Scopolamine patch





Definition

A scopolamine patch (Transdermal Scop or Transderm-V) is an adhesive medication patch that is applied to the skin behind the ear. The patch is treated with the belladonna alkaloid scopolamine, an anticholinergic drug that is a central nervous system depressant and an antiemetic.


Purpose

Scopolamine patches are prescribed to reduce postoperative nausea and vomiting (PONV) associated with anesthesia and surgery. Scopolamine also has a mild analgesic and sedative effect, which adds to its therapeutic value for some surgical patients. In addition to PONV, scopolamine patches are also used for the treatment of motion sickness.


Demographics

Elderly patients may be more sensitive to scopolamine treatment and its use should be prescribed with caution in this group. The safety of scopolamine patches has not been determined in children; therefore the drug's use in pediatric patients is not recommended.


Description

A potent drug derived from an alkaloid of belladonna ( Atropa belladonna ; common name deadly nightshade), scopolamine works by depressing the action of the nerve fibers near the ear and the vomiting center of the brain and central nervous system (CNS). The patch itself is designed with special layered materials that slowly release a small dose of the drug transdermally (through the skin) over a period of several days.

Patients who are instructed to apply their patch at home should wash their hands thoroughly both before and after the procedure. Scopolamine can be spread to the eyes by hand, which can cause blurred vision and pupil dilation. Patches should never be cut into pieces, as cutting destroys the time-release mechanism of the drug. The directions for use for the patch should be read thoroughly before application, and specific physician instructions should also be followed. The drug will start to work approximately four hours after the patch is applied.


Diagnosis/Preparation

The dime-sized scopolamine patch is applied just behind either the left or right ear. The area should be clean and hairless prior to the application, which should occur the evening before a scheduled surgery. For women who are prescribed a scopolamine patch to reduce nausea and vomiting related to a cesarean section , the patch should be applied just one hour before the procedure to minimize the baby's exposure to the drug. Scopolamine does cross the placental barrier, but as of early 2003, clinical studies have not shown any negative affects on newborn babies of mothers who used the drug in a caesarean delivery.

Patients with a history of glaucoma, prostate enlargement, kidney or liver problems, bladder obstruction, gastrointestinal obstruction, or contact dermatitis (allergic skin rash) in response to topical drugs may not be suitable candidates for scopolamine patch therapy. A physician or anesthesiologist should take a full medical history before prescribing scopolamine to determine if the medication is appropriate.


Aftercare

Patients who receive a scopolamine patch should not drive or operate heavy machinery until the therapy is complete. Patch therapy generally lasts about three days. Patches should be disposed of according to the manufacturer's directions in a secure place to ensure that small children or pets do not get access to them. If PONV has not resolved after patch therapy has ended, patients should talk to their doctor about their treatment options.


Risks

Possible complications or side effects from transdermal scopolamine include but are not limited to: short-term memory loss, fatigue, confusion, hallucinations, difficulty urinating, and changes in heart rate. The drug can trigger seizures and psychotic delusions in patients with a history of these problems. Dizziness, nausea, headache, and hypotension (low blood pressure) have also been reported in some patients upon discontinuation of scopolamine patch therapy.

Patients who experience eye pain with redness and possible blurred vision should remove the patch immediately and call their doctor, since these symptoms could be signs of a rare but possible side effect of scopolamine called narrow-angle glaucoma. Blurriness with or without pupil dilation is also a potential but generally harmless side effect of the drug.



Normal results

When scopolamine patch therapy works, it reduces or eliminates post-surgical nausea and vomiting. Patients frequently experience dry mouth as a common side effect of the drug.



Alternatives

Intravenous or intramuscular injection of scopolamine may be used as alternatives to patch therapy for some patients. Other antiemetics that may be prescribed for PONV include anti-droperidol drugs, dopaminergic drugs (i.e., promethazine, droperidol), antihistamines (i.e., diphenhydramine), and the serotonin receptor antagonists (i.e., ondansetron, granisetron, tropisetron, dolasetron). Corticosteroids may also be recommended for PONV in some patients.


Resources

BOOKS

Litwack, Kim, ed. Core Curriculum for Perianesthesia Nursing Practice, 4th edition. Philadelphia: W.B. Saunders, 1999.

PERIODICALS

Gan, T. J. "Postoperative nausea and vomiting—can it be eliminated?" Journal of the American Medical Association 287 (March 13, 2002): 1233–6.


Paula Ford-Martin

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?



When used for surgical implications, a scopolamine patch may be ordered by a physician, surgeon, or anesthesiologist, typically in a hospital setting or an ambulatory surgery center. The patch may be applied at home by the patient, or by a nurse or physician's assistant as part of preoperative preparation.

QUESTIONS TO ASK THE DOCTOR



  • When and how do I apply the patch?
  • What should I do if the patch becomes loose or falls off?
  • When can I remove or replace the patch?
  • Are there any warning symptoms which should signal me to remove the patch?

User Contributions:

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Jul 11, 2010 @ 7:07 am
I recently had a hysterectomy my ovaries and cervix were also removed. I have severe flushes all day and my dr has prescribed dixarit tablets and scopoderm patches. I am confused as all the information I can find scopoderm patches are for travel sickness I am worried that he has given me the wrong tablets.
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Nov 5, 2010 @ 8:20 pm
I have hives almost daily and Asthma. Is it safe for me to use the Scoplomine patch. I have surgery schedule for the a.m. of Nov. 8,2010. Need an answer to my question ASAP if possible.
Note: Whenever I have NOT been given an anti-drug BEFORE surgery, I always come out of the anesthetic with severe nausea and vomiting and I want to avoid this.
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Mar 28, 2011 @ 12:00 am
How long does it take for the blurred vision to go away?
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Nov 8, 2011 @ 10:10 am
My mother has been on the patch for two months, after suffering a brain stem stroke, she has tried to discontinye the use of the patch but becomes very ill. How long can a person use this patch? And is there something else she can use ? It is getting harder to get these patches, numerous pharmists tell us they are or soon will be discontinued from being made. Can anyone answer any of my concerns. Thank you
J Ives
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Jun 20, 2012 @ 4:16 pm
My wife and I are from NY and are on a cruise in France. Her use of the Transdermal Scop (1.5 mg scopolamine) almost landed her in a hospital and stranded us in France. Some doctors aboard the cruise suggested she had a stroke. she was disorientated and thought we were still in the US. She was awake most of two nights talking about things that made no sense. She had shot term memory loss, dry mouth and fatigue. All apparently due to something The size of a dime on her neck for three days and a new patch added the fourth day. She also has red eye. The French doctor ruled out a stroke and said we should wait one more day. she had taken Meclizine a few days ago which he said we should stop. He "suggested" we remove the patch also. The confirmation of her condition came from the Surgery Encyclopedia. Thanks guys. From somewhere near Rouen, France
Ann P
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Jan 24, 2013 @ 2:14 pm
I recently had a total hip replacement. A Scopoloamine patch was applied before surgery. I was one of the rare complications where for the four days following surgery I experienced confusion, agitation and disorientation. My family and friends said I was very entertaining. My husband was horrified that he would be bringing me home in this condition. The nurse removed the patch on the fourth day and within hours I was back to pretty much my normal self. The remainder of that fourth day I had ticks throughout the day. It was a horrible experience. A warning will certainly be added to my medical record regarding this product.
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Mar 24, 2013 @ 6:18 pm
My daughter had surgery 1 1/2 weeks ago and they used the patch for nausea. She told them she is extremely sensitive to all drugs including anesthesia. She has had very large pupils and very blurred vision since the surgery which makes her nauseous. They have told her that it will go away in about 2 more weeks and that this is very rare.
Anybody know anything about this?
Thanks!
Ann MArie
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Aug 12, 2013 @ 7:19 pm
My son was prescribed this patch post surgery and told to repeat the application every three days for 30 days. On day 15 after 5 patches he complained of zoning out and was taken to the ER and hospitalized by day 23 he didn't know who or where he was which was after the patch was removed for 4 days. We are now almost 60 days from the last patch and still memory is lost both short and long term. Now the medical system doesn't want to claim responsibility for this occurring and his life is altered for who knows how long. Beware of the side effects and question the use of this drug before using it. Now they can't even say why it was ordered in the first place. PROCEED WITH CASUTION>
Thomas
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Feb 10, 2014 @ 11:11 am
I had surgery also and was given the patch just 30 min before surgery for nausea. I left it on maybe two days and by the 5th day I experianced a vertigo like condition when lying down and standing up. The room would spin and I would have to catch myself. It lasts about 10 sec and goes away. Then if I only bend over it will make me unstable also. This condition is still with me and it's been 3 months since surgery. I went to my family doc 1 week after this condition occured and he said it should clear up soon and prescribed me dizziness pills but it never worked. This surgery was November last year and here it is Feb and no better. Today I'm going back to him, with these findings from the internet of other peoples symtoms and I'm going to get to the bottom of this problem. I say being a little sick after surgery is way better than playing Russian Rullet with this patch. I'll never use it again. I've been dealing with this since Nov 2013 to the present Feb 2014. Good luck to everyone to get well that has been affected by this unstable drug! Unstable is putting it lightly from the side affects it caused people.
Diana Davis
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Apr 8, 2014 @ 12:12 pm
I had hand surgery in Sept. of 2013, I always have nausea and vomiting from the anesthesia. The Scopolamine Patch was applied just before my surgery, my surgery went fine with no nausea or vomiting. I went home with the patch on, left it on for 3 days with no complications of any kind. I understand that everyone is different, but this patch was wonderful for me. My husband had to have surgery in March 2014 to remove his thyroid and will soon be having radioactive iodine treatment for folicular carcinoma, I'm going to ask the physician to prescribe this patch in case he has nausea and vomiting during this treatment time.
Donna Delgado
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Apr 9, 2014 @ 5:17 pm
My husband had hip replacement surgery. The Scopolamine patch was applied just before surgery. He became agitated, confused and having hallucinations on the 2nd day. He was given Benadryl 3 days after the surgery and the patch was not removed. He did not sleep for 3 days and a friend who is in the medical field finally saw the patch and asked that it be taken off. It took another 24 hours before he returned to normal. Now he is having prostate problems. It has been a nightmare. We will always advise people not to use this patch.

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