scopolamine (Rx)

Brand and Other Names:Transderm Scop, Scopace, more...Maldemar
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Dosing & Uses


Dosage Forms & Strengths

transdermal patch

  • 1mg/72hr

Nausea & Vomiting


0.3-0.65 mg IV/IM/SC; repeat q6-8hr if necessary

Motion Sickness


Apply 1 patch behind ear at least 4-12 hours (preferably 12 hr) before anticipated exposure to motion, then every 3 days PRN

Nausea & Vomiting Associated With Anesthesia


Transdermal patch

  • Apply 1 patch behind ear on night before scheduled surgery, then leave on for 24 hours after surgery
  • Cesarian section: Apply 1 patch behind ear 1 hour before surgery (to minimize newborn exposure, apply no sooner); remove 24 hours after surgery

Chemotherapy Induced Nausea and Vomiting (Off-label)

Apply 1 patch q72hr

Safety & efficacy not established



Interaction Checker

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            Adverse Effects


            Dry mouth (29-67%)

            Drowsiness (17%)

            Dizziness (12%)

            Blurred vision

            Frequency Not Defined



            Pruritus and edema at application site

            Anticholinergic effects

            Dilation of pupil if drug contacts eye

            Withdrawal symptoms (eg, dizziness, nausea and vomiting) if used for >3 days




            Hypersensitivity to scopolamine, belladonna alkaloids, or any component in formulation

            Closed-angle glaucoma


            Use caution in patients with benign prostatic hyperplasia, history of seizures or psychosis, ulcerative colitis, hypertension, hyperthyroidism, Down syndrome, toxin-mediated diarrhea, coronary artery disease, tachyarrhythmia, brain damage or spastic paralysis in children, cardiac conduction disorder, CHF

            Children and elderly persons are particularly susceptible to side effects of belladonna alkaloids

            Anaphylaxis, including episodes of shock reported, following parenteral administration; monitor for signs and symptoms of hypersensitivity reactions

            Lower doses may increase vagal tone and cause paradoxical bradycardia

            Avoid use in patients with severe preeclampsia

            May cause CNS depression; caution when operating heavy machinery or tasks which require mental alertness

            May cause psychiatric and cognitive effects, seizures and impair mental and/or physical abilities; monitor patients for new or worsening psychiatric symptoms during treatment and during concomitant treatment with other drugs that are associated with similar psychiatric effects

            Monitor for increased intraocular pressure in patients with open-angle glaucoma and adjust glaucoma therapy as needed; discontinue if signs or symptoms of acute angle closure glaucoma develop or if patient experiences unusual visual disturbances or pain within the eye

            Avoid contact with eye

            In patients with Parkinson disease, or abrupt discontinuation of large doses may result in adverse effects, including headache, nausea, vomiting, and dizziness; withdrawal symptoms may also appear more than 24 hr after removing transdermal patch

            Consider more frequent monitoring during treatment in patients suspected of having intestinal obstruction; patients with pyloric obstruction, urinary bladder neck obstruction or receiving other anticholinergic drugs; discontinue if patient develops difficulty in urination

            Anticholinergic symptoms may occur 24 hours or more after removal of transdermal system

            Drug interferes with gastric secretion test

            Remove transdermal system prior to MRI scan


            Pregnancy & Lactation


            Data from observational studies and postmarketing reports have not identified a drug associated risk of major birth defects, miscarriage, or adverse fetal outcomes; avoid use of in pregnant women with severe preeclampsia because eclamptic seizures have been reported after exposure to scopolamine

            Animal data

            • In animal studies, showed no evidence of adverse developmental effects with intravenous administration in rats; embryotoxicity was observed in rabbits at intravenous doses producing plasma levels approximately 100 times the levels achieved in humans using transdermal system


            Drug is present in human milk; there are no available data on effects of scopolamine on breastfed infant or effects on milk production; because there have been no consistent reports of adverse events in breastfed infants over decades of use, developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed child from treatment or from underlying maternal condition

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.



            Mechanism of Action

            Anticholinergic belladonna alkaloid

            Generally exhibits pharmacologic actions associated with other antimuscarinics

            May prevent motion-induced nausea and vomiting by blocking transmission of cholinergic impulse from vestibular nuclei to higher centers in CNS and from reticular formation to vomiting center


            Onset: IM, 0.5-1 hr; IV, 10 min

            Duration: IM, 4-6 hr; IV, 2 hr

            Peak plasma time: 24 hr (transdermal)


            Metabolized by liver (via conjugation)


            Half-life: 9.5 hr

            Excretion: Primarily urine (90% as metabolites)



            IV Incompatibilities

            Alkalies, methohexital

            IV Compatibilities

            Additive: Floxacillin, furosemide, meperidine, succinylcholine

            Syringe: Atropine, butorphanol, chlorpromazine, cimetidine, diamorphine, dimenhydrinate, diphenhydramine, droperidol, fentanyl, glycopyrrolate, hydromorphone, hydroxyzine, meperidine, metoclopramide, midazolam, morphine hydrochloride, morphine sulfate, nalbuphine, papaveretum, pentazocine, pentobarbital, perphenazine, prochlorperazine, promazine, promethazine, ranitidine, sufentanil, thiopental

            Y-site: Fentanyl, heparin, hydrocortisone, hydromorphone, methadone, morphine, potassium chloride, propofol, sufentanil, vitamins B and C

            IV Preparation

            Dilute with sterile water for injection

            IV/IM Administration

            Prevention of nausea and vomiting associated with anesthesia: Inject IV/IM/SC 30-60 minutes before anticipated induction of anesthesia

            Prevention of motion sickness: Inject IM 1 hour before anticipated exposure to motion


            Store at room temperature; protect from light





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            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
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            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
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            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
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