scopolamine

scoe-POL-a-meen

Therapeutic Classification: antiemetics

Pharmacologic Classification: anticholinergics

BEERS REMS

Prevention of motion sickness.
Prevention of postoperative nausea and vomiting.

Inhibits the muscarinic activity of acetylcholine.
Corrects the imbalance of acetylcholine and norepinephrine in the CNS, which may be responsible for motion sickness.

Therapeutic effects:

Reduction of postoperative nausea and vomiting.
Reduction of spasms.

Absorption: Well absorbed following transdermal administration.

Distribution: Crosses the blood-brain barrier.

Metabolism/Excretion: Mostly metabolized by the liver.

Half-Life: 8 hr.

(antiemetic, sedative properties)

ROUTE	ONSET	PEAK	DURATION
Transdermal	4 hr	unknown	72 hr

Contraindicated in:

Hypersensitivity;
Angle-closure glaucoma;
Acute hemorrhage;
Tachycardia secondary to cardiac insufficiency or thyrotoxicosis;
OB: Pregnant women with severe pre-eclampsia (may risk of seizures).

Use Cautiously in:

Possible intestinal obstruction;
Prostatic hyperplasia;
Chronic renal, hepatic, pulmonary, or cardiac disease;
OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk;
Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
Pedi: risk of adverse reactions in children;
Geri: Appears on Beers list. risk of adverse reactions in older adults due to anticholinergic effects. Avoid use in older adults.

CV: tachycardia, palpitations

Derm: ↓sweating

EENT: blurred vision, mydriasis, photophobia

GI: dry mouth, constipation

GU: urinary hesitancy, urinary retention

Neuro: drowsiness, confusion

Drug-drug:

↑anticholinergic effects with antihistamines, antidepressants, quinidine, or disopyramide.
↑CNS depression with alcohol, antidepressants, antihistamines, opioid analgesics, or sedative/hypnotics.
May alter the absorption of other orally administered drugs by slowing motility of the GI tract.
May ↑ GI mucosal lesions in patients taking oral wax-matrix potassium chloride preparations.

Drug-Natural Products:

↑anticholinergic effects with jimson weed and scopolia.

Transdermal (Adults ): Motion sickness: Apply 1 patch 4 hr prior to travel and then every 3 days (as needed); Preoperative: Apply 1 patch the evening before surgery (remove 24 hr after surgery).

(Generic available)

Transdermal system: 1.5 mg scopolamine/patch releases 0.5 mg scopolamine over 3 days

Monitor for nausea and vomiting before and during therapy.
Assess patient for signs of urinary retention periodically during therapy.

Apply at least 4 hr (US product) before exposure to travel to prevent motion sickness.

Instruct patient on application of transdermal patches. Apply at least 4 hr (US product) before exposure to travel to prevent motion sickness. Wash hands and dry thoroughly before and after application. Apply to hairless, clean, dry area behind ear; avoid areas with cuts or irritation. Apply pressure over system to ensure contact with skin. System is effective for 3 days. If system becomes dislodged, replace with a new system on another site behind the ear. System is waterproof and not affected by bathing or showering.
- Instruct patient to remove patch and notify health care professional immediately if symptoms of acute angle-closure glaucoma (pain or reddening of the eyes with pupil dilation) occur.
- Caution patients engaging in underwater sports of potentially distorting effects of scopolamine.
- Advise patient referred for MRI test to discuss patch with referring health care professional and MRI facility to determine if removal of patch is necessary prior to test and for directions for replacing patch.
Instruct patient to take medication as directed. Take missed doses as soon as remembered. Do not double doses.
- May cause drowsiness or blurred vision. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
- Advise patient to use caution when exercising and in hot weather; overheating may result in heatstroke.
- Advise patient to avoid concurrent use of alcohol and other CNS depressants, including opioids, with this medication.
- Inform patient that frequent mouth rinses, good oral hygiene, and sugarless gum or candy may minimize dry mouth.
Rep: Advise patient to notify health care professional if pregnancy is planned or suspected, or if breastfeeding. When the transdermal patch is used to prevent nausea and vomiting associated with surgery, dose adjustments are required prior to cesarean delivery. Avoid use of transdermal patches in pregnant patients with severe preeclampsia; may cause eclamptic seizures. Monitor for dry mouth, drowsiness, blurred vision, and dilation of the pupils in infant of a mother using transdermal scopolamine. May decrease milk production.

Prevention of motion sickness.
Prevention of postoperative nausea and vomiting.

Transderm-Scop

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Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Route/Dosage ⬆ ⬇

Availability ⬆ ⬇

Assessment ⬆ ⬇

Implementation ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Evaluation/Desired Outcomes ⬆ ⬇

US Brand Names ⬆