Dosing and uses of Transderm Scop (scopolamine)
Adult dosage forms and strengths
transdermal patch
- 1mg/72hr
Nausea & Vomiting
Treatment
0.3-0.65 mg IV/IM/SC; repeat q6-8hr if necessary
Motion Sickness
Prophylaxis
Apply 1 patch behind ear at least 4-12 hours (preferably 12 hr) before anticipated exposure to motion, then every 3 days PRn
Nausea & Vomiting Associated With Anesthesia
Prophylaxis
Transdermal patch
- Apply 1 patch behind ear on night before scheduled surgery, then leave on for 24 hours after surgery
- Cesarian section: Apply 1 patch behind ear 1 hour before surgery (to minimize newborn exposure, apply no sooner); remove 24 hours after surgery
Chemotherapy Induced Nausea and Vomiting (Off-label)
Apply 1 patch q72hr
Pediatric dosage forms and strengths
Safety & efficacy not established
Transderm Scop (scopolamine) adverse (side) effects
>10%
Dry mouth (29-67%)
Drowsiness (17%)
Dizziness (12%)
Blurred vision
Frequency not defined
Disorientation
Confusion
Pruritus and edema at application site
Anticholinergic effects
Dilation of pupil if drug contacts eye
Withdrawal symptoms (eg, dizziness, nausea and vomiting) if used for >3 days
Warnings
Contraindications
Hypersensitivity to scopolamine, belladonna alkaloids, or any component in formulation
Closed-angle glaucoma
Cautions
Use caution in patients with open-angle glaucoma, benign prostatic hyperplasia, history of seizures or psychosis, ulcerative colitis, hypertension, hyperthyroidism, Down syndrome, toxin-mediated diarrhea, coronary artery disease, tachyarrhythmia, brain damage or spastic paralysis in children, cardiac conduction disorder, CHF
Children and elderly persons are particularly susceptible to side effects of belladonna alkaloids
Anaphylaxis, including episodes of shock reported, following parenteral administration; monitor for signs and symptoms of hypersensitivity reactions
Lower doses may increase vagal tone and cause paradoxical bradycardia
May cause CNS depression; caution when operating heavy machinery or tasks which require mental alertness
Patients may experience idiosyncratic toxic psychosis, agitation, delusions, confusion, hallucinations, paranoid behavior and rambling speech
Discontinue if patient experiences unusual visual disturbances or pain within the eye
In patients with Parkinson disease, or abrupt discontinuation of large doses may result in adverse effects, including headache, nausea, vomiting, and dizziness; withdrawal symptoms may also appear more than 24 hr after removing transdermal patch
Drug interferes with gastric secretion test
Pregnancy and lactation
Pregnancy category: C
Lactation: Drug distributed into breast milk; use caution
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Transderm Scop (scopolamine)
Mechanism of action
Anticholinergic belladonna alkaloid
Generally exhibits pharmacologic actions associated with other antimuscarinics
May prevent motion-induced nausea and vomiting by blocking transmission of cholinergic impulse from vestibular nuclei to higher centers in CNS and from reticular formation to vomiting center
Absorption
Onset: IM, 0.5-1 hr; IV, 10 min
Duration: IM, 4-6 hr; IV, 2 hr
Peak plasma time: 24 hr (transdermal)
Metabolism
Metabolized by liver (via conjugation)
Elimination
Half-life: 9.5 hr
Excretion: Primarily urine (90% as metabolites)
Administration
IV Incompatibilities
Alkalies, methohexitaL
IV Compatibilities
Additive: Floxacillin, furosemide, meperidine, succinylcholine
Syringe: Atropine, butorphanol, chlorpromazine, cimetidine, diamorphine, dimenhydrinate, diphenhydramine, droperidol, fentanyl, glycopyrrolate, hydromorphone, hydroxyzine, meperidine, metoclopramide, midazolam, morphine hydrochloride, morphine sulfate, nalbuphine, papaveretum, pentazocine, pentobarbital, perphenazine, prochlorperazine, promazine, promethazine, ranitidine, sufentanil, thiopentaL
Y-site: Fentanyl, heparin, hydrocortisone, hydromorphone, methadone, morphine, potassium chloride, propofol, sufentanil, vitamins B and C
IV Preparation
Dilute with sterile water for injection
IV/IM Administration
Prevention of nausea and vomiting associated with anesthesia: Inject IV/IM/SC 30-60 minutes before anticipated induction of anesthesia
Prevention of motion sickness: Inject IM 1 hour before anticipated exposure to motion
Storage
Store at room temperature; protect from light
