Scopolamine

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

  1. agitation
  2. amblyopia
  3. amnesia
  4. anhidrosis
  5. blepharitis
  6. blurred vision
  7. bradycardia
  8. burns
  9. confusion
  10. constipation
  11. contact dermatitis
  12. cycloplegia
  13. delirium
  14. dizziness
  15. drowsiness
  16. dysphagia
  17. dysuria
  18. erythema
  19. fatigue
  20. fever
  21. flushing
  22. hallucinations
  23. headache
  24. heat intolerance
  25. hyperthermia
  26. hypotension
  27. memory impairment
  28. mydriasis
  29. nausea
  30. ocular hypertension
  31. ocular pain
  32. orthostatic hypotension
  33. palpitations
  34. paranoia
  35. pharyngitis
  36. photophobia
  37. psychomotor impairment
  38. psychosis
  39. pyrosis (heartburn)
  40. rash
  41. restlessness
  42. seizures
  43. sinus tachycardia
  44. skin irritation
  45. tremor
  46. urinary retention
  47. urticaria
  48. vertigo
  49. visual impairment
  50. vomiting
  51. withdrawal
  52. xerophthalmia
  53. xerosis
  54. 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
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