From the FDA Drug Label
- 2 Recommended Adult Dosage Motion Sickness Apply one scopolamine transdermal system to the hairless area behind one ear at least 4 hours before the antiemetic effect is required – for use up to 3 days. If therapy is required for longer than 3 days, remove the first transdermal system and apply a new scopolamine transdermal system behind the other ear PONV For surgeries other than cesarean section Apply one scopolamine transdermal system the evening before scheduled surgery. Remove the transdermal system 24 hours following surgery.
The recommended dosing of scopolamine for an elderly male is to apply one scopolamine transdermal system to the hairless area behind one ear, however, elderly patients may be more sensitive to the neurological and psychiatric effects of scopolamine transdermal system 1.
From the Research
For elderly males, the recommended dosing of scopolamine should be reduced to the lowest effective dose, typically starting with one 1.5 mg patch applied behind the ear every 72 hours (3 days) for motion sickness or postoperative nausea and vomiting, due to increased sensitivity and risk of adverse effects in the elderly. The increased sensitivity in elderly patients is due to age-related changes in pharmacokinetics, reduced drug clearance, and blood-brain barrier changes that allow more medication to reach the central nervous system 2. Elderly patients should be assessed for pre-existing conditions like benign prostatic hyperplasia, narrow-angle glaucoma, or cognitive impairment before initiating therapy, as these conditions may be exacerbated by anticholinergic medications 3. Careful monitoring is essential as they are more susceptible to anticholinergic side effects including confusion, urinary retention, dry mouth, blurred vision, and constipation 4. Some key points to consider when prescribing scopolamine to elderly males include:
- Start with the lowest effective dose and titrate cautiously if needed
- Hydration should be maintained during treatment
- The medication should be discontinued if significant adverse effects occur
- Elderly patients with mild cognitive impairment are prone to develop scopolamine patch-induced mental confusion 3
- Double-dose transdermal scopolamine may be safe for some patients, but this should be approached with caution in the elderly population 5