scopolamine (Rx)

Brand and Other Names:Transderm Scop, Scopace, more...Maldemar
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Dosing & Uses

AdultPediatric

Dosage Forms & 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

Safety & efficacy not established

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Interactions

Interaction Checker

and scopolamine

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              Serious - Use Alternative (7)

              • glucagon

                glucagon increases toxicity of scopolamine by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of anticholinergic drugs and glucagon increase the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. .

              • glucagon intranasal

                glucagon intranasal increases toxicity of scopolamine by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of anticholinergic drugs and glucagon increase the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. .

              • macimorelin

                scopolamine, macimorelin. unspecified interaction mechanism. Avoid or Use Alternate Drug. Drugs that may blunt the growth hormone (GH) response to macrimorelin may impact the accuracy of the diagnostic test. Allow sufficient washout time of drugs affecting GH release before administering macimorelin.

              • metoclopramide intranasal

                scopolamine, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

              • pramlintide

                pramlintide, scopolamine. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

              • secretin

                scopolamine decreases effects of secretin by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Concomitant use of anticholinergic drugs may cause a hyporesponse to stimulation testing with secretin. Discontinue anticholinergic drugs at least 5 half-lives before administering secretin.

              • umeclidinium bromide/vilanterol inhaled

                scopolamine, umeclidinium bromide/vilanterol inhaled. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Concomitant use with other anticholinergic-containing drugs may lead to additive anticholinergic adverse effects.

              Monitor Closely (100)

              • abobotulinumtoxinA

                abobotulinumtoxinA increases effects of scopolamine by pharmacodynamic synergism. Use Caution/Monitor. Use of anticholinergic drugs after administration of botulinum toxin-containing products may potentiate systemic anticholinergic effects.

              • aclidinium

                scopolamine and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • amantadine

                scopolamine, amantadine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Potential for increased anticholinergic adverse effects.

              • amitriptyline

                scopolamine and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • amoxapine

                scopolamine and amoxapine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • anticholinergic/sedative combos

                anticholinergic/sedative combos and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • aripiprazole

                scopolamine decreases levels of aripiprazole by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                scopolamine decreases levels of aripiprazole by pharmacodynamic antagonism. Use Caution/Monitor.

                aripiprazole increases effects of scopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • atracurium

                atracurium and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • atropine

                atropine and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • atropine IV/IM

                atropine IV/IM and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • belladonna alkaloids

                belladonna alkaloids and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • belladonna and opium

                belladonna and opium and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • benperidol

                scopolamine decreases levels of benperidol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                scopolamine decreases levels of benperidol by pharmacodynamic antagonism. Use Caution/Monitor.

                benperidol increases effects of scopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • benztropine

                benztropine and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor. Additive anticholinergic adverse effects may be seen with concurrent use.

              • bethanechol

                bethanechol increases and scopolamine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • brexanolone

                brexanolone, scopolamine. Either increases toxicity of the other by sedation. Use Caution/Monitor.

              • carbachol

                carbachol increases and scopolamine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • cenobamate

                cenobamate, scopolamine. Either increases effects of the other by sedation. Use Caution/Monitor.

              • cevimeline

                cevimeline increases and scopolamine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • chlorpromazine

                scopolamine decreases levels of chlorpromazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                scopolamine decreases levels of chlorpromazine by pharmacodynamic antagonism. Use Caution/Monitor.

                chlorpromazine increases effects of scopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • cisatracurium

                cisatracurium and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • clomipramine

                scopolamine and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • clozapine

                scopolamine decreases levels of clozapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                scopolamine decreases levels of clozapine by pharmacodynamic antagonism. Use Caution/Monitor.

                clozapine increases effects of scopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • cyclizine

                cyclizine and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • cyclobenzaprine

                cyclobenzaprine and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • darifenacin

                darifenacin and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • desipramine

                scopolamine and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • dicyclomine

                dicyclomine and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • diphenhydramine

                diphenhydramine and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • donepezil

                donepezil increases and scopolamine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dosulepin

                scopolamine and dosulepin both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • doxepin

                scopolamine and doxepin both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • droperidol

                scopolamine decreases levels of droperidol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                scopolamine decreases levels of droperidol by pharmacodynamic antagonism. Use Caution/Monitor.

                droperidol increases effects of scopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • echothiophate iodide

                echothiophate iodide increases and scopolamine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • esketamine intranasal

                esketamine intranasal, scopolamine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

              • fesoterodine

                fesoterodine and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • flavoxate

                flavoxate and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • fluphenazine

                scopolamine decreases levels of fluphenazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                scopolamine decreases levels of fluphenazine by pharmacodynamic antagonism. Use Caution/Monitor.

                fluphenazine increases effects of scopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • galantamine

                galantamine increases and scopolamine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • glycopyrrolate

                glycopyrrolate and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • glycopyrrolate inhaled

                glycopyrrolate inhaled and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • haloperidol

                scopolamine decreases levels of haloperidol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                scopolamine decreases levels of haloperidol by pharmacodynamic antagonism. Use Caution/Monitor.

                haloperidol increases effects of scopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • henbane

                henbane and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • homatropine

                homatropine and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • huperzine A

                huperzine A increases and scopolamine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • hyoscyamine

                hyoscyamine and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • hyoscyamine spray

                hyoscyamine spray and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • iloperidone

                scopolamine decreases levels of iloperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                scopolamine decreases levels of iloperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                iloperidone increases effects of scopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • imipramine

                scopolamine and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • ipratropium

                ipratropium and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              • lasmiditan

                lasmiditan, scopolamine. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

              • lemborexant

                lemborexant will increase the level or effect of scopolamine by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

              • lofepramine

                scopolamine and lofepramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • loxapine

                scopolamine decreases levels of loxapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                scopolamine decreases levels of loxapine by pharmacodynamic antagonism. Use Caution/Monitor.

                loxapine increases effects of scopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • loxapine inhaled

                loxapine inhaled increases effects of scopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

                scopolamine decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor.

              • lurasidone

                lurasidone, scopolamine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

              • maprotiline

                scopolamine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • meclizine

                meclizine and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • methscopolamine

                methscopolamine and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • midazolam intranasal

                midazolam intranasal, scopolamine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

              • neostigmine

                neostigmine increases and scopolamine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • nortriptyline

                scopolamine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • olanzapine

                scopolamine decreases levels of olanzapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                scopolamine decreases levels of olanzapine by pharmacodynamic antagonism. Use Caution/Monitor.

                olanzapine increases effects of scopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • onabotulinumtoxinA

                onabotulinumtoxinA and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • orphenadrine

                scopolamine and orphenadrine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • oxybutynin

                oxybutynin and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • oxybutynin topical

                oxybutynin topical and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • oxybutynin transdermal

                oxybutynin transdermal and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • paliperidone

                scopolamine decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                scopolamine decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                paliperidone increases effects of scopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • pancuronium

                pancuronium and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • perphenazine

                scopolamine decreases levels of perphenazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                scopolamine decreases levels of perphenazine by pharmacodynamic antagonism. Use Caution/Monitor.

                perphenazine increases effects of scopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • physostigmine

                physostigmine increases and scopolamine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • pilocarpine

                pilocarpine increases and scopolamine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • pimozide

                scopolamine decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                scopolamine decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.

                pimozide increases effects of scopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • pralidoxime

                pralidoxime and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • prochlorperazine

                scopolamine decreases levels of prochlorperazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                scopolamine decreases levels of prochlorperazine by pharmacodynamic antagonism. Use Caution/Monitor.

                prochlorperazine increases effects of scopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • promethazine

                scopolamine decreases levels of promethazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                scopolamine decreases levels of promethazine by pharmacodynamic antagonism. Use Caution/Monitor.

                promethazine increases effects of scopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • propantheline

                propantheline and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • protriptyline

                scopolamine and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • pyridostigmine

                pyridostigmine increases and scopolamine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • quetiapine

                scopolamine decreases levels of quetiapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                scopolamine decreases levels of quetiapine by pharmacodynamic antagonism. Use Caution/Monitor.

                quetiapine increases effects of scopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • rapacuronium

                rapacuronium and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • risperidone

                scopolamine decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                scopolamine decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                risperidone increases effects of scopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • rocuronium

                rocuronium and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • solifenacin

                scopolamine and solifenacin both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • stiripentol

                stiripentol, scopolamine. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

              • succinylcholine

                succinylcholine increases and scopolamine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • thioridazine

                scopolamine decreases levels of thioridazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                scopolamine decreases levels of thioridazine by pharmacodynamic antagonism. Use Caution/Monitor.

                thioridazine increases effects of scopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • thiothixene

                scopolamine decreases levels of thiothixene by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                scopolamine decreases levels of thiothixene by pharmacodynamic antagonism. Use Caution/Monitor.

                thiothixene increases effects of scopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • tiotropium

                scopolamine and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • tolterodine

                scopolamine and tolterodine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • trazodone

                scopolamine and trazodone both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • trifluoperazine

                scopolamine decreases levels of trifluoperazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                scopolamine decreases levels of trifluoperazine by pharmacodynamic antagonism. Use Caution/Monitor.

                trifluoperazine increases effects of scopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • trihexyphenidyl

                scopolamine and trihexyphenidyl both decrease cholinergic effects/transmission. Use Caution/Monitor. Potential for additive anticholinergic effects.

              • trimipramine

                scopolamine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • trospium chloride

                scopolamine and trospium chloride both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • umeclidinium bromide

                umeclidinium bromide and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor. If possible, avoid coadministration of additional anticholinergic agents

              • vecuronium

                scopolamine and vecuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • ziprasidone

                scopolamine decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                scopolamine decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.

                ziprasidone increases effects of scopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • zotepine

                scopolamine decreases levels of zotepine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                scopolamine decreases levels of zotepine by pharmacodynamic antagonism. Use Caution/Monitor.

              Minor (4)

              • dimenhydrinate

                dimenhydrinate increases toxicity of scopolamine by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

              • donepezil

                donepezil decreases effects of scopolamine by pharmacodynamic antagonism. Minor/Significance Unknown.

              • galantamine

                galantamine decreases effects of scopolamine by pharmacodynamic antagonism. Minor/Significance Unknown.

              • levodopa

                scopolamine, levodopa. Other (see comment). Minor/Significance Unknown. Comment: Anticholinergic agents may enhance the therapeutic effects of levodopa; however, anticholinergic agents can exacerbate tardive dyskinesia. In high dosage, anticholinergics may decrease the effects of levodopa by delaying its GI absorption. .

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              Adverse 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

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              Warnings

              Contraindications

              Hypersensitivity to scopolamine, belladonna alkaloids, or any component in formulation

              Closed-angle glaucoma

              Cautions

              Use caution in patients with 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

              Avoid use in patients with severe preeclampsia

              May cause CNS depression; caution when operating heavy machinery or tasks which require mental alertness

              May cause psychiatric and cognitive effects, seizures and impair mental and/or physical abilities; monitor patients for new or worsening psychiatric symptoms during treatment and during concomitant treatment with other drugs that are associated with similar psychiatric effects

              Monitor for increased intraocular pressure in patients with open-angle glaucoma and adjust glaucoma therapy as needed; discontinue if signs or symptoms of acute angle closure glaucoma develop or if patient experiences unusual visual disturbances or pain within the eye

              Avoid contact with 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

              Consider more frequent monitoring during treatment in patients suspected of having intestinal obstruction; patients with pyloric obstruction, urinary bladder neck obstruction or receiving other anticholinergic drugs; discontinue if patient develops difficulty in urination

              Anticholinergic symptoms may occur 24 hours or more after removal of transdermal system

              Drug interferes with gastric secretion test

              Remove transdermal system prior to MRI scan

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              Pregnancy & Lactation

              Pregnancy

              Data from observational studies and postmarketing reports have not identified a drug associated risk of major birth defects, miscarriage, or adverse fetal outcomes; avoid use of in pregnant women with severe preeclampsia because eclamptic seizures have been reported after exposure to scopolamine

              Animal data

              • In animal studies, showed no evidence of adverse developmental effects with intravenous administration in rats; embryotoxicity was observed in rabbits at intravenous doses producing plasma levels approximately 100 times the levels achieved in humans using transdermal system

              Lactation

              Drug is present in human milk; there are no available data on effects of scopolamine on breastfed infant or effects on milk production; because there have been no consistent reports of adverse events in breastfed infants over decades of use, developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed child from treatment or from underlying maternal condition

              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.

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              Pharmacology

              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)

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              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

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              Images

              No images available for this drug.
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              Patient Handout

              A Patient Handout is not currently available for this monograph.
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              Formulary

              FormularyPatient Discounts

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              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.