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stump

Anti-emetics

15 posts in this topic

On my kayak fishing trip last weekend I used a Scopolamine patch to combat sea-sickness.  From my mid/late teens to now I've struggled a lot with motion sickness on boats.  Interestingly not on small airplanes.  Anyway, pre-PD the Scop patches worked wonders.  Far better than Bonine or Dramamine at keeping me off the rails of the boat.  I'd often still wind up vomiting, but at least with the patch I could recover afterwards whereas with other medications I'd be down for good once the heaving started.

 

When I put the patch on as I was heading out for the coast (it takes a couple hours to get up to full effectiveness) it wasn't very long and I was starting to feel a little queasy.  Once I got to the beach that feeling persisted.  The ocean was actually fairly calm, maybe 2-3ft swells on average at probably 8-9 seconds.  A few 4-5ft rollers, but not many.  I got through the time I wanted to fish, decided to head back in, and after I had everything stowed and was paddling towards the beach it hit fairly hard.  2 or 3 good waves nausea and vomiting.  After that I managed to dig deep and paddle the last mile or so back and landed through the (thankfully benign) surf.  

 

The net day I was just not feeling great all morning.  Granted, other than a salad I didn't eat anything the night before.  I did eat some oatmeal for breakfast.  But that upset tummy feeling persisted.  I eventually launched through the surf anyway, and fished for a few hours (to no real success), and then called it a day and headed back in.  Didn't get to the point of puking at least.  Loaded up all my gear in the car and drove for home.  Still feeling like my tummy wasn't very happy for most of the drive, once I was far enough on the drive to be past the ferry portion I took the patch off finally.  Within about an hour of doing that my tummy felt just fine and all queasyness went away.

 

Brought that up with my MDS this morning.  She suggested that the anti-cholinergic effects of the Scopolamine were probably doing something with my brain to cause that reaction and suggested I not use the patches anymore.  Which, of course, begged the question of what to use.  Her suggestion was Ativan (aka lorazepam).  

 

I"m really leery of using a benzo for anything.  But I'm trying to keep an open mind.  Have any of you ever used Ativan/lorazepam for combating motion sickness or nausea from other causes?  

 

She suggested taking 1 pill at home to test how I react and if favorable then use it when on the kayak.  I'm certainly not going to even do that until my wife is back from her trip to her mom's.  I'd want a responsible adult around just in case I had a bad reaction.  

 

Even if I do decide to use this for sea-sickness relief this will be a very occasional use drug.  Like the 30 pill scrip she wrote will probably last me for 3-5 years.  So I'm not worried about developing any addictions.  Still, any advice is appreciated.

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I take Zofran. It is safe to use with PD. I wouldn't want to be drowsy on a boat. 

 

Dianne

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I've never heard of using Ativan for nausea, and it doesn't seem to be an on label use. Not to say it doesn't work, I use it off label for muscle spasm.

 

Like Dianne I use zofran for nausea. In my personal experience zofran makes me less sleepy than Ativan but still more drowsy than I'd like. When I was nauseous and losing weight last fall my PCP and I were in a constant battle over my taking it during the day and finally comprised on a 4mg prescription instead of 8. It is the least sleep inducing antiemetic on the market though, unless you count ginger. My current PCP used to work in Alaska serving the fishing vessels and he would recommend you try 1/4-1/2 a cup of ginger (it really takes that much, ginger ale isn't enough)

 

Hope you can get back to fishing soon.

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I take Zofran. It is safe to use with PD. I wouldn't want to be drowsy on a boat. 

 

Dianne

Yep. I was taking Zofran in the hospital for nausea and to keep food and water down while I was going through C-diff hell. Works wonders with very few side effects.

 

Phenergan was the other drug. More effective than Zofran, but it would literally knock me out within 20 minutes after injection.

 

Not sure I'd take a Benzo for nausea. Might work, but not sure you want to be sleepy or woozy during the day. I've also never noticed any benefit from Klonopin in terms of nausea.

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As far as any drowsiness effects, that is part of why my MDS wanted me to try a dose at home when I'm not going to go anywhere.  That way if it just knocks me out, or I have some other adverse reaction I'll also have someone around that can get me help if it came to that.

 

I will send her an email and ask about Zofran.  She may have some reason to not prescribe it.  Perhaps this is why (from the Wikipedia article on Zofran):

 

It has little effect on vomiting caused by motion sickness.
Edited by stump

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I can't take Zofran- allergic to it, but I wouldn't want to take anything with a potential sedative property around a BOAT. Just seems stupid.

 

They gave me lorazepam in the ER for nausea and it worked. It's also anti anxiety. I'm not keen on many of the benzo's because of the totally unnecessary amnesia effect. Also had Valium, which was also fine but wouldn't work in this case.

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Zofran was originally developed for cancer treatment nausea. So, it's normally very well tolerated.

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Well, as noted, Zofran is completely ineffective at treating motion sickness.

 

All of the typical motion sickness remedies have the potential to cause drowsiness.  Heck, my parent would give my sister and me Dramamine on road trips to knock us out when we were kids.  And I know plenty of fishermen that won't use the Scop patches because it makes them very drowsy.  So the fact that lorazepam might cause drowsiness isn't an automatic disqualifier in my book.  

 

Sometime in the next couple of months I'll find a weekend where I can try one and see what it does.  If the drowsiness is too bad, or some other side effect occurs that makes it not worth while to use then that'll be it.  

 

I'm also going to give the Scop patch one more chance.  If it has that same effect again then it's out as well.  

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Hontestly, dramamine works the best for me with nausea or motion sickness.  It's old school, but well proven.

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Dramamine knocks me out.  The "non-drowsy" version (aka Bonine) works sorta OK.  It's better than nothing when I'm on the water, but it's not even close to being as effective as Scop patches had been in the past.

 

All these meds effect each of us differently.

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Dramamine knocks me out. The "non-drowsy" version (aka Bonine) works sorta OK. It's better than nothing when I'm on the water, but it's not even close to being as effective as Scop patches had been in the past.

 

All these meds effect each of us differently.

I was going to mention that alot of anti-nausea meds are contradicted in PD. The Phenergan the hospital gave me? Turns out its a big no-no with PD. It blocks dopamine.

 

Whatever you choose, make sure you research it.

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So, finally had a chance to trial the lorazepam tonight.  Took half of a 1mg tablet about 3 hours ago.  From what I've read that should put me at about maximum effect an hour or so ago.  Good news is, I'm not at all sleepy (well, since it's 11:30PM that might be bad news too).  I don't feel loopy, or anything adverse.  A bit calmer than I was earlier tonight.  I could tell that I would have had an anxiety attack if I'd missed my Rytary, so it's possible that the lorazepam is helping with that a bit too.  

 

So, I'm pretty confident that if I took a half tab before getting on a boat (whether a charter boat or my kayak) that I'm not going to be a danger to myself because of the lorazepam.  Whether it will be at all effective at preventing sea-sickness remains to be seen.

 

I think I will also try to get ahold of some CBD oil to see how it affects me.  If that goes well then I guess I'll just have to experiment with each next couple times I go fishing.  It sounds like there's potential for bad interactions between CBD and lorazepam, and with the long half life of each I'd want thorough separation between them, like a week or more just to be safe.  

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I personally wouldn't worry too much about being on a boat with a small dose of ativan.  If something goes bad the adrenaline will kick in.  I've used it occasionally for years and I can drive etc. just fine.  However, here are a few of my favorite "Ed on ativan" stories that I like to tell people

 

1.  A couple years ago I took 1 mg of atavin after having not taken it for many years.  My doc warned somewhat cheekily that it is not a "cognitive enhancer".  I felt fine and decided to get some shopping done.  I filled a target cart full of stuff, then proceeded to walk out of the store and put everything in my car.  I was thinking to myself when I was piling things in my back seat "why didn't I get bags - that was dumb!".  Shortly after I got home I realized the reason I did not get bags - that only happens when you pay for stuff!  Oops!  (I then went back to the store and apologized profusely for accidentally making off with $150 in merchandise).  Lesson:  you may feel OK but don't get in your kayak without a paddle.

 

2.  I had an MRI scan a few years ago and I'm claustrophobic, so I took 2mg before my scan, which was at 2pm or so.  That evening, after I thought the drugs had dissipated, I had a beer (emphasis on "a" and not "several").  I then proceeded to become as drunk as a college freshman, much to the amusement of my wife.  Could have been worse, I suppose. 

 

Ed

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Oh my Gosh!  I'm laughing so hard I'm crying.  Thanks benderet!

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