Introduction
The products listed in this chapter fall into two categories: motion sickness, and antimalarials. Motion sickness occurs when the body moves in an unusual manner and the brain receives conflicting messages – the inner ear indicates movement, whereas the eyes send a message saying that the body is stationary. Symptoms include dizziness, nausea, vomiting, sweating and increased saliva production, and prolonged attacks can lead to dehydration and depression. Travellers to more exotic locations should be asked whether they are planning to visit any areas where malaria is prevalent. Malaria is transmitted to humans via infected mosquitoes that inject the parasite into the blood. The first signs of infection are headache, vomiting, fatigue, nausea, muscular pains and fever. These are often mistaken for flu, so patients presenting with such symptoms should be asked if they have recently (during the last year) travelled back from a malaria-endemic area. Patients can rapidly progress to delirium, impaired consciousness and convulsions, and these symptoms can lead to coma and death. Information on malaria prophylaxis and vaccination requirements is available from the National Pharmaceutical Association and the Travel Turtle website (via www.dotpharmacy.com).
Hyoscine, an anticholinergic, is considered the most effective travel sickness remedy. It works quickly, but has a short duration of action. Side effects are not usually a problem at the recommended dose, but may include drowsiness, blurred vision, dry mouth and urinary retention. Anticholinergics are not recommended in glaucoma, and should be used in caution in patients with urinary problems, hypertension and heart disease.
Meclozine and cinnarizine are antihistamines used for travel sickness. Both have a longer duration of action than hyoscine, but can cause drowsiness.
Promethazine is another antihistamine used for motion sickness, but it is very sedating and can cause sensitivity to sunlight.
Chloroquine and proguanil are the two antimalarials available over the counter. The regime should be started one week before entering the malarial area, and continued for four weeks after leaving the region. Doses for children should be calculated according to weight using the manufacturer's guidelines.

When to refer
• A patient with suspected travel sickness who has any of the following accompanying symptoms: severe vomiting, loss of balance, worsening symptoms.
• Any symptoms of malaria.
• Malaria prophylaxis for pregnant or breastfeeding women, patients with impaired kidney or liver function, epilepsy, severe gastrointestinal problems or psoriasis, anyone taking warfarin.

Associated advice
• Remedies for motion sickness should be taken before commencing travel, as most are of little use once an attack has begun.
• Travel sickness symptoms can be reduced by avoiding large meals and alcohol before and during travel.
• Passengers on ships can reduce the risk of motion sickness by travelling in the centre of the vessel, fixing the eyes on the horizon. Car sickness may be helped by travelling in the front of the car, avoiding reading and keeping the windows open.
• Many travel sickness products can cause drowsiness, so patients should be advised that their driving may be impaired, and warned off alcohol.
• Patients should be reminded that malaria prophylaxis is not 100 per cent effective, and made aware of the risks and signs of infection.
• Patients requiring malaria prophylaxis should be advised to use insect repellents and wear long sleeved tops and trousers to avoid being bitten.
• Indigestion remedies can interfere with the absorption of antimalarials, so should be taken at least two hours before or after.