What is Scopolamine
Scopolamine, also known as l-hyoscine, is a naturally occurring tertiary antimuscarinic. It is one of the major active alkaloids found in belladonna leaf.
Compared with atropine, scopolamine is more potent in its anticholinergic effects on the iris; ciliary body; and salivary, bronchial, and sweat glands. Like atropine, it is considered highly anticholinergic and produces side effects consistent with this profile.
At therapeutic doses, the drug produces CNS depression (drowsiness, euphoria, amnesia, fatigue, and dreamless sleep characterized by a decrease in the REM cycle).
Even so, paradoxical CNS excitation (restlessness, hallucinations, or delirium) can occur, especially when the patient is experiencing severe pain.
Scopolamine is very effective for the prevention of motion sickness and this indication represents the most common clinical use.
Brand Name
- Isopto Hyoscine
- Maldemar
- Scopace
- Transderm Scop
Indications
- alcohol withdrawal
- amnesia induction
- aspiration prophylaxis
- bradycardia
- mania
- motion sickness
- nausea/vomiting
- post-operative nausea/vomiting (PONV) prophylaxis
- procedural sedation
- sedation induction
- sialorrhea
Side Effects
- agitation
- amblyopia
- amnesia
- anhidrosis
- blepharitis
- blurred vision
- bradycardia
- burns
- confusion
- constipation
- contact dermatitis
- cycloplegia
- delirium
- dizziness
- drowsiness
- dysphagia
- dysuria
- erythema
- fatigue
- fever
- flushing
- hallucinations
- headache
- heat intolerance
- hyperthermia
- hypotension
- memory impairment
- mydriasis
- nausea
- ocular hypertension
- ocular pain
- orthostatic hypotension
- palpitations
- paranoia
- pharyngitis
- photophobia
- psychomotor impairment
- psychosis
- pyrosis (heartburn)
- rash
- restlessness
- seizures
- sinus tachycardia
- skin irritation
- tremor
- urinary retention
- urticaria
- vertigo
- visual impairment
- vomiting
- withdrawal
- xerophthalmia
- xerosis
- xerostomia
Monitoring Parameters
- laboratory monitoring not necessary
Contraindications
- anticholinergic medications
- asthma
- autonomic neuropathy
- bladder obstruction
- breast-feeding
- caesarean section
- cardiac arrhythmias
- children
- chronic obstructive pulmonary disease (COPD)
- closed-angle glaucoma
- contact lenses
- coronary artery disease
- dementia
- driving or operating machinery
- eclampsia
- ethanol ingestion
- gastroesophageal reflux disease (GERD)
- geriatric
- GI obstruction
- heart failure
- hepatic disease
- hiatal hernia
- hypertension
- hyperthyroidism
- ileus
- infants
- laboratory test interference
- magnetic resonance imaging (MRI)
- myasthenia gravis
- neonates
- open-angle glaucoma
- preeclampsia
- pregnancy
- prostatic hypertrophy
- psychosis
- pyloric stenosis
- renal impairment
- seizures
- tachycardia
- toxic megacolon
- ulcerative colitis
- urinary tract obstruction
Interactions
- Abatacept
- Acetaminophen; Butalbital; Caffeine; Codeine
- Acetaminophen; Caffeine; Dihydrocodeine
- Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
- Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
- Acetaminophen; Codeine
- Acetaminophen; Dextromethorphan; Doxylamine
- Acetaminophen; Diphenhydramine
- Acetaminophen; Hydrocodone
- Acetaminophen; Oxycodone
- Acetaminophen; Pentazocine
- Acetaminophen; Tramadol
- Aclidinium
- Aclidinium; Formoterol
- Acrivastine; Pseudoephedrine
- Albuterol; Ipratropium
- Alfentanil
- Alosetron
- Aluminum Hydroxide
- Aluminum Hydroxide; Magnesium Carbonate
- Aluminum Hydroxide; Magnesium Hydroxide
- Aluminum Hydroxide; Magnesium Hydroxide; Simethicone
- Aluminum Hydroxide; Magnesium Trisilicate
- Amantadine
- Ambenonium Chloride
- Aminoglycosides
- Amoxapine
- Antacids
- Anxiolytics; Sedatives; and Hypnotics
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Aspirin, ASA; Caffeine; Dihydrocodeine
- Aspirin, ASA; Caffeine; Orphenadrine
- Aspirin, ASA; Carisoprodol; Codeine
- Aspirin, ASA; Citric Acid; Sodium Bicarbonate
- Aspirin, ASA; Oxycodone
- Atomoxetine
- Atropine; Edrophonium
- Barbiturates
- Belladonna; Opium
- Benzhydrocodone; Acetaminophen
- Benzodiazepines
- Botulinum Toxins
- Brompheniramine
- Brompheniramine; Carbetapentane; Phenylephrine
- Brompheniramine; Dextromethorphan; Guaifenesin
- Brompheniramine; Guaifenesin; Hydrocodone
- Brompheniramine; Hydrocodone; Pseudoephedrine
- Brompheniramine; Pseudoephedrine
- Buprenorphine
- Buprenorphine; Naloxone
- Bupropion
- Bupropion; Naltrexone
- Butorphanol
- Calcium Carbonate
- Calcium Carbonate; Magnesium Hydroxide
- Calcium Carbonate; Risedronate
- Calcium Carbonate; Simethicone
- Cannabidiol
- Carbetapentane; Chlorpheniramine
- Carbetapentane; Chlorpheniramine; Phenylephrine
- Carbetapentane; Diphenhydramine; Phenylephrine
- Carbetapentane; Guaifenesin
- Carbetapentane; Guaifenesin; Phenylephrine
- Carbetapentane; Phenylephrine
- Carbetapentane; Phenylephrine; Pyrilamine
- Carbetapentane; Pseudoephedrine
- Carbetapentane; Pyrilamine
- Carbidopa; Levodopa
- Carbidopa; Levodopa; Entacapone
- Carbinoxamine
- Carbinoxamine; Dextromethorphan; Pseudoephedrine
- Carbinoxamine; Hydrocodone; Phenylephrine
- Carbinoxamine; Hydrocodone; Pseudoephedrine
- Carbinoxamine; Phenylephrine
- Carbinoxamine; Pseudoephedrine
- Cenobamate
- Cetirizine
- Cetirizine; Pseudoephedrine
- Chlophedianol; Dexbrompheniramine
- Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
- Chlorcyclizine
- Chlorpheniramine
- Chlorpheniramine; Codeine
- Chlorpheniramine; Dextromethorphan
- Chlorpheniramine; Dextromethorphan; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
- Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Hydrocodone
- Chlorpheniramine; Hydrocodone; Phenylephrine
- Chlorpheniramine; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Phenylephrine
- Chlorpheniramine; Pseudoephedrine
- Chlorpromazine
- Cholinergic agonists
- Cisapride
- Clemastine
- Clozapine
- Codeine
- Codeine; Guaifenesin
- Codeine; Phenylephrine; Promethazine
- Codeine; Promethazine
- COMT inhibitors
- Crofelemer
- Cyclizine
- Cyclobenzaprine
- Cyproheptadine
- Deutetrabenazine
- Dexchlorpheniramine
- Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
- Dextromethorphan; Diphenhydramine; Phenylephrine
- Dextromethorphan; Promethazine
- Dextromethorphan; Quinidine
- Digoxin
- Dihydrocodeine; Guaifenesin; Pseudoephedrine
- Dimenhydrinate
- Diphenhydramine
- Diphenhydramine; Hydrocodone; Phenylephrine
- Diphenhydramine; Ibuprofen
- Diphenhydramine; Naproxen
- Diphenhydramine; Phenylephrine
- Disopyramide
- Donepezil
- Donepezil; Memantine
- Doxylamine
- Doxylamine; Pyridoxine
- Dronabinol
- Droperidol
- Edrophonium
- Eluxadoline
- Erythromycin
- Erythromycin; Sulfisoxazole
- Esketamine
- Ethanol
- Ezogabine
- Fentanyl
- Fluoxetine; Olanzapine
- Fluphenazine
- Fluticasone; Umeclidinium; Vilanterol
- Gabapentin
- Galantamine
- Glucagon
- Glycopyrronium
- Guaifenesin; Hydrocodone
- Guaifenesin; Hydrocodone; Pseudoephedrine
- Homatropine; Hydrocodone
- Hydrocodone
- Hydrocodone; Ibuprofen
- Hydrocodone; Phenylephrine
- Hydrocodone; Potassium Guaiacolsulfonate
- Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
- Hydrocodone; Pseudoephedrine
- Hydromorphone
- Hydroxyzine
- Ibuprofen; Oxycodone
- Ipratropium
- Itraconazole
- Lasmiditan
- Lemborexant
- Levocetirizine
- Levodopa
- Levorphanol
- Linaclotide
- Lofexidine
- Loperamide
- Loperamide; Simethicone
- Loxapine
- Lubiprostone
- Lumateperone
- Lurasidone
- Macimorelin
- Magnesium Hydroxide
- Maprotiline
- Meclizine
- Memantine
- Meperidine
- Meperidine; Promethazine
- Methacholine
- Methadone
- Metoclopramide
- Mirtazapine
- Molindone
- Morphine
- Morphine; Naltrexone
- Nabilone
- Nalbuphine
- Neostigmine
- Nitrofurantoin
- Olanzapine
- Omeprazole; Sodium Bicarbonate
- Orphenadrine
- Oxycodone
- Oxymorphone
- Paroxetine
- Pentazocine
- Pentazocine; Naloxone
- Perphenazine
- Perphenazine; Amitriptyline
- Phentermine; Topiramate
- Phenylephrine; Promethazine
- Physostigmine
- Potassium
- Pramlintide
- Pregabalin
- Procainamide
- Prochlorperazine
- Promethazine
- Proton pump inhibitors
- Pyridostigmine
- Quetiapine
- Quinidine
- Rasagiline
- Remifentanil
- Revefenacin
- Rivastigmine
- Secretin
- Sedating H1-blockers
- Sincalide
- Sodium Bicarbonate
- Solifenacin
- Sufentanil
- Tacrine
- Tapentadol
- Tegaserod
- Thiazide diuretics
- Thioridazine
- Thiothixene
- Tiotropium
- Tiotropium; Olodaterol
- Tolterodine
- Topiramate
- Tramadol
- Tricyclic antidepressants
- Trifluoperazine
- Trimethobenzamide
- Triprolidine
- Trospium
- Umeclidinium
- Umeclidinium; Vilanterol
- Zonisamide
