If you notice any other effects, check with your healthcare professional. Call your doctor for medical advice about side effects.
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You may opt-out of email communications at any time by clicking on the unsubscribe link in the e-mail. Of the 17 remaining patients, all used the patch for postoperative nausea control because of prior difficult experiences.
The patches were applied for 4 to 72 hours, with the average duration being 42 hours. All these patients found the scopolamine patches to be very effective and experienced no nausea or vomiting as compared to their previous surgical experiences. None of these patients experienced any signs of withdraw symptoms after the patches were stopped. Meclizine, a piperazine-derivative H 1 -receptor antagonist, possesses anticholinergic activity and is also effective in the treatment of motion sickness.
The mechanism of action of meclizine, although not completely understood, is believed to be related to its centrally acting anticholinergic property. It is thought to affect the medullary chemoreceptor trigger zone and decrease labyrinth excitability and vestibular stimulation. Meclizine has been used successfully to treat scopolamine withdrawal syndrome.
High-dose meclizine can have significant sedative effects that vary with each patient. Caution should be used with the 50 mg dose. Alternatively, some patients were successfully treated by leaving the last scopolamine patch on for a week uninterrupted, supplemented with meclizine 25 mg orally every 8 to 12 hours on day 5 and beyond as needed.
At the end of 72 hours, each scopolamine patch still contains 0. Neither Baxter Healthcare nor Novartis were able to provide pharmacokinetic data for use beyond 72 hours. Case reports of scopolamine withdrawal syndrome appear in the literature as early as The syndrome, while debilitating, was self-limiting in most cases.
To our knowledge, despite some emergency room visits, no deaths have been attributed to withdrawal. There is little incentive to elucidate the mechanism, but it could be related to an upregulation of cholinergic receptors in the vestibular system or a supraphysiological release of acetylcholine following discontinuation of the patch.
The longer the patches were used, the higher the incidence of withdrawal symptoms. In our study, we found no withdrawal symptoms when the scopolamine patch was used for less than 72 hours; the incidence rate of extended use is still unknown. Further studies with a larger population can help refine the results.
Patients using the patch need to be made aware of the possibility of withdrawal syndrome, especially when an extended use of the patch is anticipated. No reports of withdrawal from meclizine that is used for motion sickness prophylaxis could be found in a literature search. Meclizine could be an appropriate first-line choice for motion sickness in patients who have experienced scopolamine withdrawal previously or for patients who need extended motion sickness prevention.
However, if meclizine is not adequate, management options for scopolamine patch withdrawal as mentioned should be helpful. Further research is warranted in the areas of incidence, mechanisms, and treatment.
National Center for Biotechnology Information , U. Journal List Hosp Pharm v. Hosp Pharm. Published online Mar Steve H. Find articles by Chris VanEaton. Author information Copyright and License information Disclaimer. Corresponding author: Steve H. 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.
The visual problems increase following repeated patch applications, with hypermetropic "long sighted" individuals particularly at risk. Central nervous system effects comprise reduced memory for new information, impaired attention, and lowered feelings of alertness.
Variation in response to transdermal scopolamine has also been reported, both between individuals, and between different patch applications on the same individual.
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