Keep your eyes on the Horizon if possible. 

I have popped an IV in my wife before and gave her IV phenergan, the combination of the antiemetic and a liter of L-Ringer is highly effective, but you need a RX for home IV therapy and somebody who is licensed to administer it.


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## IronSpinnaker (Mar 28, 2011)

sparrowe said:


> I can't rule out a placebo effect...


The nice thing about Placebo is it's cheap to produce, highly effective, and all the side effects are imaginary.


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## MedSailor (Mar 30, 2008)

Of course there is the century's old remedy.

RUM! 

If you still care about your seasickness, you haven't yet reached a therapeutic dose. 

MedSailor


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## MedSailor (Mar 30, 2008)

IronSpinnaker said:


> I also use Ginger root with good effect. I find that eating something light when you start to feel sick helps. I drink Gatoraid when in rough seas. I try and stay out of the head, because the enclosed space does me in every time. Keep your eyes on the Horizon if possible.
> 
> I have popped an IV in my wife before and gave her IV phenergan, the combination of the antiemetic and a liter of L-Ringer is highly effective, but you need a RX for home IV therapy and somebody who is licensed to administer it.


Phenegran suppositories (in all seriousness) are a more accessible option for most than an IV setup. Also, IV therapy, if done wrong, can lead to endocarditis and other nasty things.

Since phenegran and caffeine were shown to work better than anything else for the patient that is already sick, you could do well with some caffeine gum and phenegran suppositories in your kit.

MedSailor


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## IronSpinnaker (Mar 28, 2011)

MedSailor said:


> Phenegran suppositories (in all seriousness) are a more accessible option for most than an IV setup. Also, IV therapy, if done wrong, can lead to endocarditis and other nasty things.
> 
> Since phenegran and caffeine were shown to work better than anything else for the patient that is already sick, you could do well with some* caffeine gum and phenegran suppositories in your kit.*
> 
> MedSailor


Don't forget the lube

Yes most people can not get access to IV Therapy and even though I place IVs and administer IV drugs every day at work... Her physician made me go in and demonstrate that I had the skills... and verified my license first.

Reminds me of an episode of Doomsday Preppers, where one guy was stock piling outdated medical supplies including IV caths and bags of fluids... On the show he demonstrated placing the IV in his wife and giving her "life saving fluid" He completely missed the vein and was running fluids into her interstitial tissue...


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## kellysails (Nov 1, 2008)

sparrowe said:


> My wife uses the band and finds it gives immediate relief. I can't rule out a placebo effect, but it is a FDA approved device for post-operative nausea. It is very annoying that the band no longer is available with replaceable batteries - the new units have a shelf life of less than a year, and so if you aren't in rough or rolling water a lot it is a heavy price to pay.


This Reletex Corporation really pisses me off. They could have easily created a version that allows you to change out the battery, but no. Greedy bastards. Whenever I get into a really foul mood I like to send them nasty grams. I think they have my email blocked now. While I'm thinking about it, it's time for another email.


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## sparrowe (Nov 29, 2010)

kellysails said:


> This Reletex Corporation really pisses me off. They could have easily created a version that allows you to change out the battery, but no. Greedy bastards. Whenever I get into a really foul mood I like to send them nasty grams. I think they have my email blocked now. While I'm thinking about it, it's time for another email.


Love it! I'll join you in the fun!


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## kellysails (Nov 1, 2008)

sparrowe said:


> Love it! I'll join you in the fun!


Mistakenly I referenced their distributor. The company that manufacturers the product is Home » Neurowave Medical Technologies

They have a contact us page.


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## AE28 (Jun 20, 2008)

My Wife uses the non-electric pressure point elastic wrist bands with 100% success for daysailing, even if she forgets to put them on at dockside and puts them on after feeling the first symptoms of mal de mer.


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## jobberone (Jun 24, 2012)

MedSailor said:


> *NO NO NO NO NO!* This is a very dangerous thing you are playing with here. Don't cut the patch, not even for an experiment, and if you must, then please wear gloves so you don't give yourself a toxic dose.
> 
> Using the words "only 1mg of drug" is very *VERY* concerning to me. You know not what you are doing here. Prescription, and other drugs, are not all equal in their effects at the same number of milligrams. 1mg of tylenol is ineffective, whereas 1mg of thyroid medication will give a heart attack to a healthy person.
> 
> ...


I don't want to cut the dose because I don't get seasick. I'm merely curious and I'm a physician. I've prescribed the patch but never used it. I've been busy so I haven't cut a patch yet but I will try and get some today. And I've already stated in this thread that I'm not advocating taking any medications much less scopolamine in any form. We're only having a discussion here.

If you're a physician, too, then you know there are idiosyncratic reactions to even small doses of scopolamine with instances of psychosis lasting days. I'm very aware of anticholinergic syndrome as well but again I'm not advocating anything. Patients should not get their medical advice on internet forums but from their physician.


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## scratchee (Mar 2, 2012)

kellysails said:


> Well maybe it is the placebo effect. All I know is that while sailing in Greece in following 4m seas (as a result of a Meltimi) my wife never batted an eye. This was a six hour run. That run made me green and I never feel the effects of seasickness. 1m waves used to turn her green prior to the wrist solution.


I had a friend who experienced a "reverse placebo effect" with one of those pressure bands for motion sickness. We were in flight training, and he was getting sick, so he tried this band. He put it on in the locker room and said he was nauseated before he reached the door. He ripped it off and threw it away.

My own experience was with the scope patch. We were in the "dogfighting" stage of training (I was in the back seat,) and I was getting really, seriously sick. The flight surgeon gave me a patch, and the next dogfight was like sitting on a park bench. I was rock solid. But on a later flight I could barely stay awake, and I think I also saw some cartoon characters at one point. So..., mixed results.


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## scratchee (Mar 2, 2012)

IronSpinnaker said:


> On the show he demonstrated placing the IV in his wife and giving her "life saving fluid" He completely missed the vein and was running fluids into her interstitial tissue...


My wife and I were watching a (fictional) movie with a diabetic woman taking an insulin shot (my wife is diabetic and takes insulin shots.) The woman in the movie tied her arm with a rubber tube and went searching for a nice plump vein, like she was shooting heroin or something.


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## IronSpinnaker (Mar 28, 2011)

scratchee said:


> My wife and I were watching a (fictional) movie with a diabetic woman taking an insulin shot (my wife is diabetic and takes insulin shots.) The woman in the movie tied her arm with a rubber tube and went searching for a nice plump vein, like she was shooting heroin or something.


That would be one of the easiest ways for a diabetic to kill them selves: There is a rather Controversial and dangerous method of bringing down a high Potassium level which involves giving the Patient Insulin Intravenously. Many hospitals now ban the practice, but some still use it. I hate getting orders to preform this procedure. I have had more than one patient end up with critically low BS as a result and end up practically comatose and in the ICU. It is amazing how small of a dose of IV insulin can drop somebodies blood sugar to 20 mg/dl.. And even more amazing how much Dextrose it takes to bring them back up to a normal level.


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## IronSpinnaker (Mar 28, 2011)

jobberone said:


> I don't want to cut the dose because I don't get seasick. I'm merely curious and I'm a physician. I've prescribed the patch but never used it.


In that case prescribe somebody a patch with orders to cut it in half and watch how fast after the Pharmacist receives it you get a call that they will not dispense it.


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## daydream sailor (Mar 12, 2012)

If you are up in canada i would suggest a tablet called gravol works good, and ginger ail does a nice job with the stomach too.


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## jobberone (Jun 24, 2012)

IronSpinnaker said:


> In that case prescribe somebody a patch with orders to cut it in half and watch how fast after the Pharmacist receives it you get a call that they will not dispense it.


I really resent this. No where have I said I was interested in prescribing or advocating anything. Again this is a friendly discussion on a forum.


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## Cruisingdad (Jul 21, 2006)

IronSpinnaker said:


> In that case prescribe somebody a patch with orders to cut it in half and watch how fast after the Pharmacist receives it you get a call that they will not dispense it.


I did not read where he was advocating anyone doing that. I think he is simply curious. If you do it with gloves on, I don't see what the big deal is. If he is a physician, I assume he has enough common sense and experience to know how to handle the product.

My opinions,

Brian


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## Cruisingdad (Jul 21, 2006)

We have used a wide variety of products. I do not pretend to be the expert on them, but I will give you my experience over the last eighteen years.

A good basic product (especially for kids) is perpermint. Yes, just like you buy at the grocery store. We keep it aboard and the kids have it in their mouth anytime we are making a long run or in weather. It is cheap and works "ok". 

Next up is ginger. You can buy it from nutritional stores in large doses (milligrams). You can also buy ginger beer (it is non-alcoholic) from many nutritional stores which has a high content of ginger. Ginger Ale (Canada Dry) seems to have a very low mg. However, carbonation does seem to help us. You can also get a high concentration ginger ale as I recall, but not at the grocery stores. One easy trick is to bake ginger snaps and keep them easily accessibe. I will say that ginger is not completely without its side effects: it gives me the burps so bad I often don't bother with it. However, it too is safe for kids. We gave up long ago on carrying the ginger beer because of space and instead carry the ginger pills (and Canada Dry, but for drinks, not medicinal). The Ginger product we use is Spring Valley 550 mg Ginger Root.

We have used several of the OTC meds in the past and gave up on them as not being very effective and still making us sleepy.

Next up is Scoplamine. I have read through many of the comments about it on this thread and we quite surprised. I have never had that nor have I ever witnessed it. I am not discounting what others have said, but giving my experience over the last 18 years of boating. Quite candidly, Scope patches are our drug of choice (for adults). The issue with Scope that is a big negative for us is that you cannot make out writing or things through binocs. Forget trying to read... especially small print. I think that is part of how it works - by screwing up te signals between your eyes and brain and ears. It does make you a bit tired, but nothing like other meds we have taken. Another negative of scope is you have to put it on BEFORE you leave. It takes quite a while before really working for us (12 hours, though we generally start it the day before a passage). As such, it is not good for when you are sick, but rather a preventative beforehand. Another negative of this product is that I do not believe it can be used for children. I assume that has not changed anyways.

Next is Promethazine (Phenegran). It works pretty well and can be taken after getting sick, though honestly it is better to take before getting sick. We keep an eye out for the signs of sea sickness which are generally easy to spot (can discuss that below). We have carried both the pills and the suppository. Be aware, as the suppository was mentioned in this thread, it requires refrigeration. Personally, I would highly prefer that to trying to use an IV because it would seem to me that would be really hard to put in when the boat is rolling in large seas. If you get the pills, consider getting them in 12.5 mg. That is a "kids" dose. THe adult dose is 1-2 25mg pills. If you take two of them (25 mg), be ready to lose a lot of your cognitive ability. You will be tired and slow to react and may blur your vision. By messing around with lower doses (12.5 mg), you may find a lower dose that works for you. DO be aware that if you puke it up, you will have to wait until the next dose which I think is 6 hours.

The reality is that once someone gets sick, the key is to keep them hydrated. You have pretty much lost them to be any help for a while. We keep gatorade bottles easily available in the cockpit. Also, I would suggest keeping a 5 gallon bucket in the cockpit because it keeps someone from wanting to lean over the side of the boat to puke (dangerous). You can throw a bunch of paper towels in there with it and on top to help reduce others from sympathetic puking. We keep a line tied to it that we can toss over to fill (rinse). Good breezes and letting someone steer or put their face in the wind really helps us.

Regarding the original posters question about the Sturgeon, we did not find it any more effective than phenegran. However, everyones body is different. It is a pretty comon drug for cruisers, though we don't carry it. 

My opinions. I am NOT a physician, so I do not want anyone to take this advice for themselves. It is simply our experiences as long-time users and boaters.

Brian

PS Signs of sea sickness should be discussed with the crew beforehand. They are being lathargic, cold sweating, and watering mouth. THe biggest one is probably being lathargic and always seem to kick in first. THis is the best time to stop someone from getting sick as once they puke or are close to, it is harder to stop the whole sea sick cycle (not just puking, incidentally, but a cycle of lethargy often including puking and sometimes diarhea which becomes harder to stop). So keep an eye out for each other and when someone is showing some signs, have them move around and trim sheets, steer, face in wind, pepperint or ginger snaps, etc. If that doesn't help, pull out the phenegran and repeat the above. Keeping them moving is key as is hydration. We consider sea sickness a very serious, and often under realized, danger in boating. As a best friend and life long sailor once told me: Everyone (EVERYONE) gets sea sick. We all just have different thresholds.


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## IronSpinnaker (Mar 28, 2011)

There is no reason to be curious about it. It is illegal to use it in any manner other than what is approved by the FDA and I already showed the directions that state "DO NOT CUT THE PATCH". 

Being curious about it is like being curious about providing alcohol to minors and wondering if they will get drunk and do stupid things.


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## Cruisingdad (Jul 21, 2006)

IronSpinnaker said:


> There is no reason to be curious about it. It is illegal to use it in any manner other than what is approved by the FDA and I already showed the directions that state "DO NOT CUT THE PATCH".
> 
> Being curious about it is like being curious about providing alcohol to minors and wondering if they will get drunk and do stupid things.


To the best of my knowledge, he was not going to use it. He is cutting it. Are you suggesting that cutting the patch is illegal? Cutting and using it, yeah, that may not go over well. But cutting it to see how it works is not.

And I highly dissagree with your analogy. He is not giving it to anyone. That would have offended me too.

Brian


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## Geoff54 (Oct 30, 2011)

kellysails said:


> This Reletex Corporation really pisses me off. They could have easily created a version that allows you to change out the battery, but no. Greedy bastards. Whenever I get into a really foul mood I like to send them nasty grams. I think they have my email blocked now. While I'm thinking about it, it's time for another email.


Please excuse the thread drift but this is something I know a little about. If it makes you feel better to send emails go right ahead but don't expect anything from Reletex (Neurowave Medical Technologies) because I believe that they are only interested in maximizing profit and they have a method to do that. Here's the storey:

Reliefband was owned/manufactured by Woodside Biomedical, Inc., in Carlsbad, California.

In the search for antiemetics with less side effects and/or that were cheaper (oh, the irony) there were several clinical trials that tried Reliefband to help alleviate post-operative and chemo. induced nausea. Anyone who is interested can look these up in PubMed. I'm not sure who paid for these trials and I can't be bothered to research it but they were probably paid for in full or part by NIH grants, i.e. U.S. taxpayer dollars.

Abbott Laboratories either purchased Woodside Biomedical or purchased the rights to Reliefband and Woodside Biomedical closed down.

Based on the advantages as described in the medical trials, someone, I believe Abbott but possibly Neurowave Medical Technologies, gained FDA approval. *This is the key thing because it then allowed Reliefband (now known as Reletex) to become an approved medical device that could be charged to medical insurance, thus opening the doors significantly larger profits.*

Abbot sold the rights to Neurowave Medical Technologies. Neurowave Medical Technologies is a privately held Illinois coporation based in Chicago. If you want to find out who owns the company, you can pull the corporate record if you want but the board of directors comprises middle eastern medical marketers and U.S. venture capitalists as follows:
Khalid Alagel is the Founder and CEO of The Gulf Care Group (GCG), an innovative healthcare consulting company which develops international patient programs for client hospitals. 
Wilbur H. Gantz, III is President and Chief Executive Officer of PathoCapital LLC, a privately owned company investing in the healthcare field. 
Farhan Hussain is the President and CEO of Neurowave Medical Technologies. Prior to NMT, Mr. Hussain was a founding partner of The Gulfcare Group (GCG). 
Bruce V. Rauner is chairman of GTCR, a Chicago-based venture capital and private equity firm.

Also address for the U.S. office of Gulf Care Group is the same as the address of Neurowave Medical Technologies.

Clearly their model is to maximize profits by marketing single use medical devices to medical facilities who will use them help their patients. And because it is now a medical device and insurance will pay, they can charge much higher prices than before. And because it is single use, they can sell more of them.

I don't believe they have any incentive to market to the public or to make a device with reusable batteries. I will leave you to draw your own conclusions.


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## Geoff54 (Oct 30, 2011)

IronSpinnaker said:


> It is illegal to use it in any manner other than what is approved by the FDA


Absolutely not true - ever heard of "off label"?


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## MedSailor (Mar 30, 2008)

Geoff54 said:


> Absolutely not true - ever heard of "off label"?


Correct. If the provider prescribes it to be used in a non-FDA approved way, then it is off label and legal. As Iron Spinnaker mentioned though, a pharmacist might not fill a prescription that had instructions to cut the patch.

On the other hand, perhaps it is now re-formulated in the polymer matrix that was mentioned by another poster and it won't "dump the dose". Maybe it still is in the old medium and will dump the dose. Maybe the one you test here in the USA won't, but then the one you buy in Mexico will.

As for using it in a non-prescribed way, I'm not sure if that's legal or not. I should know that though... If it's true, then I could call the cops on 99% of my patients.

Likely safe if used as directed, and possibly unsafe if not. Be careful, that's all.

MedSailor


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## jobberone (Jun 24, 2012)

It is absolutely not illegal to prescribe a medication in a way the manufacturer does not advocate. In 30 years I and most physicians have used one and generally multiple medications on many occasions outside their intended use and/or dosage. You do open yourself up to civil liability and if you're doing something no other physician is doing and creating problems then you are open to criticism from the medical board of your state. If I actually were to tell a patient to cut a patch (and I'm not advocating that) you can avoid problems with the pharmacy by writing the prescription to be taken as directed.

I still haven't cut a patch myself but I made some calls. There is no recognized leakage when cut although there could certainly be some leakage not recognizable to the human eye. The content of one patch is 1 mg. Cut in half you would have 0.5mg. Oral bioavailability is quoted as 7-27% of ingested amount and percutaneous bioavailability is quoted as 60-90%. So 0.5mg x 75% would be 0.375 mg of scopolamine available. Even if you assumed 75% would be immediately available then 0.28mg of scopolamine could be absorded over 15-60 minutes. Hardly a fatal dose. That does not appear to be the case.

If there isn't any leakage then you've merely reduced the total dose in the patch to 50% which would be absorbed over three days in a controlled manner. The rate of release of medication would be the same cut or not but you have halved the amount absorbed over that time period.

I see little benefit for cutting the patch and would not personally do so myself for self administration and again I'm not advising anyone here medically about anything. If you are sensitive to scopolamine (not talking about those who cannot tolerate even tiny doses) then you may be better served taking the oral form which should absolutely be taken as advised by the manufacturer or alternatively by your physician or perhaps just avoiding it. Obviously if you are taking the patch without problems then carry on.

I'll mention that anecdoctally I've been told that applying it to the midline of the back of the neck will avoid dilating one pupil more than the other as can happen when placed behind the ear. Dilation of the pupil(s) is one cause of not being able to focus well. Application to the back of the neck may result in some decreased absorption of the drug relative to applying it to the back of the ear.

Someone above gave great practical advice which should be reviewed by those interested with favor. I would add that the advice of going up top and sailing the vessel is a great idea. You can interfere with some of the data coming from the canals by focusing on the horizon which is supposed to override some of the data from the canal. This should be done as early as possible. Getting your head out of the boat is great advice as is not overeating nor having an empty stomach. In time the brain will generally process the information in a way to avoid getting sick (for most).


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## outbound (Dec 3, 2012)

Humbly disagree with jobberone- Would suspect the anisocoria is not the usual cause of the poor vision in most cases. Also suspect it would not commonly relate to where the patch is placed. Believe the agent is absorbed percutaneously into the blood stream which the delievers it to the entrire circulation and brain. Rather the loss of accommendation usually of both eyes causes the blurry vision. Have had many crew and self place the patch in any non hairy spot and it works well. Lots of folks like to keep it out of the wet and somewhere it won't be rubbed.
May want to take a look in Grey's or Carpentiers as to vaso nervosum for ciliary ns. just recalling info stored from years ago.May be wrong but suspect not given neuro anatomy.


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## Geoff54 (Oct 30, 2011)

Rather than cut a patch, if you want to reduce the dosage, why not apply a piece of tape and then apply the patch so that only half of it contacts the skin?


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## jobberone (Jun 24, 2012)

outbound said:


> Humbly disagree with jobberone- Would suspect the anisocoria is not the usual cause of the poor vision in most cases. Also suspect it would not commonly relate to where the patch is placed. Believe the agent is absorbed percutaneously into the blood stream which the delievers it to the entrire circulation and brain. Rather the loss of accommendation usually of both eyes causes the blurry vision. Have had many crew and self place the patch in any non hairy spot and it works well. Lots of folks like to keep it out of the wet and somewhere it won't be rubbed.
> May want to take a look in Grey's or Carpentiers as to vaso nervosum for ciliary ns. just recalling info stored from years ago.May be wrong but suspect not given neuro anatomy.


You may be right about it being multifactoral and I'd be surprised if it weren't. However, even dilating one eye creates problems with focus and distance perception. I'm not an opthalmologist but having had my eyes dilated yearly at least now, I can say there is difficulty seeing well even with uv filters on. It's not just the aniscoria if any nor is it just related to the mechanics of the eye. It is definitely a CNS depressant and can alter sensorum. I'm not a particular fan of the drug but it works for many with minimal side effects. There have been a few cases of extremely altered sensorum in some patients who did not have the history or exam of the patch revealed and it has caused some diagnostic problems for their attendings when they also presented with anisocoria. That is my reasoning for placing it in the midline. If your experience dictates that placing it further from the eyes also reduces anisocoria then I've learned something. My guess is placing it postauricular increases absorption since that area is likely more vascular than away from the face/head/neck.


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## sparrowe (Nov 29, 2010)

Geoff54 said:


> Please excuse the thread drift but this is something I know a little about. If it makes you feel better to send emails go right ahead but don't expect anything from Reletex (Neurowave Medical Technologies) because I believe that they are only interested in maximizing profit and they have a method to do that. Here's the storey:
> 
> Reliefband was owned/manufactured by Woodside Biomedical, Inc., in Carlsbad, California.
> 
> ...


An interesting update to the Reletex/Neurowave saga: West Marine is now offering the ComfortQuest anti-motion sickness wrist band - correction, it is in the catalog and on the web site, but is shown as "out of stock." This device has a different design from the (former) Relief band, but the description is very similar (excerpt from the West Marine web site):

"The Comfort Quest Anti-Seasickness Band is a small, medical device designed to be worn on the underside of the wrist. It provides fast, moderate relief from nausea and vomiting due to motion sickness by applying gentle electrical stimulation to the nerves in your wrist. Approximately 150 hours of battery life at medium strength. Water resistant. Includes two CR2032 standard watch batteries, which are replaceable and available in many locations. Band does not require conductivity gel."

Note the key phrase about replaceable batteries!

But there is a fly in this ointment: On June 24, Neurowave filed a lawsuit against ComfortQuest alleging patent infringement. The details are quite interesting; apparently the former Director of Operations at Neurowave and its predecessor company, a Thomas Mann, is a director or officer of ComfortQuest. A Joseph Norris, also alleged to be a director or officer of ComfortQuest, was a sales rep for Neurowave. I gleaned this information from the complaint which you can read here:

http://www.knobbemedical.com/wp-content/uploads/2013/06/Complaint12.pdf

Speculation: might this lawsuit have something to do with West Marine now showing the ComfortQuest watch band as "out of stock"? Who knows. As of this morning (July 7), it is available from drugstore.com for $99, a significant savings over WM. I snapped up two; we'll see if they actually ship. Also available at various online sites is the "anti-morning sickness" version of the ComfortQuest band - which looks identical to the "anti-motion sickness" version except for the feminine color scheme. Get 'em while they are hot!

For those who, like myself, harbor considerable resentment and animosity towards Neurowave for its greed - so carefully documented in the lengthly quote above from Geoff54 - the complaint says that Neurowave has been planning for re-entry into the Over-the-Counter market of its devices and that this effort has been "materially hindered by Defendant Comfort Quest's selling of the Accused Products to Neurowave's former customer of the OTC Devices." Gee, isn't it nice to learn that Neurowave considers the people it abandoned its "customers"?


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## kellysails (Nov 1, 2008)

Thank you soooo much for finding this. My wife has the original version that has replacement batteries. It is the only thing that works for her. I just went on Drugstore.com to order a backup for her. The level of greed Neurowave demonstrates is epic.



sparrowe said:


> An interesting update to the Reletex/Neurowave saga: West Marine is now offering the ComfortQuest anti-motion sickness wrist band - correction, it is in the catalog and on the web site, but is shown as "out of stock." This device has a different design from the (former) Relief band, but the description is very similar (excerpt from the West Marine web site):
> 
> "The Comfort Quest Anti-Seasickness Band is a small, medical device designed to be worn on the underside of the wrist. It provides fast, moderate relief from nausea and vomiting due to motion sickness by applying gentle electrical stimulation to the nerves in your wrist. Approximately 150 hours of battery life at medium strength. Water resistant. Includes two CR2032 standard watch batteries, which are replaceable and available in many locations. Band does not require conductivity gel."
> 
> ...


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## Neosec (Jun 25, 2013)

*$$$ Saving Tip*
Looked through the tread and didn't see it mentioned (may have missed it)... As a cost saving tip, Bonine (et al?) cost WAY, WAY less if you go to the pharmacist and ask for the generic equivalent Meclozine. I bought a bottle of 100 for ~$14.00


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## northoceanbeach (Mar 23, 2008)

I would be scared to pull the patch off if I was offshore after a couple days. Sure, your body is probably used to the motion and will be fine but what if you are not? Seasick meds only work if you take them before you get sick so what if you pull the patch and start heaving?


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## northoceanbeach (Mar 23, 2008)

At $99 for that plastic piece of junk I don't know if I would exactly snap it up. Wait until you get it. It looks like it was made I the same factory in china that makes carnival prizes. Very cheap.


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## sparrowe (Nov 29, 2010)

northoceanbeach said:


> At $99 for that plastic piece of junk I don't know if I would exactly snap it up. Wait until you get it. It looks like it was made I the same factory in china that makes carnival prizes. Very cheap.


Hey -easy there! I like my Made in China carnival prizes! And my gold solar-powered prayer wheel with sparkling little jewels that spins on the dashboard of my car! 

Seriously, the Neurowave is cheap plastic at $150 or so, and the batteries died in a few months. The original Relief band was the same cheap plastic at $150 or so, except it was blue rather than white, but the batteries could be replaced. It is hard for me to imagine the ComfortQuest being any worse. But that's why I bought two - just in case.

I wouldn't be surprised to learn that all three come from China. Besides, the Chinese excel at making good quality stuff inexpensively if given a good design and decent specifications. My Apple gear, my Sony RX-100 camera and its waterproof case, my Tivoli radios, my oppo blueray, the Lehr outboard on the back of our boat, and all kinds of other cool stuff came from there.

What matters to me - and why I would willingly plop down $100 for a "plastic piece of junk" - is that it is the only thing that works for my spouse. She's highly sensitive to wave motion - even too many wakes on the local lake where we sail make her queasy. A few minutes with the wrist band and she is fine. She loves being on the boat, is a better sailor than I am, and is damned fine company. I'm incredibly lucky to be married to someone who wants to be on the water as much or more than I do. She doesn't gripe when I want to buy new stuff for the boat. So, the choice is simple. If she told me a $3000 Chanel purse would cure her nausea, I'd be at Nordstroms with my AMEX card in a heartbeat.

If the Comforquest proves to be junk, I'll let you know.


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## captbillc (Jul 31, 2008)

i read an article by a woman in ireland who could not get a patch. she asked an old fisherman what to use. he said he took a wad of chewing tobacco & put it in one ear so he didn't get seasick. she tried one of the foam earplugs in one ear and it worked. i never tried it because i don't get seasick. i guess it's worth a try for someone who would rather do that than use a patch. if it works for you, let everyone know about it.


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## outbound (Dec 3, 2012)

Believe NASA came up with the one earplug. Meclizine works even after emesis. Available as suppositories. Have used it on crew with benefit.


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## northoceanbeach (Mar 23, 2008)

I wasn't trying to give you a hard time, sorry it may have sounded like that. If it works for your wife get two. I've got one and it was more than $100. I just don't think the build quality is good. I thought it felt like it should be $15.


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## Geoff54 (Oct 30, 2011)

sparrowe said:


> But there is a fly in this ointment: On June 24, Neurowave filed a lawsuit against ComfortQuest alleging patent infringement. The details are quite interesting; apparently the former Director of Operations at Neurowave and its predecessor company, a Thomas Mann, is a director or officer of ComfortQuest. A Joseph Norris, also alleged to be a director or officer of ComfortQuest, was a sales rep for Neurowave. I gleaned this information from the complaint which you can read here:
> 
> http://www.knobbemedical.com/wp-content/uploads/2013/06/Complaint12.pdf


That complaint is very interesting. Quote, "Since December 2012, when it became apparent that a new CPT code would not be granted for the RX devices, Neurowave has been planning for re-entry of its OTC Devices into the market."

Translation: Ooops! We can't get a CPT code that allows us to charge obscene prices to the insurance companies, so our ridiculously profitable marketing plan has just been shot to pieces. Well, we'll just have to see what we can salvage by going OTC.

Speculation: While Neurowave went after the big bucks, a couple of employees saw a retail niche to be filled. Now that Neurowave's plans have stumbled, they don't want the competition for retail. It will be interesting see if the new guys have the money to fight and if Neurowave's patents stand up in court.

As for being a "plastic piece of junk", absolutely, but...
I don't want to medicate every time I go out because I don't usually have a problem and I have had issues with side effects. But every now and then the swell and the circumstances combine&#8230; and it's too late to take drugs. So I carry one of the old replaceable battery Relief Bands and that takes the edge off - maybe placebo but I don't care as long as it works. I agree that it's not very robust and I have been wondering what to do when mine finally dies - I would gladly pay a higher price for decent quality equivalent.

BTW, as of a week ago, at least one West Marine was selling the ComfortQuest next to the register. First time I knew it existed. There is also one other alternative, i-Trans DM-800 for about $40 and it uses a AAA battery but it's bulky and I think it's only available in teal green. I've never tried it.


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## Geoff54 (Oct 30, 2011)

outbound said:


> Meclizine works even after emesis. Available as suppositories. Have used it on crew with benefit.


A world of caution to anyone reading this.

Meclizine is a good antiemetic but no medication works for everyone. 
It is much more effective if taken prophylactically. 
Meclizine is an antihistamine. It is generally well tolerated but can have side effects and drug interactions, including some not usually considered. I know this from personal experience.
Antiemetic suppositories can be a lifesaver but there are reasons that they are RX - they should only be used when medically needed.

O.K. I'll get off my soapbox now.


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## northoceanbeach (Mar 23, 2008)

I think it goes without saying to take it prophilactically. You don't think we're swallowing those do you? 

First think I do when I wake up is keester a bottle of meclizine. Oral medicine is so 1990's.


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## Geoff54 (Oct 30, 2011)

northoceanbeach said:


> I think it goes without saying to take it prophilactically. You don't think we're swallowing those do you?
> 
> First think I do when I wake up is keester a bottle of meclizine. Oral medicine is so 1990's.


Ooops! You completely misunderstood. I don't think you know the meaning of "prophylactically" - Commonly preventive (as opposed to curative).

"Prophyactic. Adj. "Acting to defend against or prevent something, especially disease; protective. Prophylactically Adv."

So orally before you set off would be prophylactic and anally when you are desperate would be curative or kinky, depending on your point of view


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## MedSailor (Mar 30, 2008)

Geoff54 said:


> A world of caution to anyone reading this.
> 
> Meclizine is a good antiemetic but no medication works for everyone.
> It is much more effective if taken prophylactically.
> ...


All true. Try on dry land before you go.

Also, don't forget that suppositories are designed to melt in your.... um.... not in your hand. So if you're sailing in warm climes you have to think about where to store them. Preferably somewhere cool and away from direct light.... like where the sun don't shine? :laugher

MedSailor


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## jimgo (Sep 12, 2011)

Wouldn't that possibly lead to an overdose?


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## sony2000 (Jan 30, 2013)

The best prevention for sea sickness, is looking at the horizon a lot. Everything else has side effects, or moves.


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## Geoff54 (Oct 30, 2011)

MedSailor said:


> All true. Try on dry land before you go.
> 
> Also, don't forget that suppositories are designed to melt in your.... um.... not in your hand. So if you're sailing in warm climes you have to think about where to store them. Preferably somewhere cool and away from direct light.... like where the sun don't shine? :laugher
> 
> MedSailor


While leaving myself open to all kinds of innuendo, if it goes soft, putting it in a refrigerator or running it under cold water can help.


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## Geoff54 (Oct 30, 2011)

sony2000 said:


> The best prevention for sea sickness, is looking at the horizon a lot. Everything else has side effects, or moves.


Nothing works for everyone.

I stand ready to be corrected but I think the technique used by the military is the most effective "non drug" method (they only use drugs in the early stages, if needed) - I think USAF Air Sickness Management program claims 95% success overall and 85% success in high stress situations (i.e. combat).

They use a combination of biofeedback training, stress management, relaxation training and deep breathing exercises. The information isn't too difficult to find but it takes several days during which nausea is induced and then you are taught to overcome and eventually prevent it. You'll need help and you'll need to cobble together a Barany chair (30 rpm ??) for coriolis stimulation. When they do use drugs, they use a low combination of Dextroamphetamine sulphate and Scopolamine. All of this is from memory so do your own research if you are interested.


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## kellysails (Nov 1, 2008)

Hot diggity damn, our Comfort Quest arrived from Drugstore.com yesterday. Thank you so much sparrowe for keeping on top of this. I have also gained much enjoyment by sending snarky emails to Neurowave customer service on the new great find of Comfort Quest! I am sure they are getting pretty pissed off at me after the second email to them today! They deserve it, those greedy bastards.

We are much relieved knowing that if our very old and well used Relief Band does TU, we have a backup. This is the ONLY thing that works for my wife, whew!



sparrowe said:


> An interesting update to the Reletex/Neurowave saga: West Marine is now offering the ComfortQuest anti-motion sickness wrist band - correction, it is in the catalog and on the web site, but is shown as "out of stock." This device has a different design from the (former) Relief band, but the description is very similar (excerpt from the West Marine web site):
> 
> "The Comfort Quest Anti-Seasickness Band is a small, medical device designed to be worn on the underside of the wrist. It provides fast, moderate relief from nausea and vomiting due to motion sickness by applying gentle electrical stimulation to the nerves in your wrist. Approximately 150 hours of battery life at medium strength. Water resistant. Includes two CR2032 standard watch batteries, which are replaceable and available in many locations. Band does not require conductivity gel."
> 
> ...


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## sparrowe (Nov 29, 2010)

kellysails said:


> Hot diggity damn, our Comfort Quest arrived from Drugstore.com yesterday. Thank you so much sparrowe for keeping on top of this. I have also gained much enjoyment by sending snarky emails to Neurowave customer service on the new great find of Comfort Quest! I am sure they are getting pretty pissed off at me after the second email to them today! They deserve it, those greedy bastards.
> 
> We are much relieved knowing that if our very old and well used Relief Band does TU, we have a backup. This is the ONLY thing that works for my wife, whew!


You are most welcome!

Ours arrived two days ago - they seem a bit cheap but no worse that their predecessors. My main concern is the battery door seems fussy and fragile. But still, it is great to have these things!


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## Geoff54 (Oct 30, 2011)

Hey sparrowe / kellysails

How do these new ones work without using gell?

Thanks - Geoff


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## kellysails (Nov 1, 2008)

Geoff54 said:


> Hey sparrowe / kellysails
> 
> How do these new ones work without using gell?
> 
> Thanks - Geoff


I have never had to use gell, and I feel the slight electricity even at a low setting. When you put it on, you adjust the power setting so you feel a very slight tingle going up your ring finger. It occurs maybe once every 2-3 seconds.

I used it once while salmon fishing in the west coast of Canada. Huge seas in 18foot kicker boats. Really nasty weather. Everyone else was using medication but I was fine with just the Relief Band. The sensation will increase if you hand gets really wet so in conditions like that I just kept the power level very low.

Likely this won't work for everyone but it works for my wife and I very well.


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## Geoff54 (Oct 30, 2011)

Interesting. I’ve got one of the old ReliefBands and I can’t feel anything without the conductive gell – I’ve got a big tube intended for medical sensors. ComfortQuest claims that gell isn’t needed and I wondered what the difference was. Maybe I'll just get one and try it.


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## kellysails (Nov 1, 2008)

Geoff54 said:


> Interesting. I've got one of the old ReliefBands and I can't feel anything without the conductive gell - I've got a big tube intended for medical sensors. ComfortQuest claims that gell isn't needed and I wondered what the difference was. Maybe I'll just get one and try it.


I would replace the battery, maybe that is the issue. Do you put on the inside of your wrist? Man, on the #4 setting the hair on my arm start to curl Usually I use #2.


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## Geoff54 (Oct 30, 2011)

kellysails said:


> I would replace the battery, maybe that is the issue. Do you put on the inside of your wrist? Man, on the #4 setting the hair on my arm start to curl Usually I use #2.


'Been like that since new. With gell, #1 or #2 is fine. Without, I can't feel anything even on #5. I guess I'm just not that sensitive


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