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scopolamine (Transderm Scop, Hyoscine)

Tradenames: Transderm Scop, Hyoscine. Indications: 1) injection 1) adjunct to general anesthesia - pre-anesthetic sedation in conjunction with analgesics 2) salivation - inhibition of salivation & excessive respiratory secretion prior to surgery - sialorrhea 3) prevention of cholinergic effects during surgery - cardiac arrhythmias - hypotension - bradycardia 2) Transderm Scop: - prevention of motion sickness 3) ophthalmic: - mydriasis & cycloplegia - acute inflammatory conditions of the iris & uveal tract - posterior synechiae 4) irritable bowel syndrome [4] Contraindications: narrow-angle glaucoma Dosage: 1) Transderm Scop: a) one patch (1.5 mg) behind ear b) lasts up to 3 days c) box of 4 2) 0.32-0.65 mg SC/IM/IV (after dilution) TID-QID 3) ophthalmic: a) mydriasis & cycloplegia: 1-2 drops of 0.25% solution 1 hour before procedure b) iridocyclitis: 1-2 drops of 0.25% solution QD-TID Solution (ophthalmic): 0.25% (5 mL, 15 mL) Injection: (as hydrobromide) 0.4 mg/mL (1 mL) Pharmacokinetics: 1) injection - rapidly absorbed from GI tract, IM & SC injections - distribution is unknown; does cross the blood-brain barrier - metabolic & excetory fate is unknown, but thought to be completely metabolized by the liver & excreted in the urine 2) ophthalmic - maximal mydriasis in 15-30 minutes; effects may last for several days - maximal cycloplegia in 30-45 minutes; effects may last up to 7 days Adverse effects: 1) common (> 10%) a) constipation b) decreased sweating* c) dry nose, throat, or skin d) irritation at site of injection 2) less common (1-10%) - decreased flow of breast milk, difficulty swallowing, increased sensitivity to light 3) uncommon (< 1%) - rash, confusion, increased intraocular pain, orthostatic hypotension, bloating, difficulty urinating, blurred vision, drowsiness, headache, loss of memory, nausea/vomiting, weakness, tiredness, ventricular fibrillation, tachycardia, palpitations, ataxia 4) other a) drowsiness b) cycloplegia c) hallucinations 5) ophthalmic a) common (> 10%) - blurred vision, photophobia b) less common (1-10%) - local irritation, congestion, increased intraocular pressure c) uncommon (< 1%) - vascular congestion, edema, drowsiness, exudate, eczematoid dermatitis, follicular conjunctivitis * patch can increase body temperature & result in heat injury Drug interactions: - incompatible with alkali solutions Mechanism of action: 1) more potent anti-muscarinic activity than atropine on the iris, ciliary body, salivary glands, sweat glands 2) less potent anti-muscarinic activity than atropine on the heart, bronchial smooth muscle & intestinal smooth muscle

Interactions

drug interactions drug adverse effects of parasympatholytics

Related

atropine/attapulgite/hyoscyamine/scopolamine (Donnagel) atropine/belladonna/hyoscyamine/phenobarbital/scopolamine (Donnatal)

General

anti-emetic belladonna alkaloid cycloplegic agent mydriatic agent parasympatholytic (anticholinergic, antimuscarinic agent)

Properties

KINGDOM: plant MISC-INFO: elimination route LIVER

Database Correlations

PUBCHEM correlations

References

  1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
  2. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
  3. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  4. Deprecated Reference
  5. Drug Safety Communication. June 18, 2024 FDA adds warning about serious risk of heat-related complications with antinausea patch Transderm Scop (scopolamine transdermal system). https://www.fda.gov/drugs/drug-safety-and-availability/fda-adds-warning-about-serious-risk-heat-related-complications-antinausea-patch-transderm-scop

Component-of

atropine/attapulgite/hyoscyamine/scopolamine (Donnagel) atropine/belladonna/hyoscyamine/phenobarbital/scopolamine (Donnatal) chlorpheniramine/hyoscyamine/phenylephrine/phenylpropanolamine/scopolamine chlorpheniramine/hyoscyamine/phenylephrine/scopolamine chlorpheniramine/hyoscyamine/pseudoephedrine/scopolamine chlorpheniramine/phenylephrine/scopolamine hyoscyamine/phenobarbital/scopolamine hyoscyamine/phenylephrine/pseudoephedrine/scopolamine hyoscyamine/scopolamine phenylephrine/scopolamine