Transdermal Scopolamine Patch Research Articles

The effect of transdermal scopolamine plus intravenous dexamethasone for the prevention of postoperative nausea and vomiting in patients with epidural PCA after major orthopedic surgery

BackgroundPostoperative nausea and vomiting (PONV) is common complication of Patient-Controlled Analgesia (PCA) after surgery. The authors sought to determine whether a transdermal scopolamine (TDS) patch in combination with IV dexamethasone is more effective than IV dexamethasone alone or IV dexamethasone plus IV ramosetron for reducing PONV in patients receiving epidural PCA after major orthopedic surgery.Methods120 patients that received epidural PCA with hydromorphone and ropivacaine after major orthopedic surgery under spinal anesthesia were allocated to 3 groups: Group D (n = 40) received IV dexamethasone 8 mg, Group DR (n = 40) received IV dexamethasone 8 mg plus IV ramosetron 0.3 mg, Group DS (n = 40) received IV dexamethasone 8 mg plus a TDS patch (Group DS, n = 40). Nausea and vomiting incidences, VAS for nausea, the use of additional antiemetics, and adverse effects (a dry mouth, blurred vision, drowsiness) during the first 24 hours postoperatively were subjected to analysis.ResultsThe DS Group had a significantly higher rate of complete remission of PONV than the D and DR groups (82.5% vs 47.5%, and 50.0%, respectively), and had lower rates of nausea (17.5% vs 55.0%, and 50.0%), and vomiting (10.0% vs 50.0%, and 25.0%), and required less antiemetics (5.0% vs 35.0%, 22.5%) than group D and Group DR during the first 24 hours after surgery. Furthermore, no inter-group differences were observed with respect to adverse effects in the three groups.ConclusionsThe prophylactic use of a TDS patch plus dexamethasone was found to be a more effective means of preventing PONV in patients that received epidural PCA after major orthopedic surgery than dexamethasone alone or dexamethasone plus ramosetron without adversely affecting side effects.

Withdrawal symptoms after discontinuation of transdermal scopolamine therapy: Treatment with meclizine

The case of a patient who treated withdrawal symptoms from trans-dermal scopolamine with meclizine is reported. A 30-year-old woman for whom transdermal scopolamine was prescribed to manage motion sickness during a vacation experienced severe withdrawal symptoms that began 24 hours after patch removal and lasted for several days. Other medications included an oral contraceptive and as-needed zolmitriptan for migraines. She used the scopolamine patches as prescribed, applying one patch behind the ear every 3 days. After 10 consecutive days of wearing the patch and experiencing no motion sickness, she began to develop dry mouth and uncomfortable, dry eyes, which prompted her to remove the patch. After 24 hours without the patch, she developed severe nausea that did not subside during a car ride. Due to the intractable nausea, she applied a new patch, which she wore for 3 consecutive days without recurrence of the nausea. Upon returning from the trip, she removed the last patch. Twelve hours after the last patch was removed, nausea recurred but was not related to motion. She felt better while lying down, but felt nauseated when standing or walking. After 3 days of this nausea, she began taking nonprescription meclizine 25 mg orally every 12 hours. The nausea subsided after two doses, and she was able to resume her normal activities. The nausea did not recur after discontinuation of the meclizine. She had used transdermal scopolamine eight years prior without any withdrawal symptoms. Withdrawal symptoms experienced after removal of a transdermal scopolamine patch were successfully treated with oral meclizine.

Safety of Double‐Dose Transdermal Scopolamine

To evaluate the safety of double-dose transdermal scopolamine patch therapy. Randomized, crossover, double-blind study. Motion sickness clinic in Haifa, Israel. Twenty male sailors aged 18-21 years whose seasickness symptoms improved only slightly or not at all with a single transdermal scopolamine patch. Subjects received either two transdermal scopolamine patches or one scopolamine patch plus a placebo patch for 24 hours (first session). After at least 1 week from the end of the first session, they received the other treatment for 24 hours (second session). Plasma scopolamine concentrations, physiologic (heart rate and blood pressure), visual, and cognitive function parameters, and adverse effects were assessed before the first session (baseline) and after each 24-hour session. Visual function was tested again 24 hours after patch removal. Subjects also completed an adverse-effects questionnaire immediately after and 24 hours after patch removal for both treatment sessions. A significant difference was found in mean plasma scopolamine concentrations between the single-dose and double-dose treatments (81 vs 127 pg/ml [therapeutic level 100 pg/ml], p<0.01). No significant differences were found in heart rate, blood pressure, cognitive function, or visual function measurements. Mild blurred vision was the only adverse effect for which there was a significant difference between the single-dose and double-dose treatments; however, this adverse effect was judged to be not clinically significant. Double-dose transdermal scopolamine may improve treatment in patients who fail to respond to a single patch by increasing the plasma scopolamine concentration, without aggravating systemic, visual, or cognitive adverse effects. Thus we recommend that a double dose can be administered safely to these patients.

Transdermal scopolamine patch in addition to ondansetron for postoperative nausea and vomiting prophylaxis in patients undergoing ambulatory cosmetic surgery

Study Objective To determine the efficacy of transdermal scopolamine in addition to ondansetron in decreasing the incidence of postoperative nausea and vomiting (PONV). Design Randomized controlled trial. Setting Academic hospital. Patients 126 ASA physical status I and II patients undergoing outpatient plastic surgery with three or more risk factors for PONV. Interventions Patients were randomly assigned to one of two groups to receive (Group 1) a transdermal scopolamine (TDS) patch or (Group 2), a placebo patch two hours before surgery. Measurements Occurrence of vomiting, severity of nausea using a visual analog scale (VAS), rescue medication, pain intensity and pain medications, and side effects were recorded every hour until discharge from hospital, then every 4 hours thereafter for a total of 24 hours. Main Results A statistically significant reduction in postoperative nausea between 8 and 24 hours in patients receiving TDS was noted. Conclusions Transdermal scopolamine in addition to ondansetron benefits patients at high risk for PONV undergoing outpatient plastic surgery for up to 20 hours after surgery.

A Randomized, Double-Blind, Multicenter Trial Comparing Transdermal Scopolamine Plus Ondansetron to Ondansetron Alone for the Prevention of Postoperative Nausea and Vomiting in the Outpatient Setting

Postoperative nausea and vomiting (PONV) are common complications after ambulatory surgery. We sought to determine whether the use of transdermal scopolamine (TDS) in combination with IV ondansetron (OND) is more effective than one alone for reducing PONV in outpatient settings. In a randomized, double blind, multicenter trial, 620 at-risk female patients undergoing outpatient laparoscopic or breast augmentation surgery received either an active TDS patch or a similar appearing sham 2 h before entering the operating room. All patients received IV OND (4 mg) 2-5 min before induction of anesthesia followed by a general anesthetic regimen. Complete antiemetic response, defined as no vomiting/retching or rescue medication use, was measured through 24 h and 48 h after surgery. The proportion of patients with vomiting/retching, nausea, or use of rescue medication, the time from the end of surgery to the first episode of these events and the time to discharge from the hospital/surgery center, as well as the number and severity of vomiting/retching and nausea episodes, and patient satisfaction with antiemetic therapy were also collected. The combination of TDS + OND statistically significantly reduced nausea and vomiting/retching compared with OND alone 24 h after surgery but not at 48 h. The proportion of patients who did not experience vomiting/retching and did not use rescue medication was 48% for TDS + OND and 39% for OND alone (P < 0.02). Total response (no nausea, no vomiting/retching, and no use of rescue medication) was also statistically higher for the TDS + OND group compared with the OND-only group (35% vs 25%, P < 0.01). The time to first nausea, vomiting/retching, or rescue episode was statistically significantly longer for the TDS + OND group compared with the OND-only group (P < 0.05). The cumulative overall incidence of adverse events was lower in the TDS + OND group compared with the OND group (36.7% vs 49%, P < 0.01). TDS + OND reduces PONV compared with OND alone. This is achieved with a reduction in adverse events.

Abstract No. 82: Double-Blinded Randomized Controlled Trial Evaluating the Use of a Scopolamine Patch to Treat Post-Procedural Nausea After Uterine Artery Embolization

Nausea is a well-documented constitutional symptom following uterine artery embolization (UAE). A standardized treatment for post-UAE nausea has not been investigated, and there have not been any randomized control trials evaluating different strategies for managing post-UAE recovery. We designed a double-blinded randomized controlled trial to assess the efficacy of the transdermal scopolamine patch versus placebo in controlling nausea after uterine artery embolization

The Effects of Transdermal Scopolamine on Simulated Ship Navigation and Attention/Reaction Time

Transdermal scopolamine is commonly used by mariners to prevent or treat seasickness. Most studies indicate that scopolamine administered transdermally via an adhesive patch does not impair performance of skills required to navigate a vessel, but trials have not been conducted testing navigation and ship handling under realistic conditions. The aim of this study was to test the effects of transdermal scopolamine on performance using training simulators to assess complex vessel navigation and rough-weather ship handling abilities. A randomized double-blind crossover study assessed 32 Swedish maritime cadets under transdermal scopolamine and placebo conditions on simulated navigation and ship handling performance, sleepiness, and subjective measures of fitness and performance. There were no significant differences on occupational outcomes by medication condition, but sustained reaction time was significantly increased under transdermal scopolamine, relative to placebo. We conclude that the transdermal scopolamine patch does not impair simulated ship handling.

Transdermal Scopolamine: An Alternative to Ondansetron and Droperidol for the Prevention of Postoperative and Postdischarge Emetic Symptoms

Given the controversy regarding the use of droperidol and the high cost of the 5-HT3 antagonists, a cost-effective alternative for routine use as a prophylactic antiemetic would be desirable. We designed two parallel, randomized, double-blind sham and placebo-controlled studies to compare the early and late antiemetic efficacy and adverse event profile of transdermal scopolamine (TDS) 1.5 mg, to ondansetron 4 mg IV, and droperidol 1.25 mg IV for antiemetic prophylaxis as part of a multimodal regimen in "at risk" surgical populations. A total of 150 patients undergoing major laparoscopic (n = 80) or plastic (n = 70) surgery procedures received either an active TDS patch (containing scopolamine 1.5 mg) or a similar appearing sham patch 60 min before entering the operating room. All patients received a standardized general anesthetic technique. A second study medication was administered in a 2-mL numbered syringe containing either saline (for the two active TDS groups), droperidol, 1.25 mg, or ondansetron, 4 mg (for the sham patch groups), and was administered IV near the end of the procedure. The occurrence of postoperative nausea and vomiting/retching, need for rescue antiemetics, and the complete response rates (i.e., absence of protracted nausea or repeated episodes of emesis requiring antiemetic rescue medication) was reported. In addition, complaints of visual disturbances, dry mouth, drowsiness, and restlessness were noted up to 72 h after surgery. There were no significant differences in any of the emetic outcomes or need for rescue antiemetics among the TDS, droperidol, and ondansetron groups in the first 72 h after surgery. The complete response rates varied from 41% to 51%, and did not significantly differ among the treatment groups. The overall incidence of dry mouth was significantly more frequent in the TDS groups than in the droperidol and ondansetron groups (21% vs 3%). Premedication with TDS was as effective as droperidol (1.25 mg) or ondansetron (4 mg) in preventing nausea and vomiting in the early and late postoperative periods. However, the use of a TDS patch is more likely to produce a dry mouth.

Two Cases of Anticholinergic Poisoning from Transdermal Scopolamine Patch

Scopolamine transdermal patch is a form of anticholinergic drug used to prevent motion sickness. We reported two cases of anticholinergic poisoning resulting from scopolamine transdermal patch. The first case experienced local toxicity and presented with right eye mydriasis for five days. The second case developed systemic anticholinergic toxidrome contributed by the scopolamine patch and presented with acute confusion. She was treated successfully by physostigmine, an anticholinergic antidote. The recommendation on physostigmine use was also discussed. We hope that these two case reports will raise the clinician awareness of the potential side effect of this kind of product.

Assessing Risk Factors for Postoperative Nausea and Vomiting: A Retrospective Study in Patients Undergoing Retromastoid Craniectomy With Microvascular Decompression of Cranial Nerves

We have observed that patients, after retromastoid craniectomy (RMC) with microvascular decompression (MVD) of cranial nerves, frequently experienced postoperative nausea and vomiting (PONV). The authors conducted this study to track the incidence of PONV and to identify potential factors for PONV after RMC with MVD. Medical records from 185 adults, who underwent elective RMC with MVD, were identified and reviewed from January 2000 to December 2004. Extracted data included patient, anesthesia, and surgery related variables that were considered to have a possible effect on the patients experiencing PONV after RMC with MVD. Despite the use of intraoperative prophylactic ondansetron in 99% of patients, the overall incidence of PONV (nausea or emesis or both) was 60% during the first 24 hours postoperatively. It was higher for the patients after RMC with MVD of cranial nerve V [69%, 82/119, P=0.005, odds ratio (OR)=2.8]. Regression modeling demonstrated that female sex (OR=3.0, P=0.005) and use of desflurane (OR=2.8, P=0.003) were significant independent predictors of PONV. Prophylactic transdermal scopolamine patch administered preoperatively was associated with less PONV (OR=0.3, P=0.001). We concluded that PONV occurs frequently in adults recovering from RMC with MVD. The results of this study suggest that it may be necessary to administer a combination of antiemetics to decrease the incidence of PONV after RMC.

Antiemetic-related dystonic reaction unmasked by removal of a scopolamine transdermal patch

A case of a dystonic reaction is presented that occurred after the use of prochlorperazine, metoclopramide and ondansetron for the treatment of post-operative nausea and vomiting. The onset of dystonia coincided temporally with the removal of a transdermal scopolamine patch used as adjunctive antiemetic therapy. Withdrawal of concurrently administered anticholinergic medication, after recent use of antiemetic medications with dopamine receptor (D 2) inhibition, can unmask a dystonic reaction. This case also suggests that transdermal scopolamine may offer an innovative therapy for the treatment of acute dystonic reactions.

The Effects of a Preoperative Transdermal Scopolamine on the Postoperative Nausea and Vomiting after Outpatient Conization

Background: Postoperative nausea and vomiting (PONV) is one of the major causes that delays patients discharge in outpatient surgery. A transdermal scopolamine patch (TSP) is effective in preventing PONY and covers PONY for a long duration (72 hr) even after discharge. Therefore, we evaluated PONY using TSP on outpatient conization cases. Methods: Forty four patients scheduled for a conization due to cervical intraepithelial neoplasm were randomly divided into two groups. A Band-Aid)-like patch containing either scopolamine (22 patients in TSP group) or a placebo (22 patient in placebo group) was placed either mastoid area at the night before surgery. Anesthesia was induced with fentanyl (50 or 100 ) and thiopental (375 mg/kg) and maintained with enflurane (1 vol%) and nitrous oxide (60%) in oxygen. The study was performed in a double-blind placebo-controlled manner. Results: Incidences of PONY (TSP group: 4.5%, placebo group: 18.2%), requirements of antiemetics (TSP group: 0%, placebo group: 4.5%), and discharge from the hospital (TSP group: 134.8 min, placebo group: 150.0 min) were not different from each other group. There were no severe complications associated with TSP. Total incidence of side effects was higher in the TSP group than the placebo group (TSP group: 59%, placebo group: 14%) (P

Effect of Stimulation of the P6 Acupoint on Opioid-induced Nausea

Background: Use of opioids to relieve postoperative pain may cause nausea and vomiting. There is growing interest in the use of nonpharmacologic approaches to the prevention of nausea. Particularly transcutaneous electrical nerve stimulation (TENS) of the P6 acupoint has been shown to reduce the incidence of pregnancy-induced nausea and chemotherapy associated emesis. The aim of this study was to investigate the effect of stimulation of the P6 acupoint on nausea induced by opioids for postoperative pain control. Methods: We studied 103 patients receiving intravenous patient controlled analgesia (PCA) with fentanyl after a hysterectomy under general anesthesia. No antiemetic agent or device was provided in the N group (n = 31), and TENS on the P6 acupoint was applied after closure of the peritoneum in the T group (n = 32). In the P group (n = 39), a transdermal scopolamine patch was attached below the mastoid process about 1 hour before induction of general anesthesia. Incidence of nausea and pain score were assessed. Results: The incidence of nausea was significantly less in the T and P groups than in the N group. There was no difference in the incidence of nausea between the T and P groups. The pain score was decreased in all three groups after beginning the PCA. No difference was seen in pain scores among the groups over the time course. Conclusions: TENS of the P6 acupoint reduced the incidence of opioid-induced nausea after a hysterectomy. This result suggests that TENS of the P6 acupoint may be useful as a new therapeutic approach to reduce or prevent nausea caused by opioids.

Effects of transdermal scopolamine on pulmonary function, symptoms and bronchial hyperresponsiveness to methacholine

This study is a result of two consecutive double-blind, placebo-controlled, cross-over studies. In the first study, we evaluated therapeutic effects of a single transdermal scopolamine patch (Scopoderm® TTS, size 2.5 cm 2, Ciba Geigy) on forced expiratory volume in one second (FEV 1), reversibility, peak expiratory flow (PEF) and symptoms in ten patients with reversible airways disease (ΔFEV 1⩾9% predicted). During the study, blood and urine samples were taken from the patients and analysed for scopolamine levels. The drug was adequately taken up from the patch into the systemic circulation. However, no significant clinical effects, nor correlations between the scopolamine levels and the outcome parameters were observed. Because of the possibility of sub-therapeutic doses in the first study, a second study with two transdermal scopolamine patches was performed in ten patients with bronchial hyperresponsiveness to methacholine. The blood and urine concentrations of free scopolamine were doubled compared to the first study. There were still no statistically significant effects on FEV 1, PEF, symptoms, and bronchial hyperresponsiveness, yet most of the patients now reported adverse side effects. We conclude that transdermal administration of scopolamine is not clinically useful in asthma and chronic obstructive pulmonary disease. Even application of two patches does not result in therapeutically effective levels at the muscarinic receptors in the lung, yet causes several side effects.

Clinical Manifestations of Transdermal Scopolamine Addiction

Transdermal scopolamine patches have been extensively prescribed for nonspecific dizziness and vestibular disorders. Patient response may be favorable and side effects are generally limited to xerostomia and blurred vision. However, subtle dependency and outright addiction may develop. Tapered reduction and drug elimination will suffice to eliminate the dependency. However, hospitalization may be necessary to treat severe cases of physiological chemical dependency. Long-term use of transdermal scopolamine patches carries a risk of chemical dependency. Prescribing physicians should review and heed the manufacturer's recommended use.

Ocular Effects of Scopolamine Dermal Patch in Open-Angle Glaucoma

The purpose of this study was to determine the effect of transdermal scopolamine patches on intraocular pressure, pupil size, anterior chamber volume, and accommodation in patients with open-angle glaucoma. Forty patients with chronic open-angle glaucoma participated in a double-masked randomized, placebo-controlled study. Of these 40 glaucoma patients, 20 were on treatment regimens that included pilocarpine (Pilo Group) and 20 were on treatment regimens that excluded pilocarpine or any other cholinergic drug (Non-Pilo Group). For both groups, there was a significant increase in pupil size, anterior chamber volume, and near point on the scopolamine day compared to the placebo day. The pupil size, as measured by pupillography, was increased 17% for the Pilo group and increased 12% for the Non-Pilo group. The volume of the anterior chamber, as measured by photograrmmetry, was increased 8% for the Pilo group and increased 11% for the Non-Pilo group. The near point receded 12% for the Pilo group and receded 19% for the Non-Pilo group. We were unable to detect any statistically significant differences in intraocular pressure for either group. Minimal side effects were reported from both groups. We conclude that it is safe for patients with open-angle glaucoma to use transdermal scopolamine patches.

The Effect of Transdermal Scopolamine Patch on Nausea and Vomiting after Epidural Injection of Morphine

The Effect of Transdermal Scopolamine Patch on Nausea and Vomiting after Epidural Injection of Morphine

Effect of Transdermal scopolamine Patch on Nausea or Vomiting Associated with General Anesthesia

Effect of Transdermal scopolamine Patch on Nausea or Vomiting Associated with General Anesthesia

The Antiemetic Effect of Transdermal Scopolamine Following Outpatient Laparoscopy

The aim of this study was to evaluate the effects of a transdermal scopolamine patch on the incidence and severity of postoperative nausea and vomiting in patients undergoing outpatient laparoscopy.Transdermal scopolamine patch was placed behind ear the night before surgery in study group. Anesthesia was induced with thiopental(4~5mg/ku iv) and succinylcholine(1.5mg/kg) and maintained with meperidine. valium and N2O(50%) in O2.The results were as follows :1) Scopolamine-treated patients had significantly less nausea and vomiting compared with control group. Nausea and/or vomiting was present in 46.4% of the control group but only 18.5% of those getting the scopolamine-treated group.2) Side effects were more frequent among scopollamine-treated patients than control patients (77.8% vs 32.1%) but were not troublesome The common reported side effects were a dry mouth and dizziness.In conclusion transdermal scopolamine appears to be an effective antiemetic agent in patients undergoing outpatient laparoscopy.

Control of Drooling with Transdermal Scopolamine in a Child with Cerebral Palsy

Transdermal scopolamine patches (1.5 mg) were used to control drooling in a two-year-old boy with severe spastic quadriparetic cerebral palsy and developmental delay. He responded well to the continuous scopolamine therapy, with a decrease in drooling, and a secondary decrease in respiratory distress and frequency of suctioning. No significant side-effects were noted.