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Table of Contents > Herbs & Supplements > Scopolamine Print

Scopolamine

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Also listed as: Hyoscine
Related terms
Background
Evidencetable
Tradition
Dosing
Safety
Interactions
Attribution
Bibliography

Related Terms
  • Alkaloid, angel's trumpet, anisodamine, anisodine, Atropa belladonna, atropine, Barbidonna®, Barophen®, belladonna, belladonna drugs, Belladonnae folium, Belladonnae radix, Bellatal®, black henbane, bromhidrato de escopolamina (Spanish), burrachero (Spanish - Colombia), Buscopan®, corkwood tree, Datura inoxia, deadly nightshade, Donnagel®, Donnapectolin-PG®, Donnapine®, Donna-Sed®, Donnatal®, Donphen®, Duboisia myoporoides, Ficus septica Burm.f. (Moraceae), henbane, hydrobromide, hyoscine, hyoscine hydrobromide, hyoscyamine, Hyoscyamus, Hyoscyamus niger (henbane), Hyosophen®, ioscina bromidrato (Italian), Isopto® hyoscine, Kapectolin-PG®, Kinesed®, levo-duboisine, Malatal®, maldemar tablets, methylscopolamine, moonflower, Murocoll-2®, nightshade family, Polyalthia microtus Miq. (Annonaceae), Popowia odoardi Diels (Annonaceae), Scop®, Scopace®, scopace tablets, Scopine tropate®, scopolamine bromhydrate, scopolamine hydrobromide, scopolamine hydrobromidum, scopolamine ophthalmicops, Scopolia, Scopolia carniolica, Scopolia root, Scopoliae, Spaslin®, Spasmolin®, Spasmophen®, Spasquid®, Susano®, Transderm Scop® Patch, Transderm-V®.
  • Selected combination products: Twilight Sleep (morphine and scopolamine). Some older formulations of Percodan® and some European brands of methadone injectable fluid contain scopolamine hydrobromide.

Background
  • Scopolamine (also called hyoscine) occurs naturally in belladonna plants, such as henbane (Hyoscyamus niger) and deadly nightshade (Atropa belladonna). Scopolamine is available as a prescription drug and has many effects in the body, including decreasing the secretion of stomach fluids, preventing nausea, slowing digestive action of the stomach and intestines, and dilating the pupils. Traditionally, belladonna preparations have been used as both poisons and remedies.
  • Scopolamine patches placed behind the ear, which deliver a relatively low dose at a constant rate over three days, provide a convenient delivery system with fewer side effects than scopolamine taken by mouth or injected. The most common adverse effects associated with scopolamine are dry mouth, dizziness, drowsiness, and blurred vision. A nasal spray has been tested, and eyedrops are in use.
  • Due to its effectiveness against seasickness, scopolamine is commonly used by sailors and scuba divers. The U.S. National Aeronautics and Space Administration (NASA) Reduced Gravity Office (RGO) uses scopolamine alone and in combination with dextroamphetamine to treat motion sickness symptoms during test flights.

Evidence Table

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *


There is sufficient evidence to support the use of scopolamine applied to the skin in preventing motion sickness.

A


When combined with morphine, scopolamine is useful for premedication for surgery or diagnostic procedures and was widely used in obstetrics in the past. The mixture also produces amnesia and a tranquilized state known as "twilight sleep."

B


There is conflicting evidence from available research to support the use of scopolamine in the treatment of nausea after various surgeries.

B


Despite a limited number of properly organized studies, it seems that the use of scopolamine in the treatment of drooling has a sound physiological basis.

B


Antispasmodic properties of scopolamine have been shown in preliminary research. Additional studies are needed.

C


There is insufficient evidence to support the use of scopolamine in the management of cough induced by drugs that act as angiotensin-converting enzyme (ACE) inhibitors.

C


Scopolamine has been used in the past to treat addiction to drugs such as heroin and cocaine. Currently, there is insufficient evidence to recommend scopolamine as medication in this condition.

C


In several small trials, scopolamine applied to the skin failed to affect pulmonary function and symptoms of reversible airway obstruction. Currently, there is insufficient evidence to support the use of scopolamine for this condition.

C


There is not sufficient evidence to recommend scopolamine alone or in combination with tacrine for Alzheimer's disease. High-quality research in humans is required.

C


Previous research suggests that intramuscular scopolamine prevents dreams or remembering dreams in healthy young women undergoing surgery with propofol-nitrous oxide anesthesia. More research is needed in this area.

C


Although scopolamine has been reported to have antidepressant effects, the evidence in this area is conflicting. High-quality research in humans is required.

C


There is insufficient evidence to support the use of scopolamine in the treatment of biliary colic (pain associated with inflammation of the gallbladder or gallstones).

C


There is insufficient evidence to support the use of scopolamine for bowel conditions. More research is needed in this area.

C


There is insufficient evidence to support the use of scopolamine in the treatment of bronchial asthma. More research is needed in this area.

C


Scopolamine is frequently given to patients dying in the hospice during the final 24 hours, although there is not high-quality clinical evidence supporting this use.

C


Currently, there is insufficient evidence to support the use of scopolamine in the treatment of dizziness. High-quality research in humans is required.

C


There is insufficient evidence to support the use of scopolamine for the treatment of otitis media (ear infection) in children. More research is needed in this area.

C


Evidence to support the use of scopolamine for the prevention of fainting is lacking. Additional research is needed.

C


There is insufficient evidence to support the use of scopolamine in the treatment of recurrent throbbing headache. More research is needed in this area.

C


There is insufficient evidence to recommend the routine use of a low dose of scopolamine for myocardial infarction (heart attack) patients. High-quality research in humans is required.

C


Currently, there is insufficient evidence to support the use of scopolamine in treating chronic heart failure. More research is needed in this area.

C


Currently, there is insufficient evidence to support the use of scopolamine in the treatment of high blood pressure. More research is needed.

C


There is insufficient evidence to support the use of scopolamine in the routine treatment of an abnormally slow heartbeat. High-quality research in humans is required.

C


There is conflicting preliminary evidence as to whether scopolamine is effective in the management of irritable bowel syndrome. More research is needed.

C


Scopolamine shows promising results for use in labor and delivery. However, further studies are needed before conclusions can be made about its safety and effectiveness.

C


Although several studies demonstrate that scopolamine affords significant pain relief for those with kidney stones, several other drugs appear to be superior to scopolamine. More high-quality research in humans is required.

C


There is insufficient scientific evidence supporting the effectiveness of scopolamine in treating people with involuntary movements caused by antipsychotic drugs. High-quality research in humans is required.

C


The results of several studies on the effectiveness of scopolamine in the treatment of peptic ulcer are conflicting. Currently, there is insufficient evidence to recommend the use of scopolamine as routine medication for this condition.

C


Because scopolamine's ability to cross the blood-brain barrier is better than that of atropine, it has been suggested that it should be used in patients with organophosphate poisoning who have central nervous system symptoms. Further research is needed in this area.

C


There is conflicting evidence concerning the use of scopolamine for the treatment of pain after laparoscopic sterilization or open prostatectomy. Further studies are needed in this area.

C


Limited research suggests that scopolamine is able to relieve anxiety and cause sedation when used as a premedicant, although with less effectiveness than other drugs. Currently, there is insufficient evidence to support the use of scopolamine for this condition.

C


Currently, there is insufficient evidence to recommend the use of a scopolamine skin patch in the treatment of certain types of seizures. Additional research is needed in this area.

C


The results of a limited number of studies on the efficacy of a scopolamine skin patch in the treatment of overactive bladder are inconclusive. There is not sufficient evidence to recommend scopolamine as a medication for this condition.

C


There is insufficient evidence from available studies to support the use of scopolamine in controlling vomiting induced by the anticancer drug cisplatin. More research is needed.

C


Limited research suggests that scopolamine N-butyl bromide should not be used in the treatment of gastroesophageal reflux disease (GERD).

D
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)


Tradition / Theory

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

  • Abdominal cramps, antispasmodic (stomach), dental hygiene, diverticulitis (digestive disorder), dysentery (severe diarrhea), dystonia (movement disorder), epilepsy, eye disorders, gastrointestinal motility and secretion, hives (itching), intestinal inflammation, Parkinson's symptoms, respiratory disorders (sinus and lung drying agent), sleep aid.

Dosing

Adults (18 years and older)

  • For refraction (a diagnostic procedure), one or two drops of scopolamine have been placed in the eye before the procedure. For uveitis and iridocyclitis (eye inflammations), one or two drops of scopolamine have been placed in the eye up to four times daily.
  • For abdominal pain, 60 milligrams of scopolamine-N-butylbromide has been taken by mouth daily for seven days.
  • As an antidepressant, intravenous doses of four micrograms of scopolamine hydrobromide per kilogram has been given in a series of three sessions, 3-5 days apart.
  • For bladder disorders (overactive bladder without neurological cause), scopolamine patches have been applied behind the ear and been changed every three days, for a total of four applications.
  • For dizziness, a Transderm-V® patch (currently named Transderm-Scop®, Ciba Pharmaceutical Co.) has been applied to the skin with a release rate of approximately 0.17 milligrams daily, for seven days. One or two patches containing 0.5 milligrams of scopolamine have been applied to the skin and replaced every three days for one week.
  • For fainting, a Transderm-Scop® patch (Ciba-Geigy, Palo Alto, CA) has been applied to the skin.
  • For heart failure (chronic), a patch of Scopoderm® TTS (unknown dose) has been applied to the skin.
  • For heart attack, a single transdermal therapeutic system (TTS) patch (Ciba Consumer Pharmaceuticals) has been applied behind the ear for 24 hours.
  • For kidney stones, a single dose of 20 milligrams of scopolamine N-butylbromide has been injected intravenously.
  • For labor and delivery, scopolamine butylbromide has been given intravenously once women entered active labor.
  • For motion sickness, one dose of 0.3 milligrams of scopolamine hydrobromide has been taken by mouth three times daily for five days; 0.6 milligrams of scopolamine has been taken by mouth every six hours; and a single dose of 0.3-0.6 milligrams of scopolamine hydrobromide has been taken by mouth. Scopolamine applied to the skin 8-12 hours before departure for the sea provided controlled delivery of 0.5-1.5 milligrams over three days. Nasal sprays containing 0.1 and 0.2% scopolamine have been tested for an unreported amount of time.
  • For nausea (morphine-induced), a scopolamine patch applied to the skin released a starting dose of 140 micrograms, followed by a release of five micrograms per hour over three days.
  • For peptic ulcer disease, 40 milligrams of scopolamine- N-butyl bromide (Buscopan®) has been taken by mouth five times daily for 10 days.
  • For postoperative nausea and vomiting, a scopolamine patch, such as Scopoderm® or Transderm Scop® (both delivering a loading dose of 140 micrograms and then five micrograms per hour for up to 72 hours, giving an average absorption rate of 500 micrograms over three days), has been applied the evening before surgery and kept in place for 24 hours following surgery. A patch containing a dose of 0.75 or 0.375 milligrams has been applied to the skin.
  • For postoperative pain, Scopoderm® (Ciba-Geigy Ltd., Basel, Switzerland), providing continuous delivery of 0.5 milligrams of scopolamine daily over three days, has been applied on the morning of the operation. Buscopan® (20 milligrams) has been given intravenously or intramuscularly at the end of surgery.
  • For preoperative sedation, the recommended dosage of scopolamine hydrobromide is 0.3-0.6 milligrams given intramuscularly or intravenously, 45-60 minutes prior to anesthesia.
  • For saliva production control, 0.02 milligrams of scopolamine hydrobromide solution per kilogram has been taken by mouth as a single dose.
  • For uveitis, iridocyclitis (eye inflammation), one or two drops of scopolamine were placed in the eye up to four times daily.

Children (under 18 years old)

  • There is no proven safe and effective dose of scopolamine in children.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

  • Avoid with known allergy or hypersensitivity to scopolamine, atropine, belladonna, hyoscyamine, anticholinergic drugs, or any component of the skin patch system. Allergic contact dermatitis has been reported with the patch.

Side Effects and Warnings

  • Studies on the long-term effects of scopolamine are lacking.
  • Many of the adverse effects reported in clinical trials of scopolamine, particularly in the patch form, were also reported by patients in the placebo group. It is therefore possible that some of these adverse effects may be due to a component of the patch other than scopolamine itself.
  • The most common adverse effects associated with scopolamine include drowsiness, blurred vision, dilated pupils, dizziness, rapid heartbeat, thirst, and dry skin, mouth, and respiratory passages.
  • Symptoms associated with a scopolamine overdose include impaired speech, thirst, sensitivity to light, constipation, difficulty urinating, rapid heartbeat, agitation, nervousness, confusion, eye pain or redness in the whites of the eye, skin rash, itching, vomiting, headache, nausea, palpitations, flushing and fever, headache, hallucinations, and delirium. The more severe side effects are more commonly observed when scopolamine is taken by mouth or injected.
  • Other side effects include abdominal bloating; aggression; agitation; amnesia; anticholinergic syndrome; anxiety; changes in attention or sociability; changes in heart and pulse rates; changes in vision; confusion; constipation; contact dermatitis; decreased growth hormone secretion at night; decreased response to some hormones; diarrhea; difficulty focusing the eyes; difficulty urinating or defecating; disorientation; double vision; eczema (skin disorder); excessive pupil dilation; excitation; fatigue; flushing; gait disturbance; glaucoma; hallucinations; impairment of memory storage; increased intraocular pressure; increased mouthing behaviors; increased swallowing difficulties; itching or pain at the site of application; lightheadedness; loss of appetite; loss of muscle control; maturation disorders; nausea; pain; problems with the heart's electrical system; psychological dependence; rashes; reduced alertness; reduced gastrointestinal mobility; reduced sense of taste; restlessness; seizure; sexual excitement; shakiness; shortness of breath; sobbing; stomachache; sweating; swelling of the face, lips, or tongue; talkativeness; throat scratching and swelling; urinary retention; vertigo; vomiting; and withdrawal symptoms (sweating, runny nose, abdominal cramps, nausea, vomiting, vertigo, dizziness, irritability, headache, balance disturbances, and diarrhea).
  • The safety of scopolamine in pregnancy and in children has not been established. Use cautiously in patients that are pregnant, trying to get pregnant, or breastfeeding.
  • Scopolamine may cause low or high blood pressure. Caution is advised in patients taking drugs, herbs, or supplements that affect blood pressure.
  • Use cautiously in patients with heart conditions, due to the risk of fast or slow heartbeat, unpleasant feelings, and palpitations.
  • Use cautiously in psychiatric patients, as psychosis is well documented after administration.
  • Use cautiously in patients with sensitive skin, due to the risk of scopolamine patches causing localized reactions such as skin dryness, itching, redness, eczema (a skin disorder), and rashes.
  • Use cautiously in patients with eye disorders, due to the risk of visual disturbance, such as blurred or double vision and excessive pupil dilation.
  • Use cautiously in scuba divers in deep water (below 50-60 feet); some divers that use scopolamine to prevent seasickness reported pain in the eyes that subsided quickly if the diver then ascended to a depth of 40 feet or less.
  • Use cautiously in patients with nerve pain, hyperthyroidism, or a history of seizures.
  • Use cautiously with alcohol, due to the possibility of increased drowsiness and dizziness.
  • Use cautiously before surgery, as certain anesthetics may cause irregular heartbeat when used with scopolamine.
  • Use cautiously with other drugs that dry up secretions, due to increased risk of adverse effects.
  • Use cautiously in patients using central nervous system depressants (drugs that affect the central nervous system), as use of scopolamine and these agents together may theoretically cause additive effects.
  • Use cautiously in elderly patients, due to an overall higher incidence of adverse effects in this population.
  • Avoid in patients with a known allergy or hypersensitivity to scopolamine, atropine, belladonna, hyoscyamine, drugs that dry up secretions, or any component of the skin patch delivery system.
  • Avoid scopolamine patches during magnetic resonance imaging (MRI), as skin burns may theoretically occur.
  • Avoid in patients with liver, kidney, or lung insufficiency.
  • Avoid in patients with narrow-angle glaucoma (a disorder of the eyes).
  • Avoid in patients with bladder disorders (for example, bladder neck blockage due to an enlarged prostate).
  • Avoid in patients with obstructive disease of the gastrointestinal tract.
  • Avoid in patients with severe ulcerative colitis or toxic megacolon complicating ulcerative colitis (gastrointestinal disorders).
  • Avoid in patients with myasthenia gravis (a neuromuscular disorder).
  • Avoid in patients with chronic lung disease.
  • Avoid driving or operating heavy machinery, due to potential drowsiness or sedation caused by scopolamine.
  • Patients are advised to wash their hands after handling a scopolamine patch, as many adverse effects associated with scopolamine use have been experienced by individuals that have handled the patches and then contaminated their skin or eyes. Used patches should be disposed of properly to avoid contact with children or pets. Limited contact with water, as in bathing or swimming, is safe with the patch. If the patch falls off, patients are advised to throw it away and put a new one behind the other ear.
  • Patients that wear contact lenses may feel some discomfort when taking scopolamine. Lubricating drops may help.
  • Some patients may need to wear sunglasses when taking scopolamine, due to light sensitivity.
  • Patients are advised to have liquids on hand when taking scopolamine.

Pregnancy and Breastfeeding

  • Studies on the long-term effects of scopolamine are lacking. Its safety in pregnancy and in children has not been established.
  • Scopolamine is classified as U.S. Food and Drug Administration (FDA) pregnancy category C (adequate human or animal studies are lacking; or adverse fetal effects occurred in animal studies, but human data are lacking). Although scopolamine was originally used in obstetrics as an anesthetic, many researchers now consider it dangerous for both mother and baby.
  • According to the American Academy of Pediatrics Committee on Drugs, scopolamine is usually compatible with breastfeeding. Infants should be observed for anticholinergic symptoms and signs of decreased breastfeeding when scopolamine is given to the mother.

Interactions

Interactions with Drugs

  • Scopolamine may cause high or low blood pressure. Caution is advised in patients taking other drugs that affect blood pressure.
  • Scopolamine may increase the amount of drowsiness caused by some drugs. Examples include benzodiazepines such as lorazepam (Ativan®) or diazepam (Valium®), barbiturates such as phenobarbital, narcotics such as codeine, some antidepressants, and alcohol. Caution is advised while driving or operating machinery.
  • Scopolamine may also interact with agents that affect the nervous system, agents that increase movement in the stomach, alcohol, anesthetics, antidepressants, antihistamines, barbiturates, caffeine, drugs that dry up secretions, heart rate-regulating agents, hormonal agents, morphine, muscle relaxants, and potassium.

Interactions with Herbs and Dietary Supplements

  • Scopolamine may cause high or low blood pressure. Caution is advised in patients taking herbs or supplements that affect blood pressure.
  • Scopolamine may increase the amount of drowsiness caused by some herbs or supplements.
  • Scopolamine may also interact with antidepressants, antihistamines, caffeine, Ginkgo biloba, grapefruit, heart rate-regulating agents, herbs and supplements that dry up secretions, herbs and supplements that affect the nervous system, muscle relaxants, and potassium.

Attribution
  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. Bar R, Gil A, Tal D. Safety of double-dose transdermal scopolamine. Pharmacotherapy 2009;29(9):1082-8.
  2. Bartholomeusz CF, Wesnes KA, Kulkarni J, et al. Estradiol treatment and its interaction with the cholinergic system: effects on cognitive function in healthy young women. Horm Behav 2008;54(5):684-693.
  3. Buchhalter AR, Fant RV, Henningfield JE. Novel pharmacological approaches for treating tobacco dependence and withdrawal: current status. Drugs 2008;68(8):1067-1088.
  4. Dumas J, Hancur-Bucci C, Naylor M, et al. Estradiol interacts with the cholinergic system to affect verbal memory in postmenopausal women: evidence for the critical period hypothesis. Horm Behav 2008;53(1):159-169.
  5. Einarsson JI, Audbergsson BO, Thorsteinsson A. Scopolamine for prevention of postoperative nausea in gynecologic laparoscopy, a randomized trial. J Minim Invasive Gynecol 2008;15(1):26-31.
  6. Estrada A, Leduc PA, Curry IP, et al. Airsickness prevention in helicopter passengers. Aviat Space Environ Med 2007;78(4):408-413.
  7. Fredrickson A, Snyder PJ, Cromer J, et al. The use of effect sizes to characterize the nature of cognitive change in psychopharmacological studies: an example with scopolamine. Hum Psychopharmacol 2008;23(5):425-436.
  8. Fujii Y. Clinical strategies for preventing postoperative nausea and vomitting after middle ear surgery in adult patients. Curr.Drug Saf 2008;3(3):230-239.
  9. Furey ML, Pietrini P, Haxby JV, et al. Selective effects of cholinergic modulation on task performance during selective attention. Neuropsychopharmacology 2008;33(4):913-923.
  10. Grynkiewicz G, Gadzikowska M. Tropane alkaloids as medicinally useful natural products and their synthetic derivatives as new drugs. Pharmacol Rep 2008;60(4):439-463.
  11. Jogani VV, Shah PJ, Mishra P, et al. Intranasal mucoadhesive microemulsion of tacrine to improve brain targeting. Alzheimer Dis Assoc Disord 2008;22(2):116-124.
  12. Meijer JW, van Kuijk AA, Geurts AC, et al. Acute deterioration of bulbar function after botulinum toxin treatment for sialorrhoea in amyotrophic lateral sclerosis. Am J Phys Med Rehabil 2008;87(4):321-324.
  13. Mintzer MZ, Griffiths RR. Differential effects of scopolamine and lorazepam on working memory maintenance versus manipulation processes. Cogn Affect Behav Neurosci 2007;7(2):120-129.
  14. Thomas E, Snyder PJ, Pietrzak RH, et al. Specific impairments in visuospatial working and short-term memory following low-dose scopolamine challenge in healthy older adults. Neuropsychologia 2008;46(10):2476-2484.
  15. Weissman BA, Raveh L. Therapy against organophosphate poisoning: the importance of anticholinergic drugs with antiglutamatergic properties. Toxicol Appl Pharmacol 2008;232(2):351-358.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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