SCOPOLAMINE

Drugs in Pregnancy and Lactation.

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Name: SCOPOLAMINE
Class: Parasympatholytic (Anticholinergic)
Risk Factor:    CM

Fetal Risk Summary

Scopolamine is an anticholinergic agent. A scopolamine transdermal system is used to prevent nausea and vomiting associated with motion sickness and recovery from anesthesia and surgery.

Reproduction studies in rats with daily IV doses did not observe fetal harm. A marginal embryotoxic effect was seen in rabbits at daily IV doses that produced plasma concentrations approximately 100 times the level achieved in humans with the transdermal system (1).

The Collaborative Perinatal Project monitored 50,282 mother-child pairs, 309 of whom used scopolamine in the 1st trimester (2, pp. 346–353). For anytime use, 881 exposures were recorded (2, p. 439). In neither case was evidence found for an association with malformations. However, when the group of parasympatholytics was taken as a whole (2,323 exposures), a possible association with minor malformations was found (2, pp. 346–353).

In a surveillance study of Michigan Medicaid recipients involving 229,101 completed pregnancies conducted between 1985 and 1992, 27 newborns had been exposed to scopolamine during the 1st trimester (F. Rosa, personal communication, FDA, 1993). One (3.7%) major birth defect was observed (one expected), but specific information on the malformation is not available. No anomalies were observed in six categories of defects, including cardiovascular defects, oral clefts, spina bifida, polydactyly, limb-reduction defects, and hypospadias.

Scopolamine readily crosses the placenta (3). When administered to the mother at term, fetal effects include tachycardia, decreased heart rate variability, and decreased heart rate deceleration (4,5 and 6). Maternal tachycardia is comparable to that with other anticholinergic agents, such as atropine or glycopyrrolate (7).

Scopolamine toxicity in a newborn has been described (8). The mother had received six doses of scopolamine (1.8 mg total) with several other drugs during labor. Symptoms in the female infant consisted of fever, tachycardia, and lethargy; she was also “barrel chested” without respiratory depression. Therapy with physostigmine reversed the condition.

In a clinical study in women undergoing cesarean section, a scopolamine transdermal system was used with epidural anesthesia and opiate analgesia and no evidence of central nervous system depression was observed in the newborns (1).

Breast Feeding Summary

No reports of adverse effects secondary to scopolamine in breast milk have been located. The drug is excreted into human milk (1). The American Academy of Pediatrics considers scopolamine to be compatible with breast feeding (9). (See also Atropine.)

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References

  1. Product information. Transderm Scop. Novartis Consumer Health, 2000.
  2. Heinonen OP, Slone D, Shapiro S. Birth Defects and Drugs in Pregnancy. Littleton, MA: Publishing Sciences Group, 1977.
  3. Moya F, Thorndike V. The effects of drugs used in labor on the fetus and newborn. Clin Pharmacol Ther 1963;4:628–53.
  4. Shenker L. Clinical experiences with fetal heart rate monitoring of one thousand patients in labor. Am J Obstet Gynecol 1973;115:1111–6.
  5. Boehm FH, Growdon JH Jr. The effect of scopolamine on fetal heart rate baseline variability. Am J Obstet Gynecol 1974;120:1099–1104.
  6. Ayromlooi J, Tobias M, Berg P. The effects of scopolamine and ancillary analgesics upon the fetal heart rate recording. J Reprod Med 1980;25:323–6.
  7. Diaz DM, Diaz SF, Marx GF. Cardiovascular effects of glycopyrrolate and belladonna derivatives in obstetric patients. Bull NY Acad Med 1980;56:245–8.
  8. Evens RP, Leopold JC. Scopolamine toxicity in a newborn. Pediatrics 1980;66:329–30.
  9. Committee on Drugs, American Academy of Pediatrics. The transfer of drugs and other chemicals into human milk. Pediatrics 1994;93:137–50.

Index

Q&A about Scopolamine

phistron...
How does Scopolamine and Hyoscyamine affect our nerve cells?
My question needs specifics. I would like a complete walkthrough of the whole process. How does these alkaloids affect our nerve cells and what happens to our body? What does the body do to counter these effects? How do these poisons penetrate our body and so on... I would appreciate any help i get. Thanks. -omni
Scot-Rob
They're both anticholinergic drugs and act by blocking the effects of the neurotransmitter acetylocholine. What they do is to block sites on the post-synaptic membrane which acetylcholine would normally bind to and by preventing its binding they in effect reduce the level of acetylcholine signalling.

This has effects in both the peripheral and central nervous systems (because both drugs can cross the blood/brain barrier they affect the CNS). Typically they cause dry mouth and skin (sweat and mucosal secretion is under the control of PNS via acetylcholine); they can also cause changes in heart rate and breathing, together with hallucinations and dizziness. The pupils of the eye will become dilated (both drugs paralyse the muscle of the iris) and the digestive system can be affected. The muscles, particularly of the lower limbs, begin to feel very heavy too (again, this is because acetylcholine is needed to control voluntary muscle movement). The drugs both have a very steep dose/response curve and a very narrow margin between safe and fatal.

Eventually, the drugs are metabolised by the body and acetylcholine signalling returns to normal, although both drugs are long lasting and it can take 3-5 days for all drug effects to disappear. Drugs can be absorbed orally or through the skin/mucosa (they are both lipophilic and will pass through fat layers easily).
Beth G
How does scopolamine effect an elderly person?
My father is 84 yrs. and was prescribed transderm scop in Januuary, in April/May he had cataract surgery and is forgetful at times.
tj
What was your father prescribed the trasderm patch for? Dizziness with changes in head position (rolling over, going from sitting to laying down, looking up), if that is the case, he would be better off going to physical therapy and working with a therapist with experience in vestibular rehabilitation. The scopalomine patch is a central nervous system depressant used to decrease dizziness and motion sickness, it is not meant to be used long term. For short term use, it is not contraindicated in the older population; however, he may be better served by addressing the underlying cause of the problem, i.e.- why was that medication prescribed?
Beth V
Has anyone had the atropine/scopolamine injections from the stop smoking clinic?
My husband just had the atropine/scopolamine injections by Dr. Gugga. The purpose is to stop smoking. He is now on Belladona, he still has a scopolamine patch, and he has a new Rx for ativan prn. The side effects of these drugs can cause blurred vision, hallucinations, drowsiness. The Dr said he would be ok to work by day 2 which was Wednesday, but he has been acting very loopy. Has anyone had this injection? Did it make you somewhat tired, or did you not remember the events of the day? I had to get my parents to watch our kids while I go to work, because I don't think he would wake up for them. Does anyone have any experience with this?

Thanks
Alice K
Is this a legitimate clinic?? Did you google these drugs to see what they really do? Atropine dilates your eyes and speeds up your heart; belladonna is a poison; ativan is an anti-anxiety drug; and the CIA used to use scopolamine (a depressant) when they interrogated suspects. A small overdose of any ONE of these drugs can be fatal. This sounds like a very dangerous combination. How on earth are they supposed to help you quit smoking? I doubt seriously that any of them should be prescribed for that purpose. Have you spoken to your regular doctor about this?
Blonde Grey
The drug "Colombian Devil's Breath" or burundanga or scopolamine ... is it for real or just alot of hype?
kidderto...
alot of hype.
amypemcr...
Scopolamine or other meds for nausea/vertigo (related to Graves disease)?
I have Graves hyperthyroidism (on tapazole). Recently my endocrinologist decreased my thyroid meds by 1/2. Now I'm having uncontrollabled nausea, vomitting, vertigo, jittery-ness, insomnia. Basically miserable, but the worst part is the nauseas & dizziness. I've gone back to my regular tapazole dose, but I know that could take days, or longer, to kick in.

Have tried gravol, ginger supplements,etc. I'm an RN, used to work in clinical setting, & we used scopolamine patches for nausea/dizziness, etc.

Can I get this over the counter??

Any other suggestions??

(My endocrinologist isn't returning my calls and i'm too sick to sit in "urgent care" for 4 hrs.)
Deanna
Zofran is a wonder drug for nausea. But of course, its not OTC. Have you tried motion sickness tabs (dramamine)? Even benadryl or another antihistamine might help. Scopolamine is only available by script...they have it in a pill form too.

Have you tried the old trick of calling your pharmacist, and getting them to call your doctor's office to get you a script? They almost always return pharmacy calls, even if they are not returning pt calls.

I'm sorry you are feeling so ill. Hope you feel better soon!
Hector M
How to obtain scopolamine?
Better Life
it depends on where do you live , there are tablets form of it in Canada , not sure if tablets are also available in the states, but there are other derivatives if you want it for abdominal and urinary spams. i suggest doing a search at a health information center like http://google.com/coop/cse?cx=0071853080... with gives you professional information from trusted health websites.
consean2...
Has anyone here ever done Scopolamine aka Columbian devil's breathe, the drug that makes you lose free will?
what was it like?
Albert Fish
I used to mix Datura leaves with weed and smoke it. They contain atropine, scopolamine and hyoscyamine. It made the high more intense, but I didn't use enough to become delirious. I don't recommend using datura though. You can overdose and have a very bad delusional trip or die.
barry l
anyone know if those scopolamine patches for motion sickness really work? especially for sea sickness.?
REnate
Yes, they do work. Also that wristband (called a Seaband) that has the acupuncture point on it works too.

You can get the Seabands at any drugstore but the patches are prescription and so you have to ask a doctor to give a scrip to you for them.
peezpad
Does anyone know anything about scopolamine? Derivitive of mandrake root? Came up in a chat and am stumped.?
Pangolin
I prescribe scopolamine patches for patients with a history of severe post-operative nausea and vomiting. It helps prevent that from happening.

We used to use it in anesthesia for unstable trauma patients who couldn't tolerate a "real" anesthetic, so if they survived, they wouldn't remember anything.

Before my time, it was given to laboring women. They had babies with no memory of the event. (But apparently screamed their way through the delivery)

Scopolamine has some annoying side effects, like dry mouth, urinary retention and rapid heart rate.

That's pretty much all I know about it. I don't use it other than the patch.
Ymt
what is scopolamine?
Pete
Hi,

I'm a Pharmacist.

Scopolamine (more commonly known as hyoscine) is a drug from the anticholinergic class. It's main medicinal purpose is in motion sickness (sickness when travelling.)

It can also be used as to dry up bronchial secretions before and during surgery and in opthalmology to dilate the pupil.

Since it is an anticholinergic drug, it has a whole host of side effects including dry skin, blurred vision, memory impairment, insomnia, urinary retention and tachycardia to name a few.

Caution should be used in the elderly, since elderly patients are more sensitive to the adverse effects. I personally would not feel comfortable dispensing ANY anticholinergic medication to an elderly person.

Hope this helps out!