Nurses Compass
Drug Guide
Scopolamine
Classification
Therapeutic: Antiemetic, Anticholinergic
Pharmacological: Muscarinic receptor antagonist
FDA Approved Indications
- Prevention of nausea and vomiting associated with motion sickness and recovery from anesthesia and surgery
Mechanism of Action
Scopolamine blocks muscarinic receptors in the central and peripheral nervous system, reducing cholinergic transmission, which decreases nausea and vomiting signals in the brain.
Dosage and Administration
Adult: Apply one patch behind the ear 4 hours before travel, then replace every 72 hours as needed.
Pediatric: Use is not typically recommended for children under 2 years due to safety concerns. Dosing for older children should be individualized based on medical advice.
Geriatric: Use with caution due to increased risk of anticholinergic side effects in older adults.
Renal Impairment: Adjustments are not specifically established; use cautiously.
Hepatic Impairment: Use with caution; hepatic metabolism may be prolonged.
Pharmacokinetics
Absorption: Rapid absorption through intact skin from the transdermal patch.
Distribution: Widely distributed; crosses the blood-brain barrier.
Metabolism: Metabolized in the liver.
Excretion: Excreted primarily in urine.
Half Life: Approximately 9-12 hours.
Contraindications
- Known hypersensitivity to scopolamine or other belladonna alkaloids.
- Occlusive skin conditions at the application site.
Precautions
- Use cautiously in patients with glaucoma, urinary retention, obstructive gastrointestinal disease, or myasthenia gravis. Watch for anticholinergic toxicity.
Adverse Reactions - Common
- Dry mouth (Common)
- Drowsiness or sedation (Common)
- Dizziness or blurred vision (Common)
Adverse Reactions - Serious
- Psychosis or hallucinations in overdose (Rare)
- Arrhythmias or tachycardia (Rare)
- Urinary retention, bowel obstruction (Rare)
Drug-Drug Interactions
- Other anticholinergic drugs (e.g., antihistamines, tricyclic antidepressants)
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Monitor for signs of anticholinergic toxicity, skin reactions at application site, and efficacy in preventing nausea.
Diagnoses:
- Risk for falls due to dizziness or sedation.
- Risk for dry mouth.
- Risk for urinary retention.
Implementation: Apply patch behind the ear at the specified times, ensure skin is clean and dry before application.
Evaluation: Assess for reduction in nausea and side effects; inspect application site regularly.
Patient/Family Teaching
- Instruct patient on how to properly apply and rotate the patch.
- Warn about possible side effects like dry mouth, drowsiness, blurred vision.
- Advise avoiding alcohol and other CNS depressants.
- Educate on recognizing signs of anticholinergic toxicity.
Special Considerations
Black Box Warnings:
- None specified for scopolamine.
Genetic Factors: No known genetic factors affecting use.
Lab Test Interference: None reported.
Overdose Management
Signs/Symptoms: Drowsiness, hallucinations, ataxia, dry mouth, urinary retention, tachycardia.
Treatment: Supportive care, activated charcoal if ingestion is recent, physostigmine (an anticholinesterase) as antidote under specialist supervision.
Storage and Handling
Storage: Store at room temperature, away from heat and light.
Stability: Stable for use until expiration date on the package.