Scopolamine Patch Withdrawal Syndrome

Abstract

To the Editor: Scopolamine patch, Tranderm Scop, is marketed by Baxter Healthcare for Novartis for surgical antiemetic control or for the control of motion sickness. Each patch contains 1.5 mg of scopolamine programmed to deliver 1 mg over 3 days transdermally through a layer of rate controlling membrane.1 It was designed to be removed 24 hours after surgery. For control of motion sickness, it was to be changed every 72 hours and removed from the skin after the condition for motion sickness had passed. Scopolamine patch withdrawal syndrome is under-recognized and under-appreciated. A literature search and discussion with medical and pharmacy colleagues yielded very little information about adverse effects associated with discontinuation of scopolamine. Scopolamine is generally believed to be the most effective drug to control motion sickness, with a 75% reduction in motion-induced nausea and vomiting; others dispute that it is not any more effective than antihistamines like meclizine.2 Scopolamine patch is generally not recommended for children or the elderly because of toxicity. We had received several patient complaints about scopolamine patch withdrawal after using them for motion sickness control on vacations. The associated symptoms were described as being very debilitating, similar to exacerbated motion sickness with severe headache.3 This syndrome affected mostly patients who used the patch for 3 days or more, although there was at least one case in which a patient who only used the patch for 24 hours was affected. Typically, symptoms manifested 18 to 72 hours after the patch was removed and could last from several days to weeks. Common symptoms included nausea, headache, and blurred vision. These symptoms were consistent with rebound cholinergic activity and included dizziness, nausea, vomiting, paresthesias of the hands and feet, dysphoria, and hypotension.