What is the duration of use for a scopolamine (anticholinergic) patch?

From the Guidelines

A scopolamine patch should be used for no more than 3 days (72 hours) per application, as indicated by the dose of 1.5 mg patch every 3 days 1. The scopolamine patch is designed to deliver a controlled dose of scopolamine through the skin to prevent nausea and vomiting associated with various conditions, including gastroparesis. Key considerations for the use of a scopolamine patch include:

• The patch should be placed on a different area of skin behind the ear to prevent skin irritation.
• Prolonged exposure to scopolamine can lead to side effects including dry mouth, blurred vision, drowsiness, and in rare cases, confusion or hallucinations, particularly in older adults.
• The time-limited use is important to minimize the risk of adverse effects or medication tolerance. Some important details to consider when using a scopolamine patch include:
• Always wash hands thoroughly after handling the patch to avoid transferring medication to the eyes, which can cause temporary pupil dilation and blurred vision.
• Scopolamine is used off-label in gastroparesis despite lack of supporting clinical studies, as noted in the study published in Clinical Gastroenterology and Hepatology 1.
• The study provides a comprehensive overview of treatment options for refractory gastroparesis symptoms, including medications for nausea and vomiting, medications to accelerate gastric emptying, and other interventions 1.

From the FDA Drug Label

• Motion Sickness: Apply one transdermal system to the hairless area behind one ear at least 4 hours before antiemetic effect is required for use up to 3 days If therapy for more than 3 days is required, remove the first transdermal system and apply a new transdermal system behind the other ear. • PONV: For surgeries other than cesarean section, apply one transdermal system behind the ear the evening before surgery and remove 24 hours following surgery.

The scopolamine patch can be used for up to 3 days for motion sickness. If therapy is required for more than 3 days, the patch should be removed and a new one applied behind the other ear. For post-operative nausea and vomiting (PONV), the patch is typically applied the evening before surgery and removed 24 hours following surgery 2.

From the Research

Scopolamine Patch Usage Duration

• The scopolamine patch is designed to deliver a continuous slow release of scopolamine through intact skin during the first 72 hours of patch application 3, 4, 5, 6, 7.
• The patch contains a reservoir of 1.5 mg of scopolamine programmed to deliver 0.5 mg over a 3-day period 3.
• After 72 hours, the patch should be removed and a new one applied behind the opposite ear 3.
• The recommended dosage is a single TTS-S patch applied to the postauricular area at least 6-8 hours before the anti-motion sickness effect is required 3.
• For faster protection, the patch may be applied 1 hour before the journey in combination with oral scopolamine (0.3 or 0.6 mg) 3.

Adverse Effects and Efficacy

• The adverse effects produced by TTS-S, although less frequent, are qualitatively typical of those reported for the oral and parenteral formulations of this agent 3.
• Dry mouth occurs in about 50-60% of subjects, drowsiness in up to 20%, and allergic contact dermatitis in 10% 3.
• TTS-S has proved to be significantly superior to placebo in reducing the incidence and severity of motion sickness by 60-80% 3.
• Transdermal scopolamine is effective in preventing postoperative nausea and vomiting (PONV) versus placebo 5, 6, 7.