Scopolamine

TRANSDERM SCOP

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What it isAntimuscarinic; motion sickness and secretion control.

Why this oneThe patch gives 72 hours of prophylaxis, which no oral agent matches.

What limits itIt crosses into the CNS, causing confusion in the elderly. Anisocoria from hand-to-eye transfer is a classic false alarm; wash hands after applying.

FDA-approved for

motion sickness (1979)

Off-label

excessive secretions
depression (investigational)

FDA label

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FDA dosing	Population	Start	Target	Max
Motion sickness — prevention of nausea/vomiting	adult	1 transdermal system (1 mg/3 days) behind ear ≥4 h before needed	1 system worn up to 3 days; if longer needed, replace with new system behind other ear	1 system at a time
Postoperative nausea and vomiting (PONV; non-cesarean surgery)	adult	1 transdermal system the evening before surgery	Remove 24 h after surgery	1 system at a time

Renal Consider more frequent monitoring (increased risk of CNS adverse reactions)

Hepatic Consider more frequent monitoring (increased risk of CNS adverse reactions)

Delivers ~1 mg scopolamine over 3 days; apply ≥4 h before antiemetic effect is needed

Instructions

Apply to dry, hairless skin behind one ear; wear only one system at a time; do not cut
Wash hands thoroughly after applying or removing; wash application site after removal
Avoid touching/pressing the applied system (drug can ooze at edge); if displaced, replace with new system behind the other ear
Fold used system sticky-sides together and discard away from children/pets
Remove before MRI (skin burn risk)

Contraindications

Angle-closure glaucoma
Hypersensitivity to scopolamine or other belladonna alkaloids

Cautions

Acute angle-closure glaucoma from mydriatic effect
Neuropsychiatric adverse reactions (disorientation, hallucinations, acute psychosis); increased risk in elderly, renal/hepatic impairment, and with anticholinergics/CNS drugs
Eclamptic seizures — avoid in severe preeclampsia
GI and urinary disorders — worsens pyloric/intestinal obstruction and urinary retention
Hyperthermia (serious cases reported)
Withdrawal/post-removal symptoms (dizziness, nausea, vomiting, headache) 24 h or more after removal
Temporary blurred vision/mydriasis, esp. after touching system then eye
Remove before MRI — skin burns

Adverse reactions

Dry mouth
Drowsiness/somnolence
Blurred vision
Mydriasis
Dizziness
Agitation
Confusion
Pharyngitis

Pregnancy Avoid in severe preeclampsia (eclamptic seizures reported after parenteral scopolamine); observational data show no drug-associated risk of major birth defects/miscarriage

Lactation Present in human milk; no data on infant effects or milk production; weigh benefits

NO BOXED WARNINGS

Principal riskCNS confusion in the elderly; anisocoria from hand transfer

Cost, est. cash$10–$400/month

Generic entry2015

Classes and tags

Clinical profile

Therapeutic safety burden1 / 4

Overdose danger1 / 4

Weight-gain liability0 / 4

Sedation liability2 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism4 / 4

Embryofetal risk1 / 4

Legacy pregnancy categoryC

Defining liabilityGenerally tolerated at therapeutic doses; clinically important risks are agent-specific and increase with interactions or organ impairment.