Page 15 - Journal of Special Operations Medicine - Summer 2015

Scopolamine has also been used in studies for indi- the literature indicates there is evidence that cinnarizine
viduals who do not routinely participate in flight and, may offer more symptom relief from motion sickness than
therefore, do not have the luxury of habituation for im- scopolamine, but also causes more drowsiness than trans-
provement. The efficacy of four treatments and their ef- dermal formulations of scopolamine. This may be due to
fects on cognitive performance were investigated in 16 the inconsistency of absorption and plasma concentra-
Infantry Soldiers and Special Operators. Participants tion of scopolamine, as studies using oral formulations
23
were given one of four treatments (promethazine 25mg have reported symptomatic superiority to cinnarizine,
plus caffeine 200mg; meclizine 25mg; transdermal albeit with more side effects. The faster absorption with
scopolamine 1.5mg; or acupressure wristband on P6). oral formulations would explain this finding. Cognitive
Participants were their own blinded control subjects by performance did not show any significant decline with
participating twice, once receiving treatment and once the use of cinnarizine or transdermal scopolamine with
receiving placebo. The results of this study showed performance testing in several studies. Drowsiness in cin-
only a statistically significant reduction in symptoms narizine, on the other hand, has been reported inconsis-
(especially nausea) and improvement in reaction times tently, with rates ranging from 8% to 77%. It is unclear
in the promethazine plus caffeine group compared to why this may be the case.
placebo. In this study, scopolamine did not show any
statistically significant effects on symptoms or cognitive The USAF-approved medication for Operators in
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performance. 23 mari time environments is ondanestron, a medication
that has been shown to offer little improvement in
Stimulants have been used in conjunction with motion motion sickness symptoms. The survey conducted in
sickness treatment to counteract sedating side effects of response to the case study demonstrated that 78.4%
motion sickness medications. Dextroamphetamine has of responders have experienced some sort of motion
been used and studied, but based on its high potential for sickness, and 73.5% of those surveyed reported using
abuse, it is no longer recommended. In 2009, modafinil, medications for their symptoms. However, only 16 of
which is an approved stimulant for select USAF person- 75 (21.3%) who took medications found relief of their
nel on flight status, was investigated alone as a mo- symptoms. The types of medications the responders
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tion sickness treatment and in combination with oral used are unknown. The survey findings indicate Op-
scopolamine against placebo. Tolerance to disorien- erators are commonly affected by motion sickness and
24
tation, cognitive performance, and reported side ef- only a small percentage have found relief of their symp-
fects were used as outcomes. The results showed that toms with medications.
modafinil (200mg) and the oral scopolamine (0.8mg)
and modafinil combination allowed participants to tol- The PJs discussed in this report used 18mg rather than
erate more full-body tilts than other groups. Modafinil 25mg of cinnarizine and reported improvement of symp-
24
did not provide countermeasures for the cognitive per- toms with lack of adverse reactions. This case study
formance side effects of scopolamine nor did it offer documents symptom resolution after the use of cinna-
any increased tolerance to motion when used alone, rizine in the operational environment without identified
suggesting that scopolamine was the more effective side effects affecting mission completion.
medication. As mentioned, the oral formulation of
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scopolamine may be associated with more side effects Military medical personnel from countries where cin-
than the transdermal formulation and may require the narizine is approved for use may consider further testing
use of stimulants to attempt countering those effects. with the low dose used in this case study to evaluate it
for efficacy with minimal side effects.
Antagonists of the 5-HT receptors, such as ondansetron
3
and granisetron, have also been studied for treatment of This case study also highlights the need for continued
motion sickness. A study evaluating the use of ondanse- research in the United States and in the Department of
tron for postoperative nausea and vomiting found that Defense (DoD) medical community to effectively treat
patients with a propensity for motion sickness had a motion sickness for our Special Operators, and mari-
more profound response to the medication. Hershko- time and aircrew personnel. It is also relevant to con-
25
vitz et al. studied the efficacy of ondansetron 8mg for sider that the majority of the USAF medication and duty
26
motion sickness in Israeli Sailors who had known prob- limitations have been developed for aviators in single-
lems with seasickness. There was no statistically signifi- seat platforms. Future evolutions of the DoD and USAF
cant difference in treatment of seasickness between the medical regulations regarding medication use and waiv-
placebo and ondansetron groups. 26 ers must consider the operational differences between
single-seat fighter pilots and the other Operators in the
Several studies have evaluated medications for motion USAF, including ground combatants (such as PJs and
sickness that plagues our Servicemembers. Our review of Special Tactics personnel).

Cinnarizine for Sea Sickness 5