Scopolamine Hydrobromide

SCOPOLAMINE HYDROBROMIDE- scopolamine hydrobromide injection, solution
APP Pharmaceuticals, LLC

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FOR INTRAMUSCULAR, INTRAVENOUS OR SUBCUTANEOUS USE

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DESCRIPTION

Scopolamine Hydrobromide Injection, USP is a sterile solution of scopolamine hydrobromide (C17 H21 NO4 • HBr • 3H2 O) in Water for Injection. The injection is preserved with methylparaben 0.18% and propylparaben 0.02%. Scopolamine Hydrobromide Injection is intended for intramuscular, intravenous and subcutaneous use. The pH (3.5-6.5) is adjusted with hydrobromic acid if necessary.

The structural formula is:

scopolamine-structure
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CLINICAL PHARMACOLOGY

Scopolamine hydrobromide is one of the major antimuscarinic agents that inhibit the action of acetylcholine (ACh) on autonomic effectors innervated by postganglionic cholinergic nerves as well as on smooth muscles that lack cholinergic innervation. It exerts little effects on the actions of ACh at nicotinic receptor sites such as autonomic ganglia. The major action of this antimuscarinic agent is a surmountable antagonism to ACh and other muscarinic agents.

As compared with atropine, scopolamine differs only quantitatively in antimuscarinic actions. Scopolamine has a stronger action on the iris, ciliary body and certain secretory glands such as salivary, bronchial and sweat. Scopolamine, in therapeutic doses, normally causes drowsiness, euphoria, amnesia, fatigue and dreamless sleep with a reduction in rapid-eye-movement sleep. However, the same doses occasionally cause excitement, restlessness, hallucinations or delirium, especially in the presence of severe pain. Scopolamine depresses the EEG arousal response to photostimulation. It is more potent than atropine on the antitremor activity (parkinsonism) in animals induced by surgical lesions. Scopolamine is effective in preventing motion sickness by acting on the maculae of the utricle and saccule.

Scopolamine, although less potent than atropine, has been used frequently in preanesthetic medication for the purpose of inhibiting the secretions of the nose, mouth, pharynx and bronchi and reduces the occurrence of laryngospasm during general anesthesia. Scopolamine is less potent in the decrease of cardiac rate, but not in the changes of blood pressure or cardiac output. Like other antimuscarinic agents, scopolamine has been used widely in the treatment of peptic ulcers and as an antispasmodic agent for G.I. disorders. This is due to the fact that scopolamine reduces salivary secretion, the gastric secretion (both the volume and acid content), and also it inhibits the motor activity of the stomach, duodenum, jejunum, ileum and colon, characterized by a decrease in tone, amplitude and frequency of peristaltic contractions.

INDICATIONS AND USAGE

Scopolamine Hydrobromide Injection, USP is indicated as a sedative and tranquilizing depressant to the central nervous system. In its peripheral actions, scopolamine differs from atropine in that it is a stronger blocking agent for the iris, ciliary body and salivary, bronchial and sweat glands but is weaker in its action on the heart (in which it is incapable of exerting actions in tolerated doses), the intestinal tract and bronchial musculature.

In addition to the usual uses for antimuscarinic drugs, scopolamine is employed for its central depressant actions as a sedative. Frequently it is given as a preanesthetic medicament for both its sedative-tranquilizing and antisecretory actions. It is an effective antiemetic. It is used in maniacal states, in delirium tremens and in obstetrics. As a mydriatic and cycloplegic, it has a somewhat shorter duration (3 to 7 days) and intraocular pressure is affected less markedly than with atropine.

CONTRAINDICATIONS

Scopolamine hydrobromide is contraindicated in patients with narrow-angle glaucoma, since administration of the drug could raise the intraocular pressure to dangerous levels. However, this will not happen for side-angle glaucoma patients. Repeated administration of scopolamine to a patient with chronic lung disease is considered to be potentially hazardous. Patients hypersensitive to belladonna or to barbiturates may be hypersensitive to scopolamine hydrobromide.

WARNINGS

Addiction does not occur, although vomiting, malaise, sweating and salivation have been reported in patients with parkinsonism upon sudden withdrawal of large doses of scopolamine. Scopolamine is one of the most important drugs of the belladonna group from the standpoint of poisoning; infants and young children are especially susceptible to the belladonna alkaloids. Scopolamine is usually stated more toxic than atropine. Idiosyncrasy is more common with scopolamine than with atropine and ordinary therapeutic doses sometimes cause alarming reactions.

PRECAUTIONS

General

If there is mydriasis and photophobia, dark glasses should be worn. Appropriate dosage precautions must be taken with infants, children, persons with mongolism, brain damage, spasticity, or light irides. Elevated intraocular pressure, urinary difficulty and retention and constipation are more probable in elderly persons. Men with prostatic hypertrophy should especially be monitored for urinary function. Because of the tachycardic effects of the drugs, care must be exercised when tachycardia, other tachyarrhythmias, coronary heart disease, congestive heart disease or hyperthyroidism preexist. Persons with hypertension may experience both exaggerated orthostatic hypotension and tachycardia. Similarly, autonomic neuropathy requires caution. Persons with a history of allergies or bronchial asthma will show a higher than normal incidence of hypersensitivity reactions.

Laboratory Tests

Barbiturates may increase Bromosulfonphthalein (BSP) levels; administration is not recommended during the 24 hours preceding the test.

Drug Interactions

Other drugs, such as phenothiazines, tricyclic antidepressants, certain antihistamines, meperidine, etc., which have weak antimuscarinic activity, may considerably intensify the effects of antimuscarinic drugs. Aluminum- and magnesium trisilicate-containing antacids have been shown to decrease the absorption of some antimuscarinic drugs and may possibly do so with all of them.

Pregnancy Category C

Scopolamine hydrobromide can pass the placental barrier; the threat to the fetus in utero is unknown, but use during pregnancy may cause respiratory depression in the neonate and may contribute to neonatal hemorrhage due to reduction in Vitamin K-dependent clotting factors in the neonate.

Scopolamine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Nursing Mothers

Problems in humans have not been documented; however, risk-benefit must be considered since barbiturates and belladonna alkaloids are excreted in breast milk.

ADVERSE REACTIONS

With nearly all antimuscarinic drugs, dry mouth is the first and dry skin is the second most common side effect. Thirst and difficulty in swallowing occur when the mouth and esophagus become sufficiently dry; chronic dry mouth also fosters dental caries. Suppression of sweating causes reflexive flushing and heat intolerance and can result in heat exhaustion or heat stroke in a hot environment; it also contributes to the hyperthermia seen in intoxication. Mydriasis frequently occurs, especially with scopolamine; photophobia and blurring of vision are consequences of mydriasis. Cycloplegia (which exacerbates blurred vision) occurs approximately concomitantly with mydriasis, but usually higher doses are required. In susceptible persons, especially the elderly, cycloplegia may contribute to an elevation of intraocular pressure. Difficulty in urination and urinary retention may occur. Tachycardia is a common side effect. Constipation, even bowel stasis, may occur.

In the larger therapeutic doses, scopolamine may cause dizziness, restlessness, tremors, fatigue and locomotor difficulties.

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