Anticholinergics, such as scopolamine, have been shown to be capable of depressing the mucociliary transport system.Īcetaminophen Aspirin Diphenhydramine: (Moderate) The anticholinergic effects of sedating H1-blockers may be enhanced when combined with other antimuscarinics. Photophobia / Early / Incidence not knownĬycloplegia / Early / Incidence not knownĪmblyopia / Delayed / Incidence not knownīlepharitis / Early / Incidence not knownĪbatacept: (Minor) Because abatacept has been shown to potentiate the onset of respiratory infections, concomitant use of drugs that decrease mucociliary clearance should be used cautiously. Urinary retention / Early / Incidence not knownĬontact dermatitis / Delayed / Incidence not known Heat intolerance / Early / Incidence not knownĪnhidrosis / Delayed / Incidence not knownĭysphagia / Delayed / Incidence not known Hyperthermia / Delayed / Incidence not known Sinus tachycardia / Rapid / Incidence not known Orthostatic hypotension / Delayed / Incidence not known Palpitations / Early / Incidence not known Memory impairment / Delayed / Incidence not known Hypotension / Rapid / Incidence not known Hallucinations / Early / Incidence not known Although scopolamine transdermal patches are used for post-operative nausea/vomiting (PONV), the patches are for surgeries other than caesarean section. Scopolamine administered parenterally to rats and rabbits at higher doses than the dose delivered by transdermal scopolamine did not increase the duration of labor, nor did it affect uterine contractions. Scopolamine hydrobromide has been shown to have a marginal embryotoxic effect in rabbits when administered by daily intravenous injection at doses producing plasma levels approximately 100 times the level achieved in humans using a transdermal system.
In animal studies, there was no evidence of adverse developmental effects with intravenous administration of scopolamine hydrobromide revealed in rats. In published case reports, 2 pregnant patients with severe preeclampsia were administered intravenous and intramuscular scopolamine, respectively, and developed eclamptic seizures soon after scopolamine administration. Avoid use of scopolamine in pregnant women with severe preeclampsia or eclampsia because eclamptic seizures have been reported after exposure to scopolamine. The use of multiple medications with anticholinergic properties may be particularly problematic because of cumulative effects.Ĭaesarean section, eclampsia, preeclampsia, pregnancyĪvailable data from observational studies and postmarketing reports with scopolamine use in human pregnancy have not identified a drug associated risk of major birth defects, miscarriage, or adverse fetal outcomes. According to the OBRA guidelines, medications with anticholinergic properties, such as scopolamine, may cause mental status changes, constipation, drowsiness, dizziness, dryness of mucus membranes, blurred vision, urinary retention, or other adverse effects that are common and problematic, especially in older individuals. The federal Omnibus Budget Reconciliation Act (OBRA) regulates medication use in residents of long-term care facilities (LTCFs).
The Beers expert panel also recommends avoiding strong anticholinergic medications in geriatric patients with the following due to the potential for symptom exacerbation or adverse effects: dementia/cognitive impairment (adverse CNS effects), delirium/high risk of delirium (new-onset or worsening delirium), or lower urinary tract symptoms/benign prostatic hyperplasia in men (urinary retention or hesitancy). According to the Beers Criteria, systemic antispasmodics such as scopolamine are considered potentially inappropriate medications (PIMs) in geriatric patients and should be avoided due to uncertain effectiveness and high anticholinergic activity. The anticholinergic effects of scopolamine may be significant and are additive with other anticholinergic medications, particularly in the older adult. Geriatric patients may be more sensitive to the effects of scopolamine.
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