Scopolamine Hydrobromide

Administration

Administer orally or by IM, direct IV, or sub-Q injection; also may administer percutaneously by topical application of a transdermal system (Transderm Scop).a

When administered orally or IM for the prevention of motion sickness, generally administer 1 hour (range: 0.5–1.5 hours) before anticipated exposure to motion.a

When used preoperatively, administer 30–60 minutes prior to the anticipated time of induction of anesthesia or at the same time other preanesthetic medications (e.g., opiates, sedatives) are administered, since scopolamine may cause behavioral changes in patients with pain or anxiety.a (See CNS Effects under Cautions.)

Transdermal Administration

To prevent motion sickness, apply at least 4 hours (e.g., 4–24 hours) before anticipated exposure to motion.a

To prevent postoperative nausea and vomiting, apply the evening before scheduled surgery.a b

For use in cesarean section, apply 1 hour prior to surgery to minimize exposure of the fetus to the drug.a b

Transdermal system should not be cut; only one transdermal system should be worn at any time.a

Prior to administration, wipe area behind the ear with a clean, dry tissue to ensure it is dry.a

To expose adhesive surface, peel and discard the clear plastic protective strip prior to administration; avoid finger contact with exposed adhesive layer to prevent contamination of the fingers with scopolamine.a

Apply to dry, hairless area of skin behind the ear (postauricular) by firmly pressing the system with the adhesive side touching the skin.a

If the system becomes dislodged during the intended period of use (up to 72 hours), remove it and replace with another system at a different postauricular site.a

Generally not affected by limited exposure to water (e.g., during bathing or swimming).a

Dosage

Tablets and injection: Available as scopolamine hydrobromide; dosage expressed in terms of the salt.

Pediatric Patients

Children 6 month to 3 years of age: 0.1–0.15 mge

Children 3–6 years of age: 0.2–0.3 mge

Usually 0.006 mg/kg (6 mcg/kg).e

Usually 0.006 mg/kg (6 mcg/kg).e

Adults

0.4–0.8 mg.119

0.32–0.65 mg; may be repeated 3 or 4 times daily if necessary.a

Initially, 0.25–0.8 mg 1 hour before exposure to motion; subsequently, 0.25–0.8 mg 3 times daily as needed and tolerated.120

Usually 0.32–0.65 mg; may be repeated 3 or 4 times daily if necessary.a

Alternatively, 0.2–1 mg.a

Usually, one scopolamine system applied ≥4 hours prior to anticipated exposure to motion.a

May use for up to 72 hours if necessary or may remove during the 72-hour period when an antiemetic effect is no longer required.a

When necessary to continue beyond 72 hours, remove the initially applied system and place another system behind the ear at a different site.a

Apply one transdermal system the evening before scheduled surgery.a b

For cesarean section, apply 1 hour prior to surgery to minimize exposure of the infant to the drug.a b

Allow patch to remain in place for 24 hours following surgery, then remove and discard.a b

Usually 0.32–0.65 mg.a

Usually 0.32–0.65 mg.a Alternatively, 0.2–0.6 mg has been suggested.a

Usually 0.32–0.65 mg.a

Usually 0.6 mg.a

Orally Administered Drugs

Potential pharmacokinetic interaction (altered GI absorption of various drugs): Antimuscarinics may inhibit GI motility, delay gastric emptying, and prolong GI transit time.a d

Specific Drugs

Storage

Oral

15–30°C.119

Parenteral

15–30°C; protect from light.e

Topical

20–25°C.a b

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

Drug Compatibility

Scopolamine is readily racemized in the presence of dilute alkali.a Scopolamine hydrobromide solutions are incompatible with alkalies.a

Consult specialized references for specific compatibility information since the compatibility of admixtures with scopolamine hydrobromide injection depends on several factors (e.g., concentration of the drugs, resulting pH, temperature).a

A haze may form within 1 hour when scopolamine hydrobromide injection is mixed with methohexital sodium solutions.a

• Competitively inhibits acetylcholine or other cholinergic stimuli at autonomic effectors innervated by postganglionic cholinergic nerves and, to a lesser extent, on smooth muscles that lack cholinergic innervation.d

• At usual doses, principally antagonizes cholinergic stimuli at muscarinic receptors and has little or no effect on cholinergic stimuli at nicotinic receptors.d

• Generally more potent than atropine in its antimuscarinic action on the iris, ciliary body, and certain secretory (salivary, bronchial, sweat) glands, and less potent than atropine in its antimuscarinic action on the heart and on bronchial and intestinal smooth muscle.a

• Apparently corrects some central imbalance of acetylcholine and norepinephrine that may occur in patients with motion sickness.a Antimuscarinics may block the transmission of cholinergic impulses from the vestibular nuclei to higher centers in the CNS and from the reticular formation to the vomiting center; these effects result in prevention of motion-induced nausea and vomiting.a

• Antimuscarinics also have been referred to as anticholinergics (cholinergic blocking agents), but this term is appropriate only when it describes the antagonism of cholinergic stimuli at any cholinergic receptor, whether muscarinic or nicotinic.d

• Also have been referred to as parasympatholytics since the antagonized functions principally are under the parasympathetic division of the nervous system.d

• Receptors at various sites are not equally sensitive to inhibitory effects of antimuscarinics, and degree of inhibition at each site is dose dependent.d Relative sensitivity of physiologic functions (proceeding from the most sensitive) is as follows: secretions of the salivary, bronchial, and sweat glands; pupillary dilation, ocular accommodation, and heart rate; contraction of the detrusor muscle of the bladder and smooth muscle of the GI tract; and gastric secretion and motility.d Doses used to decrease gastric secretions are likely to cause dryness of the mouth (xerostomia) and interfere with visual accommodation, and possibly cause difficulty in urinating.d

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name