From the Guidelines
Scopolamine is contraindicated in patients with glaucoma, gastrointestinal or urinary obstruction, myasthenia gravis, and known hypersensitivity to the medication. The contraindications for scopolamine are primarily due to its anticholinergic properties, which can worsen certain conditions 1.
Key Contraindications
- Glaucoma, particularly narrow-angle glaucoma, as scopolamine can increase intraocular pressure
- Gastrointestinal or urinary obstruction, as scopolamine can exacerbate these conditions by reducing motility
- Myasthenia gravis, because scopolamine can worsen muscle weakness
- Known hypersensitivity to scopolamine or other anticholinergic medications
Precautions
- Patients with tachycardia, thyrotoxicosis, and cardiac disease should avoid scopolamine as it can worsen these conditions by blocking parasympathetic activity 1
- Caution is necessary in elderly patients, those with prostatic hypertrophy, and individuals with impaired liver or kidney function due to potential adverse effects
- Pregnant women should use scopolamine only if clearly needed, as safety during pregnancy is not fully established
- The medication is also contraindicated in children under certain ages, depending on the formulation, due to the risk of adverse effects
Rationale
Scopolamine's anticholinergic effects can lead to a range of adverse effects, including dry mouth, constipation, urinary retention, and confusion, particularly in vulnerable populations such as the elderly 1. Its ability to cross the blood-brain barrier also poses a risk of neurological side effects, making caution necessary in patients with a history of central nervous system disorders. Given the potential for significant adverse effects and the availability of alternative treatments, it is crucial to carefully consider the use of scopolamine in clinical practice, prioritizing patient safety and well-being.
From the Research
Contraindications to Scopolamine
- Scopolamine is contraindicated in patients with narrow-angle glaucoma, as it can cause mydriasis and increase the risk of angle-closure glaucoma 2.
- Patients with open-angle glaucoma can use transdermal scopolamine patches, but with caution, as scopolamine can increase intraocular pressure in some cases 3.
- Anticholinergics, such as scopolamine, may predispose patients to glaucoma, especially those with a history of glaucoma or at risk of developing glaucoma 4.
- Scopolamine can cause accommodation interference and may worsen glaucoma in patients with narrow angles 5.
- Other contraindications to scopolamine include:
- Myasthenia gravis
- Ulcerative colitis
- Asthma
- Thyrotoxicosis
- Hypertension
- Coronary artery disease
- Cardiac arrhythmias
- Peptic ulcer disease However, there is no direct evidence in the provided studies to support these contraindications.
- It is essential to note that scopolamine can have ocular adverse effects, and patients with a history of eye problems or at risk of developing glaucoma should be monitored closely when using scopolamine 5, 2, 6.