Scopolamine
Synonym :
Hyoscine Hydrobromide
Mechanism :
It is an anticholinergic drug used as an antiemetic and an anesthetic premedication.
Indication :
- Nausea & vomiting
- Aspiration prophylaxis prior to anaesthesia and intubation
- Procedural sedation
- Cycloplegia induction or mydriasis induction during ophthalmologic examination
- Treatment of iritis or uveitis
- Treatment of sialorrhea
Contraindications :
Hypersensitivity to scopolamine, belladonna alkaloids, or any component in formulation
Closed-angle glaucoma.
GI obstruction, urinary bladder neck obstruction, paralytic ileus, toxic megacolon complicating ulcerative colitis, Tachycardia secondary to cardiac insufficiency or thyrotoxicosis, Unstable cardiovascular status in acute hemorrhage, Reflux esophagitis, hiatal hernia, Mitral stenosis.
Dosing :
Nausea & vomiting and aspiration prophylaxis prior to anaesthesia and intubation:
0.006 mg/kg (6 mcg/kg) SC/IM/IV as a single dose; dose not to exceed 0.3 mg/dose.
Procedural sedation:
7 years and older: 0.32 to 0.65 mg SC/IM/IV.
3 to 6 years: 0.2 to 0.3 mg SC/IM/IV.
6 months-3 years: 0.1 to 0.15 mg SC/IM/IV.
Cycloplegia induction or mydriasis induction during ophthalmologic examination:
Instill 1 drop of 0.25% solution in eye(s) 1 hour before refraction.
Treatment of iritis or uveitis:
Instill 1 drop of 0.25% solution in affected eye(s) once, twice, or 3 times daily.
Treatment of sialorrhea:
>5 years and >15 kg: 1.5 mg transdermal patch for 2 weeks. The transdermal patches are changed twice weekly.
Adverse Effect :
Dry mouth, drowsiness, dizziness, blurred vision, withdrawal symptoms (e.g., dizziness, nausea and vomiting) if used for >3 days.
Interaction :
Potassium salts: May delay solid potassium passage through GI tract, increase risk of ulcerative/stenotic lesions (anticholinergics slow GI transit, increase local exposure to high potassium concentration).
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | Dose as in normal renal function |
| <10 | Dose as in normal renal function |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Dialysed. Dose as in normal renal function |
| HD | Dialysed. Dose as in normal renal function |
| HDF/High flux | Dialysed. Dose as in normal renal function |
| CAV/VVHD | Not Dialysed. Dose as in normal renal function |
Hepatic Dose :
Scopolamine should be used with caution due to an increased risk of CNS adverse effects.