Can I double up on a scopolamine (transdermal patch) if it's not working for motion sickness?

Doubling Scopolamine Patches for Motion Sickness

Doubling up on scopolamine patches is not recommended for motion sickness as it exceeds FDA-approved dosing and may increase the risk of adverse effects without clear evidence of additional benefit.

Standard Dosing and Administration

The FDA-approved dosing for scopolamine transdermal patches for motion sickness is:

• One patch (1.5 mg) applied to the hairless area behind one ear at least 4 hours before the antiemetic effect is required 1
• Each patch is designed to deliver approximately 1 mg of scopolamine over 3 days 1
• The FDA label explicitly states: "Only wear one transdermal system at any time" 1

Evidence for Double Dosing

While one small study (n=20) found that double-dose transdermal scopolamine increased plasma concentrations from 81 pg/ml to 127 pg/ml without significant increases in adverse effects 2, this research is limited by:

• Small sample size
• Short duration (24 hours)
• Young, healthy male subjects only (18-21 years)
• Not endorsed by FDA labeling or clinical guidelines

Potential Risks of Exceeding Recommended Dose

Doubling the dose may increase the risk of adverse effects:

• Neuropsychiatric effects: confusion, disorientation, memory impairment, hallucinations 1
• Acute angle closure glaucoma in susceptible individuals 1
• Anticholinergic side effects: dry mouth, blurred vision, drowsiness 3
• Increased risk of cognitive impairment, especially in elderly patients 1

Alternative Approaches for Inadequate Motion Sickness Control

If a single scopolamine patch is ineffective, consider these alternatives:

1. Ensure proper application:

   • Apply to clean, dry, hairless area behind the ear
   • Apply at least 4 hours before antiemetic effect is needed 1

2. Try alternative medications:

   • Antihistamines (meclizine 12.5-25 mg TID, dimenhydrinate 25-50 mg TID) 4
   • Combination therapy with different mechanism agents

3. Non-pharmacological approaches:

   • Position yourself where motion is minimized (center of boat, front seat of car)
   • Focus on the horizon
   • Avoid reading or screens during travel
   • Consider use of handheld fans directed at the face 4

Conclusion

While one small study suggests double-dosing might be safe in young healthy males, the FDA labeling explicitly instructs to use only one patch at a time. The potential risks of adverse effects outweigh the uncertain benefits of doubling the dose. If motion sickness persists despite proper application of a single patch, consider alternative or complementary therapies rather than exceeding the recommended dose.