• Severe, worsening, sudden, or unusual headache
• Repeated or persistent vomiting, unable to retain fluids, or markedly reduced urine
• Fever, neck stiffness, rash
• Drowsiness, confusion, fainting, seizure
• Blurred/double vision, weakness, trouble walking, speaking, or hearing
• Recent head injury

• A sudden, very severe, or rapidly worsening headache, especially “worst headache”
• Confusion, unusual behavior, extreme sleepiness, difficult to wake, fainting, or seizure
• New weakness, numbness, facial droop, trouble speaking, walking, balancing, or coordinating
• Double vision, persistent blurred vision, abnormal eye movements, or new squint
• Fever with severe headache, neck stiffness, rash, or sensitivity to light
• Repeated, persistent, projectile, overnight, or early-morning vomiting, especially with headache
• Cannot keep fluids down, urinates very little, dry mouth/no tears, marked weakness, or lethargy suggesting dehydration
• Headache that wakes him from sleep or is worse lying down, coughing, straining, or exertion
• Recent head injury, especially with vomiting, worsening headache, confusion, or altered alertness
• Severe ear pain, hearing loss, or continuous spinning vertigo with inability to walk
• Any breathing difficulty, blue/gray lips, or severe abdominal pain

Preferred for a future flight or travel

• 50 mg by mouth 30-60 minutes before travel
• May repeat every 4-6 hours if needed
• Maximum: 400 mg in 24 hours
• Can cause sleepiness, dry mouth, blurred vision, and sometimes paradoxical agitation.

• 25 mg by mouth 1 hour before travel
• Usually lasts about 24 hours. Follow the local product label; some products allow 25-50 mg in those age 12+.
• Often less sedating than dimenhydrinate, but can still cause drowsiness.

Non-drug measures

• Eat a light meal, avoid a heavy/fatty meal before flying.
• Sit near the wing, face forward, look at the horizon or outside.
• Avoid reading, gaming, or phone use during turbulence.
• Keep the head supported, get fresh air if possible, and use slow regular breathing.
• Small frequent sips of oral rehydration solution or water if vomiting occurred.

Important for this child now

• Use it only as prescribed, at the lowest effective dose and for the shortest time.
• Do not combine it with sedating motion-sickness medicines, such as dimenhydrinate, meclizine, diphenhydramine, promethazine, or alcohol, unless the prescriber specifically instructs it.
• Keep up small, frequent oral fluids or oral rehydration solution.

• Known prolonged QT/QTc interval, prior fainting due to an arrhythmia, significant heart disease, or slow heart rate
• Significant dehydration or suspected low potassium/magnesium from ongoing vomiting
• Moderate or severe liver disease
• A medicine that prolongs QT, or a potent CYP3A4 inhibitor, such as clarithromycin, erythromycin, ketoconazole/itraconazole, or certain HIV medicines
• Suspected pheochromocytoma

• Non-drug measures
• Dimenhydrinate or meclizine before travel, if appropriate

• For the next flight: Stemtil is generally not first choice for prevention.
• For persistent vomiting now: do not use it repeatedly at home without a clinician assessing him, especially since he has headache as well.
• If a doctor has prescribed a single short course, follow that exact prescription and stop/seek urgent help if abnormal movements, marked drowsiness, confusion, or breathing/swallowing difficulty occur.