From the Guidelines
Scopolamine patches are effective for preventing post-operative nausea and vomiting, and the standard dose is one 1.5mg patch applied behind the ear at least 4 hours before surgery, providing relief for up to 72 hours. According to the guidelines for postoperative care in cesarean delivery, anticholinergic agents like scopolamine are effective in reducing postoperative nausea and vomiting 1. The patch works by blocking acetylcholine receptors in the brain's vomiting center, preventing the conflicting sensory signals that cause nausea and vomiting.
Key Points to Consider
- The standard dose of scopolamine patch is 1.5mg, applied behind the ear at least 4 hours before surgery 1.
- Side effects may include dry mouth, drowsiness, blurred vision, and dizziness.
- Patients should avoid touching the patch and then touching their eyes, as this can cause pupil dilation.
- The patch should be removed after 72 hours and a new one applied if needed.
- Those with glaucoma, urinary retention, or certain heart conditions should consult their doctor before using scopolamine patches.
Clinical Considerations
In clinical practice, scopolamine patches can be used as part of a multimodal approach to prevent nausea and vomiting, especially in patients undergoing surgery 1. However, it's essential to consider the potential side effects and interactions with other medications. The guidelines for perioperative care for liver surgery also recommend the use of preoperative hyoscine patches in patients with high risk for postoperative nausea and vomiting, but caution against their use in the elderly 1.
Recommendation
The use of scopolamine patches is recommended for preventing post-operative nausea and vomiting, especially in patients undergoing surgery, due to their effectiveness and relatively low risk of side effects. However, it's crucial to carefully evaluate each patient's individual risk factors and medical history before prescribing scopolamine patches 1.
From the FDA Drug Label
1 INDICATIONS AND USAGE Scopolamine transdermal system is indicated in adults for the prevention of:
• nausea and vomiting associated with motion sickness. • post-operative nausea and vomiting (PONV) associated with recovery from anesthesia and/or opiate analgesia and surgery.
The scopolamine patch is used for the prevention of:
- nausea and vomiting associated with motion sickness
- post-operative nausea and vomiting (PONV) associated with recovery from anesthesia and/or opiate analgesia and surgery 2.
From the Research
Scopolamine Patch Overview
- Scopolamine is used to prevent and treat motion sickness, which can cause symptoms such as nausea, vomiting, and headaches 3, 4, 5.
- The medication can be administered via transdermal patches, tablets, capsules, oral solutions, or intravenously 3, 4.
Efficacy of Scopolamine
- Scopolamine has been shown to be more effective than placebo in preventing motion sickness symptoms 3, 4, 5.
- Comparisons between scopolamine and other agents, such as antihistamines and calcium channel antagonists, are limited, but suggest that scopolamine may be superior or equivalent as a preventative agent 3, 4.
- A meta-analysis with Trial Sequential Analysis (TSA) found that scopolamine had a greater reduction in nausea than placebo, with the included sample size exceeding the required information size (RIS) 5.
Safety and Adverse Effects
- Scopolamine may cause adverse effects such as dry mouth, drowsiness, blurring of vision, and dizziness, but these effects are not significantly more likely than with other agents 3, 4.
- Dry mouth was more likely with scopolamine than with methscopolamine or cinnarizine 3, 4.