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Uses

Motion Sickness

Prevention of motion-induced nausea and vomiting; considered most effective drug for this use.

Oral or IM administration usually reserved for patients exposed to short periods of intense motion or those highly susceptible to motion because these routes have short duration of effect and high incidence of adverse effects.

Transdermal administration is effective and has fewer adverse effects and increased duration compared with oral administration.

Postoperative Nausea and Vomiting

Used transdermally for prevention of nausea and vomiting associated with recovery from anesthesia and surgery, but efficacy is equivocal.

Surgery

Has been used preoperatively to inhibit salivation and excessive respiratory tract secretions, but use of general anesthetics (e.g., thiopental, halothane) that do not stimulate secretions has reduced the need for this use.

Used preoperatively and in obstetrics in conjunction with analgesics or sedatives to produce tranquilization and amnesia; however, benzodiazepines may be preferred.

Has greater sedative, antisecretory (e.g., on respiratory secretions), and antiemetic effects than atropine; however, less effective than atropine in preventing intraoperative cholinergic effects (e.g., cardiac arrhythmias, hypotension, bradycardia).

Parkinsonian Syndrome

Has been used for symptomatic treatment of parkinsonian syndrome; however, antimuscarinincs generally have been replaced with dopaminergic drugs.

Dosage and Administration

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^®).

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.

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. (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.

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

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

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

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

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.

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

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.

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

Dosage

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

Pediatric Patients

Usual Dosage

IM, IV, Sub-Q

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

Children 3–6 years of age: 0.2–0.3 mg

Motion Sickness

Sub-Q

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

Postoperative Nausea and Vomiting

Sub-Q

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

Adults

Usual Dosage

Oral

0.4–0.8 mg.

IM, IV, Sub-Q

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

Motion Sickness

Oral

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.

IM, IV, Sub-Q

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

Alternatively, 0.2–1 mg.

Transdermal

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

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.

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

Postoperative Nausea and Vomiting

Transdermal

Apply one transdermal system the evening before scheduled surgery.

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

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

Surgery

Obstetric Anmesia or Preoperative Sedation

IM, IV, Sub-Q

Usually 0.32–0.65 mg.

Inhibition of Salivation

IM, IV, Sub-Q

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

Amnestic Effect

IM, IV, Sub-Q

Usually 0.32–0.65 mg.

Sedative or Tranquilizing Effect

IM, IV, Sub-Q

Usually 0.6 mg.