苯丙胺 + 东莨菪碱或抗组胺药
尽管苯丙胺联合东莨菪碱(莨菪碱)或抗组胺药已被在军事和航空项目用作晕动病预防药,但在研发出无不良反应的有效类似物之前,将其用于一般出行大众的可能性较小。
5-HT1 激动剂(曲坦类药物)
目前流行用于偏头痛药物是以 5-HT1 激动剂为基础(例如舒马普坦)。它们在用于晕动病试验时的原理是5-羟色胺 (5-HT) 的消耗会诱发偏头痛并增强非偏头痛患者对晕动病症状的易患性。[31]Drummond PD. Effect of tryptophan depletion on symptoms of motion sickness in migraineurs. Neurology. 2005;65:620-622.http://www.ncbi.nlm.nih.gov/pubmed/16116130?tool=bestpractice.com此外,经证明 5-HT1 激动剂可有效治疗动物的晕动病。[39]Yates BJ, Miller AD, Lucot JB. Physiological basis and pharmacology of motion sickness: an update. Brain Res Bull. 1998;47:395-406.http://www.ncbi.nlm.nih.gov/pubmed/10052567?tool=bestpractice.com[67]Javid FA, Naylor RJ. The effect of serotonin and serotonin receptor antagonists on motion sickness in Suncus murinus. Pharmacol Biochem Behav. 2002;73:979-989.http://www.ncbi.nlm.nih.gov/pubmed/12213545?tool=bestpractice.com 它们可以降低有眩晕症状(眩晕性偏头痛)的偏头痛患者的晕动病易患性,但尚未对治疗偏头痛使用的药物在预防晕动病时的普遍适用性进行系统试验。[68]Marcus DA, Furman JM. Prevention of motion sickness with rizatriptan: a double-blind, placebo-controlled pilot study. Med Sci Monit. 2006;12:PI1-PI7.http://www.ncbi.nlm.nih.gov/pubmed/16369474?tool=bestpractice.com晕动病的易患性:有中等质量证据表明,与安慰剂相比,用利扎曲坦预处理后,偏头痛眩晕患者的晕动病易患性有所降低。[68]Marcus DA, Furman JM. Prevention of motion sickness with rizatriptan: a double-blind, placebo-controlled pilot study. Med Sci Monit. 2006;12:PI1-PI7.http://www.ncbi.nlm.nih.gov/pubmed/16369474?tool=bestpractice.com受试者<200名的随机对照临床试验(RCT)、受试者>200名且方法学存在缺陷的随机对照临床试验(RCT)、方法学存在缺陷的系统评价或者高质量的观察性(队列)研究。
普萘洛尔
动物研究显示普萘洛尔是促进药物吸收的有效辅助剂,晕动病中的胃滞留会抑制药物吸收。[69]Gupta Y, Chaudhary G. Effect of antiemetic drugs on decrease in gastric emptying in experimental model of motion sickness in rats. Acta Pharmacol Sin. 2003;24:296-300.http://www.ncbi.nlm.nih.gov/pubmed/12676066?tool=bestpractice.com
鼻内或口腔东莨菪碱
口腔吸收对东莨菪碱有效,[60]Nachum Z, Shahal B, Shupak A, et al. Scopolamine bioavailability in combined oral and transdermal delivery. J Pharmacol Exp Ther. 2001;296:121-123.http://jpet.aspetjournals.org/content/296/1/121.fullhttp://www.ncbi.nlm.nih.gov/pubmed/11123371?tool=bestpractice.com且最近开发的口香糖配方展现了在减少不良反应的情况下充分预防晕动病的前景。[70]Valoti M, Frosini M, Dragoni S, et al. Pharmacokinetics of diphenhydramine in healthy volunteers with a dimenhydrinate 25 mg chewing gum formulation. Methods Find Exp Clin Pharmacol. 2003;25:377-381.http://www.ncbi.nlm.nih.gov/pubmed/12851661?tool=bestpractice.com鼻内东莨菪碱喷雾剂提供更快的路径,且[71]Klocker N, Hanschke W, Toussaint S, et al. Scopolamine nasal spray in motion sickness: a randomised, controlled, and crossover study for the comparison of two scopolamine nasal sprays with oral dimenhydrinate and placebo. Eur J Pharm Sci. 2001;13:227-232.http://www.ncbi.nlm.nih.gov/pubmed/11297908?tool=bestpractice.com更高 pH 值(碱性)稀释配方可促进吸收,因此可在数分钟内达到峰值血液水平。[72]Ahmed S, Sileno AP, de Meireles JC, et al. Effects of pH and dose on nasal absorption of scopolamine hydrobromide in human subjects. Pharm Res. 2000;17:974-977.http://www.ncbi.nlm.nih.gov/pubmed/11028944?tool=bestpractice.com东莨菪碱(莨菪碱)血药浓度:有高质量的证据表明,鼻腔给药氢溴酸东莨菪碱(氢溴酸莨菪碱)时可取得有效的东莨菪碱血药浓度。吸收随着配方 pH 值和剂量的增加而大幅增加。[72]Ahmed S, Sileno AP, de Meireles JC, et al. Effects of pH and dose on nasal absorption of scopolamine hydrobromide in human subjects. Pharm Res. 2000;17:974-977.http://www.ncbi.nlm.nih.gov/pubmed/11028944?tool=bestpractice.com系统评价或者受试者>200名的随机对照临床试验(RCT)。 一项研究显示,鼻内给药低剂量莨菪碱可减少旋转鼓室引起的晕动病。[73]Simmons RG, Phillips JB, Lojewski RA, et al. The efficacy of low-dose intranasal scopolamine for motion sickness. Aviat Space Environ Med. 2010;81:405-412.http://www.ncbi.nlm.nih.gov/pubmed/20377145?tool=bestpractice.com
穴位按压
用手指、手镯或电刺激来刺激心包 6 (P6) 穴可预防晕动病的恶心和呕吐。[74]Streitberger K, Ezzo J, Schneider A. Acupuncture for nausea and vomiting: an update of clinical and experimental studies. Auton Neurosci. 2006;129:107-117.http://www.ncbi.nlm.nih.gov/pubmed/16950659?tool=bestpractice.com[75]Hu S, Stern RM, Koch KL. Electrical acustimulation relieves vection-induced motion sickness. Gastroenterology. 1992;102:1854-1858.http://www.ncbi.nlm.nih.gov/pubmed/1587405?tool=bestpractice.com P6 穴位于掌长肌和桡侧腕屈肌之间,离腕部屈肌折痕约 3 指宽。