Neurologic manifestations and scopolamine patch

Marina Riad ; Candice C. Authors Marina Riad 1 ; Candice C. Hithe 2. Scopolamine is a medication used to manage and treat postoperative nausea and vomiting PONV and motion sickness. It is in the anticholinergic class of drugs. This activity will highlight the indications, mechanism of action, adverse event profile, and other key factors e. Objectives: Identify the mechanism of action of scopolamine. Describe the potential adverse effects of scopolamine.

Explain the signs of scopolamine toxicity and its proper management. Review team strategies for improving care coordination and communication to advance scopolamine therapy and improve outcomes.

Access free multiple choice questions on this topic. FDA Labeled Indications [1] [2]. Scopolamine can be used as an off-label adjunct to treat certain conditions listed below due to its anticholinergic properties. Scopolamine derives from the plants of Datura stramonium Jimsonweed , Scopolia carniolica , and Hyoscyamus niger henbane. These plants produce toxic compounds called belladonna alkaloids as a protective mechanism. Peripherally this results in smooth muscle relaxation and reduced gland secretion.

Centrally, unlike atropine, scopolamine causes mostly sedation, but over-excitement and restlessness can occur at higher doses. The vomiting center of the brain is located in the medulla oblongata and contains a high amount of M1 muscarinic acetylcholine, H1 histamine, NK1, and 5-HT3 serotonin receptors. Thus, any agent that antagonizes these receptors will have antiemetic properties. Scopolamine exerts its action by primarily affecting the M1 receptor.

However, some research has reported H1 receptor activity. The most commonly used dose form of scopolamine in the United States is a transdermal patch. Each patch is a circular shape of about 2. Its design is in four layers for step-wise delivery of a priming dose of micrograms of scopolamine initially, followed by a steady 1.

Per package labeling, the recommendation is to apply scopolamine the night before surgery if used to prevent postoperative nausea and vomiting or four hours before exposure if used for motion sickness.

For cesarean sections, apply one hour before surgery to limit exposure to the baby. The manufacturer also recommends discontinuation of the patch 24 hours after surgery because there was no significant antiemetic effect of scopolamine for PONV between 24 and 48 hours.

For motion sickness, reapplication can be every 72 hours. Patch placement should be on the postauricular area the hairless area behind the ear. The stratum corneum, which acts as a significant barrier to percutaneous absorption, is the thinnest at this location.

Patients should not cut the scopolamine patch, as it will alter the delivery system, and blood levels become less controlled. There are two other scopolamine products available outside the USA: scopolamine hydrobromide and scopolamine butylbromide. Both are useable in parenteral, intramuscular, intravenous, and subcutaneous forms. The short duration of action, less predictable blood levels, and common side effects resulted in the exclusion of these products from U.

The most commonly reported side effects of scopolamine patch use are blurred vision, dilated pupils, and dry mouth. The vision disturbances are most often due to inadequate handwashing techniques after the application of the patch. These side effects are usually mild and quick to resolve after patch removal. If needed, the clinician can administer a reversal agent like physostigmine if a side effect persists.

The FDA currently lists two contraindications for scopolamine: allergy to belladonna alkaloids and angle-closure glaucoma. Patients with angle-closure glaucoma should not be prescribed scopolamine. Scopolamine causes mydriasis or pupillary dilation. A dilated iris prohibits proper drainage of fluid from the anterior chamber, creating a further increase in anterior chamber pressure and precipitating acute angle-closure glaucoma.

There are several conditions in which scopolamine use requires caution or its effects monitored more frequently. There are reports of scopolamine worsening psychosis. Reports also exist of acute toxic psychosis, agitation, speech disorder, hallucinations, paranoia, and delusions. Use caution in using scopolamine for patients with myasthenia gravis. It is also used to prevent nausea and vomiting caused by motion sickness.

Scopolamine belongs to the group of medicines called anticholinergics. It works on the central nervous system CNS to create a calming effect on the muscles in the stomach and bowels gut. There is a problem with information submitted for this request. Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID, plus expertise on managing health. Error Email field is required.

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