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Action/Kinetics:
Anticholinergic with CNS depressant effects; produces amnesia when given with morphine or meperidine. In the presence of pain, delirium may be produced. Causes pupillary dilation and paralyzes the muscle required to accommodate for close vision (cycloplegia). This enables the physician to examine the inner structure of the eye, including the retina, as well as to examine refractive errors of the lens without automatic accommodation by the client. Tolerance may develop if scopolamine is used alone. When used for refraction:
peak for mydriasis, 20-30 min;
peak for cycloplegia, 30-60 min;
duration: 24 hr (residual cycloplegia and mydriasis may last for 3-7 days). Recovery time can be reduced by using 1-2 gtt pilocarpine (1% or 2%). To reduce absorption, apply pressure over the nasolacrimal sac for 2-3 min.
The transdermal therapeutic system contains 1.5 mg scopolamine, which is slowly released from a mineral oil-polyisobutylene matrix. Approximately 0.5 mg is released from the system per day.
Uses:
Ophthalmic: For cycloplegia and mydriasis in diagnostic procedures. Preoperatively and postoperatively in the treatment of iridocyclitis. Dilate the pupil in treatment of uveitis or posterior synechiae.
Investigational: Prophylaxis of synechiae, treatment of iridocyclitis.
Parenteral: Antiemetic, antivertigo. Preanesthetic sedation and obstetric amnesia. Antiarrhythmic during anesthesia and surgery.
Oral: Prevention of motion sickness.
Transdermal: Antiemetic, antivertigo. Prevention of motion sickness.
Additional Contraindications:
Use of the transdermal system in children or lactating women. Ophthalmic use in glaucoma or infants less than 3 months of age. Use for prophylaxis of excess secretions in children less than 4 months of age.
Special Concerns:
Use with caution in children, infants, geriatric clients, diabetes, hypo- or hyperthyroidism, narrow anterior chamber angle.
Additional Side Effects:
Disorientation, delirium, increased HR, decreased respiratory rate.
Ophthalmologic: Blurred vision, stinging, increased intraocular pressure. Long-term use may cause irritation, photophobia, conjunctivitis, hyperemia, or edema.
How Supplied:
Scopolamine hydrobromide:
Injection: 0.4 mg/mL, 1 mg/mL;
Ophthalmic Solution: 0.25%;
Tablet: 0.4 mg.
Scopolamine transdermal therapeutic system:
Film, extended release: 0.33 mg/24 hr, 0.5 mg/24 hr
Dosage
?Ophthalmic Solution
Cycloplegia/mydriasis.
Adults: 1-2 gtt of the 0.25% solution in the conjunctiva 1 hr prior to refraction;
children: 1 gtt of the 0.25% solution b.i.d. for 2 days prior to refraction.
Uveitis.
Adults and children: 1 gtt of the 0.25% solution in the conjunctiva 1-4 times/day, depending on the severity of the condition.
Treatment of posterior synechiae.
Adults and children: 1 gtt of the 0.25% solution q min for 5 min. (1 gtt of either a 2.5% or 10% solution of phenylephrine instilled q min for 3 min will enhance the effect of scopolamine.)
Postoperative mydriasis.
Adults: 1 gtt of the 0.25% solution once daily. For dark brown irides, administration 2 or 3 times/day may be required.
Pre- or Postoperative iridocyclitis.
Adults and children: 1 gtt of the 0.25% solution 1-4 times/day as required. Individualize the pediatric dose based on age, weight, and severity of the inflammation.
?Injection (IM, IV, SC)
Anticholinergic, antiemetic.
Adults: 0.3-0.6 mg (single dose).
Pediatric: 0.006 mg/kg (0.2 mg/m
2) as a single dose.
Prophylaxis of excessive salivation and respiratory tract secretions in anesthesia.
Adults: 0.2-0.6 mg 30-60 min before induction of anesthesia.
Pediatric (given IM): 8-12 years: 0.3 mg;
3-8 years: 0.2 mg;
7 months-3 years: 0.15 mg;
4-7 months: 0.1 mg. Not recommended for children less than 4 months of age.
Adjunct to anesthesia, sedative-hypnotic.
Adults: 0.6 mg t.i.d-q.i.d.
Adjunct to anesthesia, amnesia.
Adults: 0.32-0.65 mg.
?Tablets
Prevent motion sickness.
0.4-0.8 mg taken 1 hr before travel.
?Transdermal System
Antiemetic, antivertigo.
Adults: 1 transdermal system placed on the postauricular skin to deliver either 1 mg or 0.33 mg over 3 days (apply at least 4 hr before antiemetic effect is required). The Canadian product should be applied about 12 hr before the antiemetic effect is desired.
