If you forget to wear or change a patch, put one on as soon as you can. If it is almost time to put on your next patch, wait until then to apply a new patch and skip the one you missed. Do not apply extra patches to make up for a missed dose. Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing. After removing a used patch, fold the patch in half with the sticky sides together. Make sure to dispose of it out of the reach of children and pets.
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It is also important information to carry with you in case of emergencies. Scopolamine Transdermal Patch pronounced as skoe pol' a meen. Why is this medication prescribed? How should this medicine be used? Other uses for this medicine What special precautions should I follow? What should I do if I forget a dose? What side effects can this medication cause? What should I know about storage and disposal of this medication? Brand names Other names. To apply the patch, follow these instructions: After washing the area behind the ear, wipe the area with a clean, dry tissue to ensure that the area is dry.
Avoid placing on areas of your skin that have cuts, pain, or tenderness. Remove the patch from its protective pouch. Peel off the clear plastic protective strip and discard it. Don't touch the exposed adhesive layer with your fingers.
Place the adhesive side against the skin. After you have placed the patch behind your ear, wash your hands thoroughly with soap and water. Do not cut the patch. Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient. Other uses for this medicine. What special precautions should I follow?
Before using scopolamine patches, tell your doctor and pharmacist if you are allergic to scopolamine, other belladonna alkaloids, any other medications, or any of the ingredients in scopolamine patches. Ask your doctor or pharmacist, check the package label, or check the Medication Guide for a list of the ingredients. Be sure to mention any of the following: antihistamines such as meclizine Antivert, Bonine, others ; medications for anxiety, irritable bowel disease, motion sickness, pain, Parkinson's disease, seizures or urinary problems; muscle relaxants; sedatives; sleeping pills; tranquilizers; or tricyclic antidepressants such as desipramine Norpramin , clomipramine Anafranil , imipramine Tofranil , and trimipramine Surmontil Many other medications may also interact with scopolamine patch, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list.
Your doctor will probably tell you not to use scopolamine patch. Scopolamine exerts its action by primarily affecting the M1 receptor. However, some research has reported H1 receptor activity. The most commonly used dose form of scopolamine in the United States is a transdermal patch. Each patch is a circular shape of about 2. Its design is in four layers for step-wise delivery of a priming dose of micrograms of scopolamine initially, followed by a steady 1.
Per package labeling, the recommendation is to apply scopolamine the night before surgery if used to prevent postoperative nausea and vomiting or four hours before exposure if used for motion sickness. For cesarean sections, apply one hour before surgery to limit exposure to the baby.
The manufacturer also recommends discontinuation of the patch 24 hours after surgery because there was no significant antiemetic effect of scopolamine for PONV between 24 and 48 hours. For motion sickness, reapplication can be every 72 hours. Patch placement should be on the postauricular area the hairless area behind the ear. The stratum corneum, which acts as a significant barrier to percutaneous absorption, is the thinnest at this location.
Patients should not cut the scopolamine patch, as it will alter the delivery system, and blood levels become less controlled. There are two other scopolamine products available outside the USA: scopolamine hydrobromide and scopolamine butylbromide.
Both are useable in parenteral, intramuscular, intravenous, and subcutaneous forms. The short duration of action, less predictable blood levels, and common side effects resulted in the exclusion of these products from U. The most commonly reported side effects of scopolamine patch use are blurred vision, dilated pupils, and dry mouth.
The vision disturbances are most often due to inadequate handwashing techniques after the application of the patch. These side effects are usually mild and quick to resolve after patch removal. If needed, the clinician can administer a reversal agent like physostigmine if a side effect persists. The FDA currently lists two contraindications for scopolamine: allergy to belladonna alkaloids and angle-closure glaucoma.
Patients with angle-closure glaucoma should not be prescribed scopolamine. Scopolamine causes mydriasis or pupillary dilation. A dilated iris prohibits proper drainage of fluid from the anterior chamber, creating a further increase in anterior chamber pressure and precipitating acute angle-closure glaucoma.
There are several conditions in which scopolamine use requires caution or its effects monitored more frequently. There are reports of scopolamine worsening psychosis.
Reports also exist of acute toxic psychosis, agitation, speech disorder, hallucinations, paranoia, and delusions. Use caution in using scopolamine for patients with myasthenia gravis. Myasthenia gravis is caused by a lack of proper nerve impulse transmission due to antibodies to acetylcholine receptors, resulting in muscle fatigue.
Although myasthenia gravis primarily affects skeletal muscle, the use of anticholinergic agents, like scopolamine, causes unpredictable results. There has been some concern about the use of scopolamine in patients with a seizure history. The speculated reason is that scopolamine might lower seizure threshold potential. However, further examination of medical records showed this not to be true. This false claim was primarily attributable to the coding of reported cases as "dizziness, rule out seizures.
Currently, the understanding of preeclampsia has its basis in a vasospasm theory, and the use of anticholinergic agents may leave the sympathetic system unopposed, further deteriorating the condition of preeclampsia into eclampsia and HELLP syndrome.
Patients should also discontinue using a scopolamine patch before MRI. One of the four layers contains metal and can burn the skin during MRI imaging. Due to scopolamine's anticholinergic properties, its use can decrease gastrointestinal motility and cause urinary retention. Discontinue scopolamine in patients who develop difficulty urinating. Scopolamine use also merits caution in special populations. Children, pregnant or lactating mothers, patients with hepatic or renal impairment, and the elderly should be monitored earlier for more severe side effects.
Toxicity does not happen as frequently with the transdermal form of scopolamine due to its extended-release nature. Data on the toxic dose of scopolamine in the tablet form is scattered. Reports exist that 10 mg a day can be lethal for children. In adults, consumption of more than mg a day did not result in death. The other feared toxidrome of scopolamine overdose is an anticholinergic syndrome resulting in tachycardia, hallucinations, hyperthermia, and dry membranes.
Physostigmine 1 to 4 mg IV can serve as an antidote in such severe cases.
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