Dimenhydrinate (Motion Sickness Pills)

Over-the-counter (OTC) medication abuse can be a problematic issue because it typically occurs in younger individuals under the age of 26, and OTC medications are readily available. A 2008 research article published in the Journal of the American Board of Family Medicine concluded that:

• People who abuse OTC medications are typically younger individuals.
• They are most often female and Caucasian.
• OTC medication abuse typically occurs in conjunction with the use or abuse of alcohol, creating a dangerous situation.
• OTC medication abuse most often occurs in individuals who are unable to obtain illicit drugs or get prescription drugs illicitly.

Prevalence of Dimenhydrinate Abuse

Dimenhydrinate is a medication marketed in the United States under the brand name Dramamine. This medication is an over-the-counter antihistamine that is often used for the relief of nausea associated with numerous causes, but most often for motion sickness. As a result, dimenhydrinate is sometimes referred to as a “motion sickness pill.”

Abuse of dimenhydrinate has been reported in research literature and most often involves oral ingestion of extremely high doses to produce euphoria, hallucinations, and sedation (anti-anxiety effects). Most of the clinical literature consists of case studies of adolescents who have abused the drug. Most of these studies occurred in the 1990s and early 2000s.

There appears to be a potential for the development of physical dependence on the drug in individuals who chronically abuse it, although there are only a few cases reported in the literature of physical dependence on the drug. The anti-anxiety effects of taking large doses of dimenhydrinate make it an attractive drug of abuse for people who are diagnosed with psychiatric disorders, such as anxiety disorders, trauma- and stressor-related disorders, obsessive-compulsive disorders, and even schizophrenia.

A recent study sponsored by the National Institutes of Health highlighted an extensive literature search that looked at cases of OTC medication abuse reported from January 1, 2005 through November 5, 2015. There were no research reports of dimenhydrinate abuse found in the literature search. A study was also conducted in 74 pharmacies in France that involved questionnaires completed by 530 patients. No cases of dimenhydrinate abuse were reported in the questionnaires. Although there is certainly case study evidence to support the notion that abuse of dimenhydrinate does occur, its abuse is most likely rare.

Symptoms of Dimenhydrinate Abuse

The book Drug Facts and Comparisons reports that the symptoms associated with abuse of dimenhydrinate can be quite variable from person to person. Case studies suggest that individuals use extremely high doses of the drug to get the desired psychoactive effects.

The side effects that can occur as a result of dimenhydrinate abuse include:

• Headache
• Problems with coordination
• Extreme sedation
• Drowsiness
• Confusion
• Dry mouth
• Nausea
• Irregular heartbeat
• Changes in blood pressure
• Other cardiac issues
• Psychosis
• Seizures
• A comatose state
• Potential death from an overdose, most often due to seizures or heart attack

Using motion sickness pills in conjunction with alcohol can lead to significantly slurred speech, muscle weakness, lack of ordination, nausea and vomiting, and cognitive problems. Combining dimenhydrinate with alcohol can lead to a seriously confused state known as delirium that consists of confusion, disorientation, hyperactivity or hypoactivity, and psychosis.
Long-term abuse of dimenhydrinate is associated with:

• Cardiovascular issues, including irregular heartbeat, increased blood pressure, and susceptibility to heart attack or stroke
• Problems with kidney functioning that potentially lead to kidney failure
• Liver damage, particularly if dimenhydrinate is taken in medications that also include acetaminophen
• Stomach ulcers and bleeding

Using or abusing any type of motion sickness pill when operating machinery or while driving can be extremely dangerous.
Symptoms of an overdose on dimenhydrinate include:

• Enlarged pupils
• Dry eyes
• Blurred vision
• Dry mouth
• Ringing in the ears
• Nausea
• Vomiting
• Difficulty urinating
• Stomach pain and cramps
• Reduced blood pressure
• Rapid heartbeat
• Difficulty breathing
• Dry skin, rash, or hives
• Significant confusion, drowsiness, depression, and/or anxiety
• Agitation, psychosis, and/or seizures
• A comatose state

Overdose on dimenhydrinate can be fatal. Treatment for overdose includes having the stomach pumped, the use of activated charcoal, IV fluids, breathing support if needed, and other medications to address the symptoms associated with the overdose.

Treatment Issues

Because there is some evidence that use of dimenhydrinate may produce physical dependence, a person suspected of using the drug would be initially treated by a physician who specializes in addiction medicine. The physician could use medications to address any withdrawal symptoms. This approach would most likely involve the physician managing the symptoms via medications. The antipsychotic medication Clozaril (clozapine) has been reported to reduce cravings in those with serious dimenhydrinate abuse issues.

Individuals with any type of substance use disorder should become involved in a long-term program of recovery that includes the following:

• A thorough assessment of the individual’s functioning at all levels
• The development of a treatment plan to address the needs of the individual based on the findings of the assessment
• A plan to address any co-occurring mental health disorders and other co-occurring substance use disorders along with treatment for the individual’s abuse of dimenhydrinate
• Medications when appropriate
• Therapy, delivered in substance use disorder therapy groups, individual sessions, or a combination of groups and individual sessions
• Participation in peer support groups, such as 12-step groups
• Family involvement