Scopolamine (Isopto-Hyoscine, TransdermScop)

Category:

• Nervous system  

Description:

• Mydriatic, cycloplegic, antiemetic, antivertigo agent, anticholinergic

Indications:

• Systemic: reduction of secretions before surgery, calm delirium

• Transdermal: motion sickness, vertigo

• Ophth: uveitis, iritis, cycloplegia, mydriasis

Contraindications:

• Narrow-angle glaucoma, increased intraocular pressure, adhesions between iris and lens

• Unstable cardiovascular status, myasthenia gravis, GI or GU obstruction

Precautions:

• Pregnancy category C

• Children, elderly, prostatic hypertrophy, Down’s syndrome

• Debilitated COPD, asthma, CHF, hypertension, dysrhythmia, hiatal hernia

Adverse Reactions (Side Effects):

• CNS: anxiety, confusion, delirium, delusions, depression, dizziness, drowsiness, excitement, headache, flushing, hallucinations, incoherence, irritability, restlessness

• CV: palpitations, paradoxical bradycardia, postural hypotension, tachycardia

• EENT: blurred vision, difficulty swallowing, dilated pupils, photophobia

• GI: abdominal distress, constipation, dry mouth, paralytic ileus, nausea, vomiting

• GU: hesitancy, retention

• METAB: decreased sweating, fever

• MISC: nasal congestion, suppression of lactation, urticaria

Dosage:

Administered topically, intravenously, intramuscularly, subcutaneously

• Adult:            

  • Preoperatively: 

    • SC/IM/IV 0.32-0.65mg; dilute IV with sterile water; transderm 1.5mg

  • Uveitis or iritis: 

    • OPHTH 1-2 drops 3-4 times daily; 1-2 drops before refraction

  • Motion sickness: 

    • Place 1 patch behind ear 4-5 hours before travel, replace every 72 hours as needed

  • Nausea associated with analgesia and opiate anesthesia: 

    • Transderm 1.5mg every 72 hours

• Child:            

  • OPHTH: 1-2 drops twice daily for 2 days before refraction

  • Preoperatively: 

    • SC 0.006 mg/kg or 0.2 mg/meter square