Yes

Anticholinergic Agent

Preoperative medication to produce amnesia and decrease salivary and respiratory secretions; to produce cycloplegia and mydriasis; treatment of iridocyclitis; prevention of motion sickness; prevention of nausea/vomiting associated with anesthesia or opiate analgesia (patch); symptomatic treatment of postencephalitic parkinsonism and paralysis agitans (oral); inhibits excessive motility and hypertonus of the gastrointestinal tract in such conditions as the irritable colon syndrome, mild dysentery, diverticulitis, pylorospasm, and cardiospasm; it may also prevent motion sickness (oral)

C

Hypersensitivity to scopolamine or any component; narrow-angle glaucoma; acute hemorrhage, gastrointestinal or genitourinary obstruction, thyrotoxicosis, tachycardia secondary to cardiac insufficiency, paralytic ileus

Use with caution with hepatic or renal impairment since adverse CNS effects occur more often in these patients; use with caution in infants and children since they may be more susceptible to adverse effects of scopolamine; use with caution in patients with GI obstruction; anticholinergic agents are not well tolerated in the elderly and their use should be avoided when possible

Ophthalmic:

>10%: Ocular: Blurred vision, photophobia

1% to 10%:

Ocular: Local irritation, increased intraocular pressure

Respiratory: Congestion

<1%: Vascular congestion, edema, drowsiness, eczematoid dermatitis, follicular conjunctivitis, exudate

Systemic:

>10%:

Dermatologic: Dry skin

Gastrointestinal: Constipation, xerostomia, dry throat

Local: Irritation at injection site

Respiratory: Dry nose

Miscellaneous: Diaphoresis (decreased)

1% to 10%:

Dermatologic: Increased sensitivity to light

Endocrine & metabolic: Decreased flow of breast milk

Gastrointestinal: Dysphagia

<1%: Orthostatic hypotension, ventricular fibrillation, tachycardia, palpitations, confusion, drowsiness, headache, loss of memory, ataxia, fatigue, rash, bloated feeling, nausea, vomiting, dysuria, weakness, increased intraocular pain, blurred vision

Note: Systemic adverse effects have been reported following ophthalmic administration

Symptoms of overdose include dilated pupils, flushed skin, tachycardia, hypertension, EKG abnormalities, CNS manifestations resemble acute psychosis; CNS depression, circulatory collapse, respiratory failure, and death can occur

Pure scopolamine intoxication is extremely rare. However, for a scopolamine overdose with severe life-threatening symptoms, physostigmine 1-2 mg (0.5 mg or 0.02 mg/kg for children) S.C. or I.V. slowly should be given to reverse the toxic effects.

Decreased effect of acetaminophen, levodopa, ketoconazole, digoxin, riboflavin, potassium chloride in wax matrix preparations

Increased toxicity: Additive adverse effects with other anticholinergic agents; GI absorption of the following drugs may be affected: acetaminophen, levodopa, ketoconazole, digoxin, riboflavin, potassium chloride wax-matrix preparations

Avoid acid solutions, because hydrolysis occurs at pH <3; physically compatible when mixed in the same syringe with atropine, butorphanol, chlorpromazine, dimenhydrinate, diphenhydramine, droperidol, fentanyl, glycopyrrolate, hydromorphone, hydroxyzine, meperidine, metoclopramide, morphine, pentazocine, pentobarbital, perphenazine, prochlorperazine, promazine, promethazine, or thiopental

Blocks the action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands and the CNS; increases cardiac output, dries secretions, antagonizes histamine and serotonin

Onset of effect: Oral, I.M.: 0.5-1 hour; I.V.: 10 minutes

Duration of effect: Oral, I.M.: 4-6 hours; I.V.: 2 hours

Peak effect: 20-60 minutes; it may take 3-7 days for full recovery

Absorption: Well absorbed by all routes of administration

Protein binding: Reversibly bound to plasma proteins

Metabolism: In the liver

Elimination: In urine

Preoperatively:

Children: I.M., S.C.: 6 mcg/kg/dose (maximum: 0.3 mg/dose) or 0.2 mg/m² may be repeated every 6-8 hours or alternatively:

4-7 months: 0.1 mg

7 months to 3 years: 0.15 mg

3-8 years: 0.2 mg

8-12 years: 0.3 mg

Adults:

I.M., I.V., S.C.: 0.3-0.65 mg; may be repeated every 4-6 hours

Transdermal patch: Apply 2.5 cm² patch to hairless area behind ear the night before surgery (the patch should be applied no sooner than 1 hour before surgery for best results)

Motion sickness: Transdermal: Children >12 years and Adults: Apply 1 disc behind the ear at least 4 hours prior to exposure and every 3 days as needed; effective if applied as soon as 2-3 hours before anticipated need, best if 12 hours before

Ophthalmic:

Refraction:

Children: Instill 1 drop of 0.25% to eye(s) twice daily for 2 days before procedure

Adults: Instill 1-2 drops of 0.25% to eye(s) 1 hour before procedure

Iridocyclitis:

Children: Instill 1 drop of 0.25% to eye(s) up to 3 times/day

Adults: Instill 1-2 drops of 0.25% to eye(s) up to 4 times/day

Oral: 0.4 to 0.8 mg as a range; the dosage may be cautiously increased in parkinsonism and spastic states.

May cause drowsiness; may rarely cause confusion or amnesia

May decrease the effects of levodopa; concurrent use with psychotropics may produce additive sedation of anticholinergic side effects (dry mouth)

No information available to require special precautions

>10% of patients medicated with scopolamine patch (Transderm Scop®) will experience significant dry mouth. This will disappear with cessation of drug therapy.

Take as directed (see below). You may experience drowsiness, confusion, impaired judgment, or vision changes (use caution when driving or engaging in tasks requiring alertness until response to drug is known); dry mouth, nausea, or vomiting (small frequent meals, frequent mouth care, chewing gum, or sucking lozenges may help); orthostatic hypotension (use caution when climbing stairs and when rising from lying or sitting position); constipation (increased exercise, fluid, or dietary fiber may reduce constipation, if not effective consult prescriber); increased sensitivity to heat and decreased perspiration (avoid extremes of heat, reduce exercise in hot weather); decreased milk if breast-feeding. Report hot, dry, flushed skin; blurred vision or vision changes; difficulty swallowing; chest pain, palpitations, or rapid heartbeat; painful or difficult urination; increased confusion, depression, or loss of memory; rapid or difficult respirations; muscle weakness or tremors; or eye pain.

Ophthalmic: Instill as often as recommended. Wash hands before using. Sit or lie down, open eye, look at ceiling, and instill prescribed amount of solution. Do not blink for 30 seconds, close eye and roll eye in all directions, and apply gentle pressure to inner corner of eye for 1-2 minutes. Do not let tip of applicator touch eye or contaminate tip of applicator. Temporary stinging or blurred vision may occur.

Pregnancy precautions: Inform prescriber if you are or intend to be pregnant.

Topical disc is programmed to deliver in vivo 0.5 mg over 3 days; wash hands before and after applying the disc to avoid drug contact with eyes

Disc, transdermal: 1.5 mg/disc (4's)

Injection, as hydrobromide: 0.3 mg/mL (1 mL); 0.4 mg/mL (0.5 mL, 1 mL); 0.86 mg/mL (0.5 mL); 1 mg/mL (1 mL)

Solution, ophthalmic, as hydrobromide: 0.25% (5 mL, 15 mL)

Tablet: 0.4 mg

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