scopolamine

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;
Schizophrenia (may worsen condition);
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 due to anticholinergic effects;
Geri: Appears on Beers list. ↑ risk of adverse reactions in older adults due to anticholinergic effects. Avoid use in older adults.

Adv. Reactions/Side Effects ⬆ ⬇

CV: tachycardia, palpitations

Derm: ↓sweating

EENT: blurred vision, mydriasis, photophobia

GI: dry mouth, constipation

GU: urinary hesitancy, urinary retention

Neuro: drowsiness, agitation, confusion, delusions, disorientation, hallucinations, paranoia, psychosis, speech disorder

Misc: HYPERTHERMIA

Interactions ⬆ ⬇

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.

Route/Dosage ⬆ ⬇

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).

Availability ⬆ ⬇

(Generic available)

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

Assessment ⬆ ⬇

Monitor for nausea and vomiting before and during therapy.
Assess for signs/symptoms of urinary retention periodically during therapy; discontinue if difficulty urinating develops.
Monitor for anticholinergic side effects such as ↓ in GI motility (constipation, obstruction), urinary retention, temporary dilation of pupils resulting in blurred vision, and ↑ intraocular pressure.
Monitor for acute psychosis, agitation, speech disorder, hallucinations, paranoia, and delusions, especially in patients receiving other drugs concurrently that are associated with similar psychiatric effects; if condition occurs, discontinue scopolamine.
Geri: Older adults may be more sensitive to neurological (drowsiness, disorientation, confusion) and psychiatric effects, as well as for risk of hyperthermia; consider more frequent monitoring.

Implementation ⬆ ⬇

Apply ≥4 hr before exposure to travel to prevent motion sickness.

Patient/Family Teaching ⬆ ⬇

Educate patient on reason for scopolamine and side effects. Instruct them to use medication as directed. Take missed doses as soon as remembered. Do not double doses. Advise patient to read Patient Information before starting and with each Rx refill in case of changes.
Advise patients if body temperature ↑ or if they are not sweating when exposed to warm conditions, to remove the transdermal patch and contact a health care provider.
Instruct patient on application of transdermal patches. Apply ≥4 hr 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. Once secured, avoid touching or applying pressure to system being worn. Do not cut the transdermal system; only one system should be worn at a time. 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.
- On removal, fold the used transdermal system in half with the sticky side together and discard in household trash in a manner that prevents accidental contact or ingestion by children, pets, or others. Wash hands thoroughly after removing system.
- Instruct patient to remove patch and notify health care provider 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 provider and MRI facility to determine if removal of patch is necessary prior to test and for directions for replacing patch.
Rep: Advise women of reproductive potential to notify health care provider 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 ↓ milk production.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇