Scopolamine Contraindications and Precautions
- autonomic neuropathy
- cardiac arrhythmias
- closed-angle glaucoma
- coronary artery disease
- GI obstruction
- ileus
- myasthenia gravis
- open-angle glaucoma
- toxic megacolon
- ulcerative colitis
- urinary tract obstruction
- anticholinergic medications
- asthma
- breast-feeding
- children
- chronic obstructive pulmonary disease (COPD)
- contact lenses
- elderly
- gastroesophageal reflux disease (GERD)
- heart failure
- hepatic disease
- hiatal hernia
- hypertension
- hyperthyroidism
- pregnancy
Scopolamine Contraindications and Precautions
The anticholinergic effects of scopolamine may be significant and are additive with other anticholinergic medications.
Scopolamine is contraindicated in patients with closed-angle glaucoma or open-angle glaucoma because the drug can induce cycloplegia and mydriasis, which would result in increased intraocular pressure. The anticholinergic effects of scopolamine may make the eyes dry. This can cause an increased lens awareness, or blurred vision for wearers of contact lenses. The use of lubricating drops may be necessary, or in severe cases discontinued use of contact lenses while using scopolamine skin patches.
Scopolamine is contraindicated in patients with urinary tract obstruction or bladder neck obstruction due to prostatic hypertrophy because it can cause urinary retention via its antimuscarinic effects on the ureters and bladder.
Scopolamine is contraindicated in patients with GI obstruction because its antimotility effects can exacerbate this disease state and can cause paralytic ileus. Scopolamine is contraindicated in patients with severe ulcerative colitis because it decreases GI motility and can exacerbate the condition. Scopolamine is contraindicated in patients with adynamic ileus, and toxic megacolon because it further decreases intestinal motility and exacerbates these conditions. Scopolamine should be used cautiously in patients with gastroesophageal reflux disease (GERD) or hiatal hernia associated with reflux esophagitis. Antimuscarinics decrease gastric motility and relax the lower esophageal sphincter. These effects promote gastric retention and aggravate reflux in these patients.
Scopolamine should be used with caution in patients with asthma or chronic obstructive pulmonary disease (COPD) because of its effects on bronchial smooth muscle and bronchial secretory glands.
Scopolamine is contraindicated in patients with myasthenia gravis or autonomic neuropathy because the drug competes with the small amount of acetylcholine that has potential to act in the body.
Scopolamine is contraindicated in patients with coronary artery disease or congestive heart failure because it can increase heart rate, which would increase the oxygen demand on the heart. Scopolamine should be used with caution in patients with hyperthyroidism because these patients may be at an increased risk of suffering adverse effects, especially in the heart. Scopolamine should be used with caution in patients with hypertension since the drug has some actions on the heart and can exacerbate this condition. Scopolamine is contraindicated in patients with cardiac arrhythmias because it can potentiate arrhythmias by blocking the vagal inhibition of the SA node.
Patients with a known hypersensitivity to belladonna alkaloids can experience an allergic reaction including anaphylaxis.
Scopolamine should be used with caution in patients with hepatic disease because the drug can accumulate to toxic levels in the body.
Scopolamine is classified as FDA pregnancy risk category C. Although there are no adequate human studies of the effects of this drug on the fetus, animal reproduction studies have shown adverse fetal effects. Therefore, in making the decision to administer this drug during pregnancy, the potential risks to the fetus must be weighed against the potential benefits to the mother.
Scopolamine is excreted in human milk. The manufacturer warns that caution should be exercised when administering scopolamine to a breast-feeding woman. However, the American Academy of Pediatrics considers scopolamine to be generally compatible with breast-feeding.
Children and the elderly may be more sensitive to the effects of scopolamine.
[ Last revised: 3/9/2004 10:25:00 AM ]
References
. American Academy of Pediatrics (AAP) Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics 2001;108:776 - 89.
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