Today I will review anti-sickness tables which are available over the counter from a pharmacy. Most commonly used anti-sickness tablets over the counter in the UK are drugs used for motion sickness. There are, however, other options for the management of sickness associated with migraines or nausea caused by other medications including radiotherapy. I will also briefly talk about the management of ‘morning’ sickness with over the counter (OTC) anti-sickness tablets and prescription-only medicines.
Summary of this post:
- common causes of nausea and sickness
- Nausea and vomiting: do I need to see my GP?
- Can you buy anti-sickness tablets over the counter?
- Anti-sickness tablets over the counter – overview
- Anti-sickness tablets over the counter: motion sickness
- Anti-sickness tablets other uses: Cyclizine
- Anti-sickness tablets for migraine-related nausea
- Can you use OTC anti-sickness tablets in pregnancy?
Common causes of nausea and sickness
There are many reasons which can cause a feeling of nausea. Some common reasons include:
- Motion sickness (nausea during travelling by boar, plane or car)
- Food poisoning (stomach bug)
Nausea and vomiting: do I need to see my GP?
There is no need to see GP, when nausea or vomiting is experienced by an adult with a known cause, for example, a stomach bug. Food poisoning is usually self-resolving, which means that the main symptoms – diarrhoea and vomiting should go on their own. If both symptoms are present, the key is to stay well hydrated to avoid dehydration. Parents of young babies and toddlers who are worried about their child should call NHS 111 service. An adult who experiences vomiting for more than two days or and adult who has the symptoms of dehydration.
NHS recommends to call 999 or go to A&E when:
- Vomiting looks like ‘ground coffee.’
- Vomit is yellow or green in colour.
- Vomiting is associated with pain when looking at bright lights, and patients are experiencing a stiff neck.
- Symptoms are accompanied by severe stomach ache or severe headaches that cames on suddenly.
- Patients who take drugs, which can be toxic (for example digoxin) with sickness being one of the symptoms of toxicity
Can you buy anti-sickness tablets over the counter?
All products used in the management of nausea are pharmacy-only medicines (P). ‘P’ medicines are sold in pharmacies, only including online chemists. Anti-sickness tablets available over the counter are used to prevent and treat mainly:
- motion sickness (a few different options for the treatment),
- nausea associated with migraines, for which customers can buy single anti-sickness medication or combination products containing an antiemetic as an active ingredient, together with paracetamol and codeine, and
- nausea and vomiting associated caused by drugs in the post-operative period or related to radiotherapy treatment or associated with vertigo
Anti-sickness tablets over the counter – overview
Over the counter drugs which are used in the treatment and prevention of sickness belong to one of the following classes of drugs:
- antihistamines (promethazine, cinnarizine, cyclizine)
- anticholinergic drugs with hyoscine being most commonly used
The use if both classes of drugs is associated with drowsiness.
Anti-sickness tablets over the counter: motion sickness
Over the counter hyoscine containing anti-sickness tablets
Hyoscine is classified as anti-muscarinic drugs. Hyoscine is one of the most effective drugs to prevent sickness caused by travelling. 1Its limits include a short duration of action and number of common side effects, of which drowsiness is most prominent.
Kwells are one of the most known brands of tablets used to prevent travel sickness.
Kwells contain hyoscine hydrobromide as an active ingredient. The main advantage of Kwells as anti-sickness tablets is a rapid onset of action (start to work fast). Kwells melt in the mouth, speeding up the absorption process. They can be taken 20-30 minutes before travelling or when one experiences symptoms of nausea and sickness.
Kwells can be used by children and adults over ten years of age. Younger children (below 10) can use Kwells Kids to prevent motion sickness.
Kwells Kids contain the same active ingredient – hyoscine hydrobromide. Kwells Kids are half strength of Kwells and contain 150mcg of hyoscine hydrobromide. Kwells Kinds can be used by children from 4 years of age.
Joy-rides tablets are another brand of hyoscine containing tablets for prevention of motion sickness. Joy-rides are licensed for adults and children from 3 years of age.
Joy-rides contain the same amount of hyoscine hydrobromide per tablets as Kwells Kids. Joy-rides should preferably be taken 20 minutes before the start of the journey.
Scopoderm patches (anti-sickness patches)
Last on the list of hyoscine containing medicines are Scopoderm patches. As with previously discussed products, Scopoderm patch is a pharmacy-only medicine used to prevent travel sickness symptoms including nausea, vomiting and vertigo.
Each Scopoderm patch contains 150 micrograms of hyoscine. Scopoderm patch can be used by adults and children from 10 years of age.
The main advantage for the use of Scopoderm patches is the extended duration of action of each patch. When applied, One Scopoderm patch should provide anti-sickness protection for up to 72 hours.
Scopoderm patch comes in a box of two patches, which may cost over £15, which is significantly more expensive than hyoscine-containing tablets.
Anti-sickness tablets other uses: Cyclizine
Cyclizine is a pharmacy-only product licensed for the prevention and treatment of nausea and vomiting in adults and children over six years of age. Cyclizine has the mot broad licensed use as over the counter anti-sickness tablet. Cyclizine can be used for prevention and the treatment of:
- Motion sickness (travel sickness)
- Nausea and vomiting caused by drugs and following surgery (general anaesthetics used)
- Vomiting caused by radiotherapy (for example, cancer treatment, especially the treatment of breast cancer).
- Nausea & vomiting during vertigo episodes linked with Menière’s disease
Cyclizine is not commonly sold or displayed to the public. Almost with certainty, one needs to ask a member of a pharmacy team to get cyclizine from the pharmacy should they wish to purchase this drug.
Cyclizine is an ‘old’ antihistamine, with the drowsiness being the main side effect for this drug.
Anti-sickness tablet: promethazine
Promethazine is mostly known as a sedative antihistamine, which is used in ‘cold and flu products’ such as Night Nurse and over the counter sleeping pills. The main difference between promethazine and hyoscine anti-sickness tablets is a prolonged duration of action and significant drowsiness associated with their use.
Products containing promethazine, which can be used to stop sickness and nausea include promethazine 10mg and 25mg tablets (Phenergan) and Avomine.
Avomine tablets – motion sickness tablets
Avomin tablets contain 25mg promethazine theoclate. Adults and children over nine years of age can use Avomin tablets for prevention or treatment of travel sickens.
As I already mentioned, promethazine is a common ingredient in ‘cold and flu’ medicines where sedation is preferable and over the counter sleeping pills. Promethazine in its generic form and branded as (Phenergan).
Phenergan tablets are a pharmacy-only medicine. Not all pharmacies may display Phenergan tablets; therefore, one may need to ask a member of a pharmacy team to get them from the dispensary.
Phenergan tablets are licensed for the treatment of allergic conditions, for short term use to help with sleeping problems and anti-sickness medication. As anti-sickness tablets, Phenergan tablets are approved for adults and children from 5 years of age. For children aged 2-5, Phenergan exists as a liquid antihistamine.
Anti-sickness tablets for migraine-related nausea
Buccastem M buccal tablets – anti-sickness tablets
Buccastem M buccal tablets are pharmacy-only medicine licensed for nausea (feeling sick) and vomiting caused by migraines (diagnosed by a doctor) in adults over 18 years of age. Buccastem M tablets contain prochlorperazine 3mg.
Buccal tablets are placed on the (top) gum, under the lip and allow to dissolve.
When used over the counter, Buccastem M tablets can only be for a maximum of two days. Occasionally, a GP may prescribe Buccastem M or generic buccal prochlorperazine or prochlorperazine 5mg tablets. In this case, follow the directions from your GP for dose instructions.
Not all patients can use over the counter prochlorperazine tablets. There are several groups of patients, who should not use Buccastem M tablets, including patients with:
- Parkinson’s disease
- Prostatic hypertrophy
- Liver problems (impaired function)
- Glaucoma (narrow-angle)
Migraleve – migraine relief – pain and anti-sickness
Migraleve tablets are a well-known brand of tablets used for symptomatic management of migraines. Like other over the counter codeine-containing medicines, Migraleve can be used to manage acute, moderate pain for which paracetamol, ibuprofen or aspirin did not help. The licensed recommendation also includes the management of migraine-associated nausea and vomiting.
Migraleve Pink tablets contain three active ingredients:
- Codeine phosphate
Buclizine is an antihistamine, which works as an anti-sickness drug in a similar way to promethazine (discussed earlier).
Syndol for migraines
Syndol is another combination product containing codeine, paracetamol, and additionally caffeine and doxylamine. Syndol has a similar use to Migraleve and other over the counter codeine products. Doxylamine is classified as an antihistamine, and it is known to reduce nausea and vomiting.
Codeine and codeine-containing products have some restrictions when purchased from the pharmacy:
- Over the counter codeine-containing products can only be used for three days only
- Co-codamol and other combination brands of codeine can only be used in adults and children over 12 years of age.
- Pack size restrictions: maximum of 32 tablets or capsules
Pepto-Bismol for upset stomach and nausea
Pepto-Bismol range of products (including chewable tablets) are advertised to relief five symptoms:
- upset stomach
The main active ingredient found in Pepto-Bismol is bismuth subsalicylate (related to aspirin). It can be used by adults and children over 16 years of age. Because of its main active ingredient, certain people should not take Pepto-Bismol, including pregnant or breastfeeding women.
Read product information leaflet to learn if Pepto-Birmol is suitable for you, or speak to your pharmacist.
The exact mechanism of action of Pepto-Bismol is not known, but anti-nausea properties are different to all anti-sickness tablets discussed in this post.
Can you use OTC anti-sickness tablets in pregnancy?
Nausea and vomiting are common symptoms experienced by pregnant women in the early stages of pregnancy, which usually settle around 20th week of pregnancy (NICE, 2020). Pregnant women who experience nausea and vomiting should speak to their midwife or GP.
The management of ‘morning sickness’ include self-care advice, for example, rest, appropriate fluid intake, and having small but frequent meals (ibid).
Pregnant women who request over the counter anti-sickness tablets will most likely be referred by to their GP.
Drug treatment is only considered after a self-care measure failed to relieve nausea or/and sickness.
A NICE guide on nausea and vomiting in pregnancy recommends an antihistamine, for example, cyclizine or promethazine or phenothiazine drug such as prochlorperazine as a first-line anti-sickness drug. Pregnant women usually need reassessment after 24 hours.
Other prescription-only drugs which are considered if the above medicines failed to provide adequate control of symptoms include:
Treatment with the above drugs is usually limited to 5 days only.
Anti-sickness tablets: alternative options
Alternative, non-drug products, which are a popular choice as anti-sickness remedies include a range of motion sickness patches and sickness relief wristbands. Anti-sickness wrist bands are based o the principle of acupressure, whereas patches may contain herbal ingredients.
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NICE (2020). Nausea/vomiting in pregnancy. Available at: https://cks.nice.org.uk/topics/nausea-vomiting-in-pregnancy/ Accessed on 23/12/2020
Benson, Alan J. Medication for motion sickness. ROYAL AIR FORCE FARNBOROUGH (UNITED KINGDOM) SCHOOL OF AVIATION MEDICINE, 2001. https://apps.dtic.mil/sti/citations/ADP011049