Your patients will be asking about a new prescription motion sickness med they saw advertised. Here’s what to tell them.
In this episode, TRC Healthcare Associate Editor and Clinical Pharmacist Vickie Danaher, PharmD, discusses preventing motion sickness with today’s OTC and prescription products. She covers where the new neurokinin-1 antagonist tradipitant fits into therapy, which options are first-line, non-drug measures patients can try, and more.
This is an excerpt from our July 2026 Pharmacy Essential Updates continuing education webinar series.
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TRC Healthcare offers CE credit for this podcast for pharmacist subscribers at our platinum level or higher and pharmacy technician subscribers. Log in to your Pharmacist’s Letter or Pharmacy Technician’s Letter account and look for the title of this podcast in the list of available CE courses. None of the speakers have anything to disclose.
Clinical Resources from Pharmacist’s Letter, Pharmacy Technician’s Letter, and Prescriber Insights:
- Article: Explain How New Rx Tradipitant Stacks Up for Motion Sickness
- CE Course: Pharmacist’s Guide to Travel Medicine
- CE Course: Managing Common Travel-Related Illnesses
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Transcript:
This transcript is automatically generated.
00:00:01 Narrator
Your patient slept through her entire last cruise on meclizine.
00:00:04 Narrator
Now what?
00:00:06 Narrator
Is the first new motion sickness prescription med in over 40 years actually her answer?
00:00:15 Narrator
Welcome to Clinical Capsules from TRC Healthcare, your trusted source for practical, evidence-based updates.
00:00:22 Narrator
On this episode, Associate Editor and Clinical Pharmacist Vickie Danaher
00:00:26 Narrator
shares practical guidance on preventing motion sickness with today’s OTC and prescription options in an excerpt from our popular Pharmacy Essential Updates webinar series.
00:00:36 Narrator
This podcast offers continuing education credit for pharmacists and pharmacy technicians.
00:00:42 Narrator
Please log in to your Pharmacist’s Letter or Pharmacy Technician’s Letter account and look for the title of this podcast in the list of available CE courses.
00:00:50 Narrator
None of the speakers have anything to disclose.
00:00:53 Narrator
Catch new episodes of Clinical Capsules every 2nd and 4th Tuesday, bringing concise, actionable insights from TRC experts straight to your ears.
00:01:02 Narrator
Let’s dive in.
00:01:09 Vickie Danaher
And now even more questions about how to prevent motion sickness or spinning due to the approval of a new drug called tradipitant or brand name Nereus.
00:01:20 Vickie Danaher
And this drug is being promoted as the first prescription med approved for motion sickness in over 40 years.
00:01:27 Vickie Danaher
So today we’re going to discuss where tradipitant fits in alongside all the other OTC and prescription options that we’ve been recommending for years.
00:01:37 Vickie Danaher
But first, let’s take off with a quick background about why motion sickness even happens.
00:01:43 Vickie Danaher
So motion sickness occurs when there’s a disconnect between what the brain sees through the optic nerve and what it feels through the balance and orientation sensors in the body.
00:01:56 Vickie Danaher
So your eyes could be telling the brain one thing, like you’re sitting still in a cruise cabin, but your inner ear is saying something totally different, like you’re rolling on a boat.
00:02:08 Vickie Danaher
And that signal mismatch triggers the classic cascade of symptoms that we all know, usually starting with stomach awareness or kind of a vague stomach discomfort, warmth and sweating, and then progressing to dizziness, nausea, and sometimes ultimately vomiting.
00:02:27 Vickie Danaher
Now, anyone can experience motion sickness, but some patients are more prone to it than others.
00:02:33 Vickie Danaher
For example, risk factors include a younger age, particularly ages two to 12 years old, women, and people who get migraines.
00:02:44 Vickie Danaher
And because motion sickness is such an unpleasant part of travel, patients are going to keep asking us for help on how to prevent it, whether they’ve dealt with it before or not.
00:02:54 Vickie Danaher
So let’s start to think about how to approach these conversations with the patient case.
00:03:00 Vickie Danaher
So our patient today is Patti.
00:03:02 Vickie Danaher
She’s a 52 year old female going on a three day cruise in a couple of weeks.
00:03:09 Vickie Danaher
Patti has a history of motion sickness with nausea and vomiting during travel, but otherwise her medical history only includes hypertension or high blood pressure for which she takes lisinopril daily.
00:03:24 Vickie Danaher
Patti tells you that she’s tried meclizine to prevent motion sickness on her last cruise, and it made her so tired that she actually slept through the entire trip.
00:03:35 Vickie Danaher
Now she’s asking about the new prescription med tradipitant that she saw advertised and whether that would be a better choice for her.
00:03:43 Vickie Danaher
So pause for a few seconds here and think.
00:03:46 Vickie Danaher
What would you say or recommend for Patti?
00:03:50 Vickie Danaher
What questions would you want to ask her before deciding next steps?
00:03:56 Vickie Danaher
All right, let’s first talk about the new kid on the block, tradipitant, since that’s what’s making a splash right now.
00:04:02 Vickie Danaher
So it works by blocking neurokinin-1 receptors to reduce the binding of substance P, which is a neurotransmitter involved in motion-induced vomiting.
00:04:14 Vickie Danaher
So this mechanism is really different from our old standbys like dimenhydrinate or scopolamine, which work through histamine and muscarinic receptors.
00:04:26 Vickie Danaher
Explain that taking tradipitant 85 or 170 milligrams by mouth about 60 minutes before a triggering event, so like a boat trip, prevents vomiting in about one in four adults with a history of motion sickness versus placebo with minimal sedation.
00:04:44 Vickie Danaher
So that efficacy is actually pretty meaningful.
00:04:49 Vickie Danaher
But the catch here is that tradipitant does not significantly reduce nausea, and nausea is often the biggest, most miserable symptom of motion sickness.
00:05:00 Vickie Danaher
So this drug is really targeted at vomiting prevention.
00:05:06 Vickie Danaher
And then there’s the cost.
00:05:08 Vickie Danaher
Tradipitant runs about $255 per 85 milligram capsule at wholesale acquisition cost pricing, or it might be a little bit less through manufacturer direct-to-consumer programs.
00:05:22 Vickie Danaher
So expect payer rejects for tradipitant since most plans are going to want patients to try other options before they’re going to pay for it.
00:05:32 Vickie Danaher
And continue to emphasize non-drug measures and other meds to prevent motion sickness first.
00:05:37 Vickie Danaher
So let’s walk through what actually is first line, starting with the non-drug strategies that often don’t cost patients a thing.
00:05:47 Vickie Danaher
And for some patients, honestly, this is all that they might need.
00:05:52 Vickie Danaher
So, for example, emphasize sitting in the front of a vehicle over the wing of a plane or midship lower deck on a boat if possible, since these areas avoid the locations of maximum motion.
00:06:09 Vickie Danaher
Advise focusing on the horizon or a fixed point in the distance, and explain not to be looking at their phone, not looking at a book, or not looking at a screen in front of them, since reading and using screens inside of a moving vehicle is one of the most common triggers.
00:06:29 Vickie Danaher
Patients should also avoid alcohol and nicotine before and during travel, since both can worsen symptoms.
00:06:37 Vickie Danaher
But on the other hand, explain that controlled breathing, so breathing slow, steady at their normal resting rate, has actually been shown in trials to reduce symptoms.
00:06:49 Vickie Danaher
And then be aware that most evidence suggests that acupressure wristbands, so like those Sea-Bands, are no more effective than placebo.
00:06:59 Vickie Danaher
But some patients, including myself, swear by them, and they’re safe and inexpensive.
00:07:05 Vickie Danaher
So if a patient feels like they help, there’s no harm in trying them.
00:07:11 Vickie Danaher
If non-drug strategies aren’t enough, an OTC first-generation oral antihistamine is the typical next step to prevent motion sickness.
00:07:20 Vickie Danaher
This is true especially for short-term exposures, such as six hours or less, with mild to moderate motion.
00:07:28 Vickie Danaher
And here we have three main products, dimenhydrinate, which we usually know as Dramamine, diphenhydramine or Benadryl, and meclizine or Bonine.
00:07:43 Vickie Danaher
Point out that dimenhydrinate, diphenhydramine, or meclizine are all generally taken 30 to 60 minutes before travel or motion, but a big difference is patient age.
00:07:57 Vickie Danaher
So dimenhydrinate or diphenhydramine are approved for ages two and older, but meclizine is only for ages 12 years and up.
00:08:08 Vickie Danaher
So we’ll want to remember to clarify who the medication is going to be used by and help patients read those labels closely.
00:08:18 Vickie Danaher
When picking products, technicians especially can also be watching closely for brand name extensions.
00:08:23 Vickie Danaher
For instance, Dramamine usually contains dimenhydrinate, but Dramamine Less Drowsy actually contains meclizine.
00:08:33 Vickie Danaher
So it has that age 12 and up limit, and Dramamine Advanced Herbals actually contains ginger root, which, as we’ll discuss shortly, doesn’t have strong evidence behind it.
00:08:46 Vickie Danaher
So we want to flag these for the pharmacist to help ensure patients get the intended product.
00:08:52 Vickie Danaher
Now, these first generation antihistamines work pretty well for preventing motion sickness, but keep in mind that they come with anticholinergic side effects, so sedation, dry mouth, confusion, and urinary retention.
00:09:05 Vickie Danaher
And these are especially problematic in older adults where sedation could lead to falls or confusion, and that can mimic or worsen cognitive impairment.
00:09:16 Vickie Danaher
So usually want to avoid these or use them with real caution in older adults, as well as with conditions such as narrow-angle glaucoma or benign prostatic hyperplasia.
00:09:28 Vickie Danaher
And then in young kids, remember that first generation antihistamines can actually lead to some children getting wired up or agitated instead of sleepy.
00:09:37 Vickie Danaher
So trying a test dose at home before the trip is smart advice.
00:09:45 Vickie Danaher
Moving right along, suggest prescription scopolamine patch or Transderm Scop if a med with a longer duration is needed, so like cruises or long haul international flights, since one patch only needs to be applied every three days. But explain that it isn’t more effective than most antihistamines, it’s only slightly less sedating, and it costs about $10 per patch.
00:10:11 Vickie Danaher
Plus, transdermal scopolamine shouldn’t be used in older adults due to its significant anticholinergic effects or in kids since the dose is too high.
00:10:21 Vickie Danaher
And FDA recently added a warning about a rare but serious hyperthermia risk with scopolamine.
00:10:28 Vickie Danaher
It can raise body temperature and cause heat related complications, in some cases led to hospitalization and death.
00:10:35 Vickie Danaher
So we want to counsel patients to avoid heating pads, hot tubs, or saunas while wearing the patch.
00:10:43 Vickie Danaher
And if their temperature starts creeping up or they stop sweating in the heat, you should really take that patch off and contact a healthcare professional.
00:10:52 Vickie Danaher
Also educate patients getting scopolamine to apply that patch at least four hours before travel behind the ear on clean, dry, hairless skin.
00:11:03 Vickie Danaher
They should then wash their hands right after application to avoid getting med in the eye and dilating the pupil, and also remind them not to cut the patch.
00:11:11 Vickie Danaher
It’s a controlled release system, so cutting it can raise the risk of toxicity.
00:11:18 Vickie Danaher
And then if a treatment is needed past day three, advise to remove the old patch and apply a new one behind the other ear.
00:11:27 Vickie Danaher
Next, let’s go back to the new drug tradipitant, but now in the context of where it actually fits in therapy.
00:11:34 Vickie Danaher
And like I mentioned earlier, tradipitant does not significantly reduce nausea related to motion sickness, and it costs $255 per 85 milligram capsule.
00:11:44 Vickie Danaher
So we want to save this one for adults whose primary concern is preventing vomiting if they can’t take the other options and if they can afford the cost.
00:11:54 Vickie Danaher
That’s really the sweet spot.
00:11:58 Vickie Danaher
If patients get tradipitant, watch for use with strong CYP3A4 inhibitors such as clarithromycin or some HIV meds.
00:12:07 Vickie Danaher
These may increase tradipitant exposure and its side effects, mainly fatigue and headache.
00:12:16 Vickie Danaher
Advise taking tradipitant on an empty stomach at least an hour before motion and not to exceed one dose in 24 hours.
00:12:27 Vickie Danaher
Now, another med you might be wondering about is promethazine or Phenergan, but it also has a more narrow niche for motion sickness.
00:12:35 Vickie Danaher
We want to reserve it for acute, intense stimuli.
00:12:38 Vickie Danaher
Think severe symptoms that other options haven’t touched.
00:12:42 Vickie Danaher
It seems to be about as effective as scopolamine, but it’s the most sedating option we have.
00:12:48 Vickie Danaher
So it’s really not a great choice for someone who needs to function.
00:12:53 Vickie Danaher
And then a critical safety point is that promethazine can cause fatal respiratory depression in kids younger than two years.
00:13:00 Vickie Danaher
So stay alert for promethazine prescriptions in this age group and notify the pharmacist or prescriber accordingly.
00:13:08 Vickie Danaher
Patients also ask about ondansetron or Zofran all the time because it’s a go to for chemo related or post-op nausea.
00:13:17 Vickie Danaher
But explain that ondansetron does not work for motion sickness.
00:13:22 Vickie Danaher
The 5-HT3 receptors that it targets aren’t the ones driving motion-induced nausea and vomiting.
00:13:29 Vickie Danaher
So if a patient asks about it or a prescriber is considering it, we’ll want to steer them to another option.
00:13:34 Vickie Danaher
And then questions often come up about ginger supplements, especially with patients who prefer natural options.
00:13:43 Vickie Danaher
But contrary to popular belief, most research shows that oral ginger does not prevent or treat motion sickness.
00:13:51 Vickie Danaher
The doses that have been studied, which are typically 500 to 1000 milligrams taken about every four hours prior to travel, led to some patients reporting subjective feelings of improvement, but in many studies, the objective measures did not significantly improve.
00:14:09 Vickie Danaher
However, if patients still want to try it, explain that oral ginger is generally well tolerated with its most common side effects, including belching, diarrhea, and heartburn.
00:14:22 Vickie Danaher
Caution that ginger may have antiplatelet and hypoglycemic effects, so it may increase the risk of bleeding or increase the risk of low blood sugar, especially in combinations with other meds or supplements with these effects, like garlic, warfarin, or some diabetes medications.
00:14:43 Vickie Danaher
Okay, let’s revisit Patti, our 52-year-old heading out on a three-day cruise with a history of motion sickness who’s tried meclizine previously and slept through her entire trip.
00:14:56 Vickie Danaher
And here’s how I was thinking I’d approach this.
00:15:00 Vickie Danaher
So first, I continue to emphasize non-drug measures.
00:15:04 Vickie Danaher
So things like booking a midship cabin on a lower deck, focusing on the horizon, avoiding reading below deck and limiting alcohol, things like that.
00:15:15 Vickie Danaher
And then second, because it’s a three-day trip, the scopolamine patch, I think, is a strong candidate.
00:15:21 Vickie Danaher
She’s 52, so age isn’t a barrier, but I’d still counsel her carefully on the anticholinergic effects and the hyperthermia warning, especially on a cruise where she might be lounging in the sun.
00:15:35 Vickie Danaher
Otherwise, I do think she could consider a different OTC oral antihistamine, but because she slept through meclizine previously, I’d probably move away from oral antihistamine since dimenhydrinate and diphenhydramine can actually even be more so sedating than meclizine.
00:15:56 Vickie Danaher
And then what about the new prescription tradipitant that Patti saw advertised?
00:16:02 Vickie Danaher
I’d explain to her that tradipitant would address vomiting, but it’s not really going to touch her nausea and she may hit an insurance reject and have to pay out of pocket.
00:16:12 Vickie Danaher
So overall, I’d walk her through these options and the trade-offs and kind of let her make the final call considering all of that information.
00:16:22 Vickie Danaher
Let’s land the plane now with the key points to go home with today about preventing motion sickness.
00:16:28 Vickie Danaher
One, non-drug measures and OTC antihistamines remain first line for most patients, especially for short-term exposures, like six hours or less, with mild to moderate motion.
00:16:42 Vickie Danaher
Two, the scopolamine patch is useful for longer trips with moderate to more intense motion, but be mindful of anticholinergic effects and that newer FDA hyperthermia warning.
00:16:57 Vickie Danaher
Three, tradipitant is the first new prescription option in over 40 years and prevents vomiting but not nausea at about $255 per dose.
00:17:10 Vickie Danaher
Four, promethazine is reserved for acute intense stimuli.
00:17:14 Vickie Danaher
It’s the most sedating option and it’s going to be a hard stop in kids under age two.
00:17:21 Vickie Danaher
Five, ondansetron does not work for motion sickness.
00:17:25 Vickie Danaher
Don’t recommend it, and gently redirect patients or prescribers who ask about it.
00:17:31 Vickie Danaher
And then six, proper counseling on timing and administration is critical for every one of these options.
00:17:37 Vickie Danaher
So as pharmacists and techs, we can help patients choose the right option, start it at the right time, use it correctly, and know what adverse effects to watch for.
00:17:50 Vickie Danaher
Now we know that motion sickness is just one health issue that comes up during travel and vacations.
00:17:55 Vickie Danaher
So you can explore our CE courses, Pharmacist’s Guide to Travel Medicine and Managing Common Travel-Related Illnesses to unpack advice on jet lag, traveler’s diarrhea, altitude illness and more.
00:18:13 Narrator
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00:18:14 Narrator
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00:18:18 Narrator
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00:18:35 Narrator
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