What are the side effects of hyoscine (scopolamine) in children?

Side Effects of Hyoscine (Scopolamine) in Children

Hyoscine causes significant anticholinergic side effects in children, with the most concerning being central nervous system effects including confusion, hallucinations, drowsiness, and psychosis, along with peripheral effects like dry mouth, blurred vision, tachycardia, and hypotension. 1, 2

Central Nervous System Effects

The most serious side effects in children involve CNS toxicity:

• Confusion, disorientation, and short-term memory loss are commonly reported, particularly in overdose situations 1
• Visual and auditory hallucinations can occur and may persist for 12-48 hours after drug exposure 1, 2
• Psychosis has been documented in sensitive individuals, presenting with dysarthria, ataxia, euphoria, anxiety, agitation, and inappropriate affect 1
• Drowsiness and sedation are frequent, impairing the ability to perform activities requiring mental alertness 1, 3
• Impaired cognitive function, including reduced memory for new information and decreased attention, has been demonstrated 4

Cardiovascular Effects

Hyoscine produces notable cardiovascular changes in children:

• Tachycardia is a common finding, particularly in overdose scenarios 2
• Hypotension can occur and may be clinically significant 2
• QTc prolongation on ECG has been documented in pediatric overdose cases 2
• Bradycardia may paradoxically occur in some cases 4

Ocular Effects

Visual disturbances are particularly problematic:

• Blurred vision and impaired visual accommodation (mydriasis) occur frequently 1, 3
• Visual problems may worsen with repeated applications, especially in hypermetropic (farsighted) children 4
• Finger-to-eye contamination can cause direct ocular effects when using transdermal preparations 3

Gastrointestinal and Autonomic Effects

Peripheral anticholinergic effects include:

• Dry mouth (xerostomia) is one of the most common side effects 1, 3, 4
• Reduced salivary secretions occur consistently 4
• Urinary retention or difficulty urinating may develop 3

Thermoregulatory Effects

A critical safety concern in children:

• Heat prostration, fever, and heat stroke can occur due to decreased sweating, particularly in high environmental temperatures 1
• This represents a potentially life-threatening complication requiring immediate recognition

Age-Specific Considerations

Children are particularly vulnerable to unintentional overdose due to:

• Attractive packaging and over-the-counter availability making accidental ingestion more likely 2
• Lower body weight resulting in higher per-kilogram doses from standard formulations 2
• Psychiatric manifestations (hallucinations, confusion, ataxia) may be the primary presenting features in young children 2

Duration and Resolution

• Most CNS effects resolve within 12-48 hours after discontinuation of the drug 1
• Visual and auditory hallucinations may persist throughout this period without requiring specific treatment 2

Critical Warnings

Contraindications in specific situations:

• Should not be used in children with incomplete intestinal obstruction, as diarrhea may be an early warning symptom that would be masked 1
• Extreme caution is required in hot environments due to impaired thermoregulation 1
• Children should be warned against activities requiring mental alertness while taking this medication 1

Monitoring Recommendations

When hyoscine is administered to children:

• Monitor for early signs of CNS toxicity including behavioral changes, confusion, or visual disturbances 1, 2
• Assess cardiovascular parameters including heart rate and blood pressure 2
• Watch for signs of heat intolerance in warm environments 1
• Evaluate urinary output to detect retention 3