Standard Order and Dispense for Scopolamine Patch
The standard order for scopolamine patch is one transdermal patch (1.5 mg) applied to the hairless area behind one ear at least 4-6 hours before the antiemetic effect is required, with effectiveness for up to 72 hours (3 days). 1
Administration Details
Patch Specifications
- Each scopolamine transdermal system contains a 1.5 mg reservoir of scopolamine
- Delivers approximately 1 mg of scopolamine over 3 days
- Includes a 140 μg priming dose in the adhesive layer for faster onset 2
- Releases medication at a constant rate of approximately 5 μg/hour 2
Application Instructions
- Apply to the hairless area behind one ear (postauricular area)
- Only wear one transdermal system at a time
- Do not cut the transdermal patch
- Wash hands thoroughly with soap and water after application
- Avoid touching or applying pressure to the patch once applied 1
Timing Considerations
- Apply at least 4 hours before antiemetic effect is required for motion sickness
- For post-operative nausea and vomiting (PONV), apply the evening before scheduled surgery
- Protective plasma concentration (approximately 50 pg/mL) is achieved after 6 hours
- Steady-state concentration (approximately 100 pg/mL) is achieved 8-12 hours after application 2
Duration and Replacement
- Each patch is effective for up to 72 hours (3 days)
- If therapy is required for longer than 3 days, remove the first patch and apply a new one behind the opposite ear 1
- Upon removal, fold the used patch in half with the sticky side together and discard in household trash to prevent accidental contact 1
Clinical Applications
Breakthrough Treatment for Chemotherapy-Induced Nausea/Vomiting
- Scopolamine patch (1 patch every 72 hours) is recommended as a breakthrough treatment option 3
- Can be added to current antiemetic regimen when first-line treatments are insufficient
Palliative Care
- Useful for managing secretions in end-of-life care 3
- Can be used as part of a multimodal approach to symptom management
Important Precautions
Contraindications
- Angle closure glaucoma
- Hypersensitivity to scopolamine or other belladonna alkaloids 1
Common Side Effects
- Dry mouth (occurs in about 50-60% of subjects)
- Drowsiness (up to 20% of subjects)
- Blurred vision and dilation of pupils
- Allergic contact dermatitis (approximately 10% of subjects) 2
Special Considerations
- Monitor intraocular pressure in patients with open-angle glaucoma
- Use with caution in elderly patients due to increased risk of CNS effects
- A double-dose (two patches) may be considered in patients who fail to respond to a single patch, though this should be done with caution and monitoring for adverse effects 4
By following these guidelines, healthcare providers can appropriately order and dispense scopolamine patches for effective management of nausea and vomiting in various clinical scenarios.