Can a 12-year-old male use a scopolamine (anticholinergic) patch?

Scopolamine Patch Use in a 12-Year-Old Male

Scopolamine transdermal patches are not approved for use in pediatric patients and should not be used in a 12-year-old male due to safety concerns and lack of established efficacy in this age group.

Safety Concerns in Pediatric Patients

Scopolamine patches carry significant risks when used in children:

• The FDA label explicitly states: "Safety and effectiveness in pediatric patients have not been established" 1
• Pediatric patients are particularly susceptible to adverse reactions of scopolamine, including:
  • Mydriasis (pupil dilation)
  • Hallucinations
  • Amblyopia (vision impairment)
  • Drug withdrawal syndrome 1

Documented Adverse Events in Children

Multiple case reports document serious adverse effects when scopolamine patches have been used in children:

• A 4-year-old boy developed toxic psychosis with hallucinations, aggressive behavior, hyperactivity, and incoherent speech 2
• A 9-year-old child experienced central anticholinergic syndrome with hallucinations and incontinence more than 24 hours after patch placement 3
• Two children (ages 5y 8mo and 7y 6mo) showed significant visual side effects including reduced near visual acuity and dilated pupils with reduced or no response to light 4

Alternative Anticholinergic Options for Children

For managing conditions that might warrant anticholinergic therapy in children (such as excessive secretions):

• Glycopyrrolate is the preferred medication for drying tracheal secretions due to its limited central nervous system penetration 5
• The American Academy of Pediatrics recommends glycopyrrolate dosing of 0.004 mg/kg IV, not to exceed 0.1 mg in a single dose 5

Appropriate Antiemetic Options for Children

If the intended use is for nausea and vomiting management:

• The NCCN guidelines recommend several alternatives for breakthrough nausea/vomiting that would be more appropriate for pediatric patients 6:
  • 5-HT3 receptor antagonists (e.g., ondansetron)
  • Metoclopramide (10-40 mg PO or IV every 4-6 hours)
  • Prochlorperazine (10 mg PO or IV every 4-6 hours)

Conclusion

Scopolamine patches should not be used in a 12-year-old male due to:

1. Lack of FDA approval for pediatric use
2. Documented serious adverse effects in children
3. Availability of safer alternatives with established pediatric dosing

When managing conditions that might warrant anticholinergic therapy in children, glycopyrrolate should be considered as the first-line agent with appropriate pediatric dosing. For antiemetic purposes, 5-HT3 antagonists or other age-appropriate options should be used instead.