Scopolamine (Patch)

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Contents

[edit] BRAND NAMES

[edit] STRUCTURE

Scopolamine.jpg

[edit] MECHANISM OF ACTION

Transdermal scopolamine system is a circular flat patch designed for continuous release of scopolamine following application to an area of intact skin on the head, behind the ear.

In some people, motion of ships, airplanes, trains, automobiles, and buses increases activity of the nerve fibers of the inner ear, which are part of the body's balance mechanism. The result is motion sickness, which is characterized by dizziness, nausea, and vomiting.

Scopolamine is structurally similar to the neurotransmitter acetylcholine and acts by blocking the muscarinic acetylcholine receptors; it is thus classified as an anticholinergic. It has been suggested that scopolamine acts in the central nervous system (CNS) by blocking cholinergic transmission from the vestibular nuclei to higher centers in the CNS and from the reticular formation to the vomiting center, making it an effective anti-motion sickness drug, when used prophylactically.

Scopolamine can inhibit also the secretion of saliva and sweat, decrease gastrointestinal secretions and motility, cause drowsiness, dilate the pupils, increase heart rate, and depress motor function

[edit] INDICATIONS

  • Prevention of nausea and vomiting associated with motion sickness and recovery from anesthesia and surgery (post-operative nausea and vomiting).

[edit] DOSAGE

To prevent the nausea and vomiting associated with motion sickness, one Scopolamine Patch should be applied to the hairless area behind one ear at least 4 hours before the antiemetic effect is required. The patch is programmed to deliver approximately 1.0 mg of scopolamine over 3 days. if therapy is required for longer than 3 days, the first patch should be removed and a fresh one placed on the hairless area behind the other ear.

To prevent post operative nausea and vomiting, the patch should be applied the evening before scheduled surgery. To minimize exposure of the newborn baby to the drug, apply the patch one hour prior to cesarean section. The patch should be kept in place for 24 hours following surgery at which time it should be removed.

Only one patch should be worn at any time. Do not cut the patch.

[edit] CONTRAINDICATIONS

  • Persons who are hypersensitive to scopolamine
  • Patients with angle-closure (narrow angle) glaucoma

[edit] WARNINGS AND PRECAUTIONS

  • Glaucoma: scopolamine may cause an increase in intraocular pressure. Contact a physician in the unlikely event that they experience symptoms of acute narrow-angle glaucoma (pain and reddening of the eyes, accompanied by dilated pupils).
  • Scopolamine (Patch) should not be used in children and should be used with caution in the elderly or in individuals with impaired liver or kidney functions because of the increased likelihood of CNS effects
  • Effects on ability to drive and use machines: Since drowsiness, disorientation, and confusion may occur with the use of scopolamine, patients should be warned of the possibility and cautioned against engaging in activities that requiremmental alertness, such as driving a motor vehicle or operating dangerous machinery.
  • Rarely, idiosyncratic reactions (unusual individual reaction) may occur with ordinary therapeutic doses of scopolamine. The most serious of these that have been reported are: acute toxic psychosis, including confusion, agitation, rambling speech, hallucinations, paranoid behaviors, and delusions.
  • Prostatic enlargement: Scopolamine (Patch) should be used with caution in patients with prostatic enlargement, as it may precipitate or aggravate urinary retention.
  • Caution should be exercised in patients with a history of seizures or psychosis, since scopolamine can potentially aggravate both disorders

[edit] INTERACTIONS

  • The absorption of oral medications may be decreased during the concurrent use of scopolamine because of decreased gastric motility and delayed gastric emptying.
  • Scopolamine should be used with care in patients taking other drugs that are capable of causing CNS effects such as sedatives, tranquilizers, or alcohol.
  • Special attention should be paid to potential interactions with drugs having anticholinergic properties; e.g.: Tricyclic antidepressants (Amitriptyline, Imipramine, Nortriptyline), Tetracyclic antidepressants (Mirtazapine, Mianserin), Antipsychotics, Antihistamines, Anticholinergics (e.g. tiotropium, ipratropium, atropine-like compounds)

[edit] PREGNANCY AND LACTATION

  • Pregnancy Category C (US). Scopolamine (Patch) should be used in pregnancy only if the potential benefit justifies the potential risk to the fetus.
  • Nursing Mothers: Because scopolamine is excreted in human milk, caution should be exercised whenScopolamine (Patch) is administered to a nursing woman

[edit] SIDE EFFECTS

Some side effects are very common (may affect more than 1 in 10 people)

  • dryness of the mouth
  • drowsiness, dizziness
  • blurring of (near) vision and enlargement of the pupils (sometimes in one eye only)
  • loss of ability to focus on close or far objects (visual accommodation)

Some side effects are common (may affect between 1 and 10 in every 100 people)

  • irritation of the eyelids
  • skin irritation

Some side effects are rare (may affect between 1 and 10 in every 10,000 people)

  • difficulty in urinating
  • impairment of memory or concentration, restlessness, disorientation, confusion, or hallucinations
  • slight decrease in blood pressure

Some side effects are very rare (may affect less than 1 in every 10,000 people)

  • skin rash

[edit] RELATED LINKS

[edit] BIBLIOGRAPHY

[edit] REFERENCES

Antiemetics
5-HT3 receptor antagonists Dolasetron   Granisetron   Ondansetron   Palonosetron   Tropisetron
Dopamine antagonists Alizapride   Bromopride   Clebopride   Domperidone   Metoclopramide   Prochlorperazine   Thiethylperazine
H1 antagonists Dimenhydrinate   Meclizine
NK1 receptor antagonists‎ Aprepitant   Fosaprepitant   Maropitant
Motion sickness‎ Cinnarizine   Dimenhydrinate   Meclizine   Meclizine/Pyridoxine   Scopolamine (Patch)
Pregnancy Meclizine/Pyridoxine   Ondansetron
Veterinary Maropitant