Seasickness and Stugeron

[Kris626]

Hi! I'm a fairly new diver and I struggle with some SERIOUS seasickness. This wasn't a huge problem when we lived in the Midwest, but now that we've moved to Charleston, it is more of an issue. I've been on boats pretty much all of my life, but as soon as the boat stops, I am insanely sick. While we were in the Bahamas, a dive shop owner suggested Stugeron. I've tried pretty much everything available (dramamine, bonine, scop patch, every homeopatic remedy I've ever heard of...). Does anyone have any experience with Stugeron? I know it isn't available here, but I was hoping someone might have some insight. Thanks!

 

[ChrisA]

Hi! I'm a fairly new diver and I struggle with some SERIOUS seasickness. This wasn't a huge problem when we lived in the Midwest, but now that we've moved to Charleston, it is more of an issue. I've been on boats pretty much all of my life, but as soon as the boat stops, I am insanely sick. While we were in the Bahamas, a dive shop owner suggested Stugeron. I've tried pretty much everything available (dramamine, bonine, scop patch, every homeopatic remedy I've ever heard of...). Does anyone have any experience with Stugeron? I know it isn't available here, but I was hoping someone might have some insight. Thanks!

It is not available in the US but is sold in the UK all of the other english speaking contries (NZ, AZ, Bahamas,..) and in Mexico. Here on the west coast cuising sailors typically head down the coast to mexico or farther before turning right and heading out into the Pacific It is pretty common for them to pick up a supply of Stugeron (sp?) in Mexico. In places where it is sold it is an over the counter non-prescription drug.

Google found this....
Rx Stugeron Consumer Information- Prescription Free Stugeron - FDA approved meds online - Buy with/out RX.

 

[DocVikingo]

Hi Kris626,

It's too bad that you have not been able find a medication that lessens your susceptibility to mal de mar. However, given this report there is no compelling reason to expect that Stugeron (cinnarizine) will be the answer.

Also, as ChrisA has stated, it is not available in the U.S., although it can be found in Canada, Mexico, the greater Caribbean and most other places in the world.

You might find the following informative:

Tame the Technicolor Yodel: Managing Mal de Mer
Doc Vikingo's Sea Sickness Remedies

Helpful?

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

 

[Kris626]

Thank you both for your feedback. Since I have fairly easy access to getting the drug (I have friends heading to Canada to visit soon), I may try it. Short of making it worse (heaven forbid) or some serious side effect, I'm ready to try just about anything.

 

[Scubakevdm]

I've always found that wrapping my arms tightly around an oak tree clears it right up.

Really though, I used to get unbelievably seasick, praying that the next wave would be large enough to carry me away and end my suffering. I have managed to make a living on the ocean for all but about five years of my adult life, lobstering, being in the navy, and then working on dive boats. I learned to isolate my head from the movement of the boat by flexing at the joints . Pretend your head is a cup full of water , and you don't want any to spill. Do this while looking out away from the boat so that you don't see it moving around, and try to get as much fresh air as on your body as possible, even to the point of removing your wetsuit if conditions permit.

 

[kbuschmann]

I have used and prescribed Stugeron many times for offshore sailing. There is, as is the case for most motion-sickness drugs, a fair bit of inter-individual variability. Some sailors swear by it, others find it no more effective than Bonamine, Dimenhydrinate, etc. Remember, it is an antihistamine and can therefore be sedating. It can also cause gastrointestinal upset, including an apparent paradoxical urge to vomit. For offshore racing, where we sail no matter the conditions, it has been combined with a motility agent (Metoclopropamide, Domperidone) to control this latter effect. Liver or kidney problems or the presence of Parkinson's disease are contraindications to its use.
There are not, to my knowledge, any well controlled published studies comparing it to its alternatives. It's worth a try, but don't expect miracles.

I am often asked about Zofran (Ondansetron), an anti-emetic used primarily for cancer therapy patients. It does not seem to have significant benefit for motion-sickness.

The combination of Phenergan plus Modafanil or Dextroamphetamine is probably the best supported treatment, but is a 'big gun' and is to be used under medical supervision only.

 

[kbuschmann]

By the way, I meant to mention that it is NOT available in Canada.

 

[DocVikingo]

By the way, I meant to mention that it is NOT available in Canada.

Hi KB,

I'm a little confused here. Given that you are from Victoria, BC, how have you "...used and prescribed Stugeron (cinnarizine) many times for offshore sailing" if it is not available in Canada? Do you purchase and prescribe it through one of the many Canada-based online pharmacy services that offer it without a prescription, e.g., Stugeron : Affordable Stugeron buy Stugeron at Canada Pharmacy Online, Buy Generic Stugeron Cinnarizine from a licensed Canadian pharmacy, CanadaDrugs.com - Over the Counter?

In any event:

There are not, to my knowledge, any well controlled published studies comparing it to its alternatives. It's worth a try, but don't expect miracles.

I concur not to expect miracles.

There are decently controlled published studies comparing cinnarizine to a number of its alternatives and at least one of these is mentioned in my mal de mer article linked above. In case to you do not have ready access to the full article in J Travel Med. 1994 Dec 1;1(4):203-206 entitled "Comparison of Seven Commonly Used Agents for Prophylaxis of Seasickness," you may wish to go to:
Blackwell Synergy - Cookie Absent

I am often asked about Zofran (Ondansetron), an anti-emetic used primarily for cancer therapy patients. It does not seem to have significant benefit for motion-sickness.

I concur that ondansetron seems to be of minimal benefit in the prevention of motion sickness, not mention its cost relative to most of the alternatives.

Regards,

DocVikingo

 

[Scubakevdm]

Blackwell Synergy - Cookie Absent

For you non-medical types who may be wondering, cookie absent is a medical term referring to the condition one is in after having tossed their cookies. Just thought I'd clear that up.

 

[kbuschmann]

"I'm a little confused here. Given that you are from Victoria, BC, how have you "...used and prescribed Stugeron (cinnarizine) many times for offshore sailing" if it is not available in Canada? Do you purchase and prescribe it through one of the many Canada-based online pharmacy services that offer it without a prescription,"



The drug is not approved for use in Canada and you will not find it in a regular pharmacy. Internet 'pharmacies' outsource this and other drugs for resale from foreign jurisdictions where the drug is approved. Apparently that's a legal (for now) practice.
I have accessed Stugeron in many locations around the world (Mexico, Central and South America, UK, most of Europe - remember the stuff about offshore sailing?) where it is usually available off-the-shelf. I should, perhaps, have said recommended rather than prescribed, as I've never had to actually write a script.



"There are decently controlled published studies comparing cinnarizine to a number of its alternatives and at least one of these is mentioned in my mal de mer article linked above. In case to you do not have ready access to the full article in J Travel Med. 1994 Dec 1;1(4):203-206 entitled "Comparison of Seven Commonly Used Agents for Prophylaxis of Seasickness,"
DocVikingo[/QUOTE]"

That study was criticized for the dosage scheduling in Arm 1, the reduction of comparatives to Stugeron and Scopolamine in Arm 2, the limitation of endpoint criteria, and the absence of correlation of specific drug response to stimulus conditions(though they did apparently collect the data necessary to do so). I guess it maybe depends on our definition of "well" or "decently" controlled studies. Interestingly, a study (also of somewhat questionnable worth to our target audience) was published 6 months prior to that in 'Aviation,Space and Environmental Medicine' which found opposite results in comparing Stugeron to Scopolamine (the latter being more efficacious).

Any way, I'm not sure this forum is the right place to debate the relative merits of the literature, and I apologize for starting it. We should say, however, that all of these anti-motion-sickness meds are at least relatively contraindicated for use in diving owing to their side effect profiles (in particular the sedation thing). In the Canadian Navy, they are absolutely contraindicated for active divers.