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Transderm scopolamine: A painless, noninvasive option for control of postoperative nausea and vomiting
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Transderm Scopolamine: A Painless, Noninvasive Option for Control of Postoperative Nausea and Vomiting Debbie Sandlin, RN, CPAN SCOPOLAMINE, AN anticholinergic drug once widely used as an anesthetic premedication, has recently received renewed interest as an antiemetic in the form of a transdermal patch for the treatment of postoperative nausea and vomiting (PONV).1 Scopolamine is a belladonna alkaloid that is thought to act by blocking cholinergic transmission in the vomiting center of the central nervous system. It also inhibits saliva and sweat secretion, increases heart rate, dilates the pupils, and causes drowsiness and depressed motor function.2 The Transderm Scop Patch System (TDS) is a tan-colored, circular flat patch designed to continuously release scopolamine, and should be applied to clean skin behind either ear (Fig 1).
Risk Factors Influencing PONV Many patients may benefit from preoperative antiemetic treatment, including those with a history of PONV or motion sickness, those already experiencing preoperative nausea and vomiting, and those who are young women. Several surgical procedures are likely to produce PONV including craniotomy; ear, nose, and throat procedures; plastic surgery procedures; major intraabdominal procedures; shoulder procedures; oral surgical procedures; corrective surgery for strabismus; and procedures greater than one hour in duration. Other contributing factors may include dehydration, anxiety, obesity, and pain. According to Marley,3 outpatient PONV contributes to patient dissatisfaction, adverse physiological sequelae, delays in discharge from the facility, unanticipated hospital admission, and added cost. Journal of PeriAnesthesia Nursing, Vol 17, No 6 (December), 2002: pp 427-429
Dosage and Administration The Transderm Scopolamine patch is designed to deliver approximately 1.0 mg of scopolamine over 3 days. It should be applied to the hairless area behind one ear at least 4 hours before the anticipated antiemetic need. The backing of the patch should be peeled off and the patch pressed firmly behind the ear (Fig 2). Patients can shower while wearing the patch without affecting its potency.4 Although the patch is designed to last for 3 days, it can be removed earlier if needed, and the effects will wear off. Hands should be washed thoroughly with soap and water after handling the patch to prevent temporary dilatation of the pupils and blurred vision, which can be caused by inadvertently touching the eye area.
Adverse Effects Rare idiosyncratic reactions may include acute toxic psychosis, confusion, agitation, rambling speech, hallucinations, paranoia, and delusions. Patients participating in underwater sports may occasionally experience disorienting effects from scopolamine.4 The most frequent adverse effects of this drug are dry mouth and dizziness.
Debbie Sandlin, RN, CPAN, is the Clinical Coordinator for the PACU and Presurgical Holding Unit at Southern Hills Medical Center, Nashville, TN. Address correspondence to Debbie Sandlin, RN, CPAN, 508 Michele Dr, Antioch, TN 37013. © 2002 by American Society of PeriAnesthesia Nurses. 1089-9472/02/1706-0011$35.00/0 doi:10.1053/jpan.2002.36555 427
DEBBIE SANDLIN
428
Fig 1.
Schematic of Transderm Sco p patch. Reprinted with permission from Novartis.
Contraindications and Precautions The TDS is contraindicated in persons who are allergic or hypersensitive to scopolamine or other belladonna alkaloids and in patients with narrow-angle glaucoma. It may be used in wideangle glaucoma patients if closely monitored,
Fig 2.
because increased intraocular pressure may result. The patch should not be used in children and should be used with caution in the elderly population. Scopolamine has also been shown to be excreted in human milk and should therefore be used with caution in lactating women.4
Correct positioning of the Transderm Sco p patch. Reprinted with permission from Novartis.
TRANSDERM SCOPOLAMINE FOR CONTROL OF PONV
Caution should be exercised in patients with pyloric, urinary bladder neck, or intestinal obstruction, as well as in patients with impaired liver or kidney function. Scopolamine may potentially aggravate pre-existing seizure disorders or psychosis, and patients who are taking sedatives, tranquilizers, antihistamines, tricyclic antidepressants, and muscle relaxants should be monitored carefully.
429
though not appropriate for all patient populations, it is an alternative that should be considered by perianesthesia professionals. Additional information about this product can be obtained by contacting Novartis Pharmaceuticals Corporation at One Health Plaza, East Hanover, NJ 07936-1080, or by calling them at 973-7818300. Product information may also be accessed on line at www.transdermscop.com.
Effectiveness Several studies have been conducted to evaluate the efficacy of the TDS. A study by Bailey et al5 concluded that prophylactic TDS is a safe and effective antiemetic for the prevention of PONV in patients undergoing outpatient surgery. Stromberg et al6 concluded that transderm scopolamine was effective in reducing, but not eliminating postoperative nausea. Kotelko et al7 found that the TDS provides a simple, painless, continuously administered dose of scopolamine, which significantly reduced, but did not completely eliminate, the occurrence of nausea, vomiting, or retching postoperatively.
Conclusion Transdermal scopolamine has a unique role in the prevention and management of PONV. Al-
References 1. Gan TJ: Postoperative nausea and vomiting—Can it be eliminated? JAMA 287:1233-1236, 2002 2. Physicians’ Desk Reference (ed 56). Montvale, NJ, Medical Economics Inc, 2002, pp 2302-2304 3. Marley R: Postoperative nausea and vomiting: The outpatient enigma. J PeriAnesth Nurs 11:147-161, 1996 4. Transderm Scop: Prescribing Information. 2000 Novaritis Consumer Health, Inc. East Hanover, NJ, Novartis. Available at www.transdermscop.com. Accessed May 28, 2002 5. Bailey PL, Streisand JB, Pace NL, et al: Transderm scopolamine reduces nausea and vomiting after outpatient laparoscopy. Anesthesiology 72:977-980, 1990 6. Stromberg BV, Reines DH, Ackerly J: Transderm scopolamine for the control of perioperative nausea. Am Surg 57:712715, 1991 7. Kotelko DM, Rottman RL, Wright WC, et al: Transdermal scopolamine decreases nausea and vomiting following cesarean section in patients receiving epidural morphine. Anesthesiology 71:675-678, 1989
Transderm Scopolamine: A Painless, Noninvasive Option for Control of Postoperative Nausea and Vomiting Debbie Sandlin, RN, CPAN SCOPOLAMINE, AN anticholinergic drug once widely used as an anesthetic premedication, has recently received renewed interest as an antiemetic in the form of a transdermal patch for the treatment of postoperative nausea and vomiting (PONV).1 Scopolamine is a belladonna alkaloid that is thought to act by blocking cholinergic transmission in the vomiting center of the central nervous system. It also inhibits saliva and sweat secretion, increases heart rate, dilates the pupils, and causes drowsiness and depressed motor function.2 The Transderm Scop Patch System (TDS) is a tan-colored, circular flat patch designed to continuously release scopolamine, and should be applied to clean skin behind either ear (Fig 1).
Risk Factors Influencing PONV Many patients may benefit from preoperative antiemetic treatment, including those with a history of PONV or motion sickness, those already experiencing preoperative nausea and vomiting, and those who are young women. Several surgical procedures are likely to produce PONV including craniotomy; ear, nose, and throat procedures; plastic surgery procedures; major intraabdominal procedures; shoulder procedures; oral surgical procedures; corrective surgery for strabismus; and procedures greater than one hour in duration. Other contributing factors may include dehydration, anxiety, obesity, and pain. According to Marley,3 outpatient PONV contributes to patient dissatisfaction, adverse physiological sequelae, delays in discharge from the facility, unanticipated hospital admission, and added cost. Journal of PeriAnesthesia Nursing, Vol 17, No 6 (December), 2002: pp 427-429
Dosage and Administration The Transderm Scopolamine patch is designed to deliver approximately 1.0 mg of scopolamine over 3 days. It should be applied to the hairless area behind one ear at least 4 hours before the anticipated antiemetic need. The backing of the patch should be peeled off and the patch pressed firmly behind the ear (Fig 2). Patients can shower while wearing the patch without affecting its potency.4 Although the patch is designed to last for 3 days, it can be removed earlier if needed, and the effects will wear off. Hands should be washed thoroughly with soap and water after handling the patch to prevent temporary dilatation of the pupils and blurred vision, which can be caused by inadvertently touching the eye area.
Adverse Effects Rare idiosyncratic reactions may include acute toxic psychosis, confusion, agitation, rambling speech, hallucinations, paranoia, and delusions. Patients participating in underwater sports may occasionally experience disorienting effects from scopolamine.4 The most frequent adverse effects of this drug are dry mouth and dizziness.
Debbie Sandlin, RN, CPAN, is the Clinical Coordinator for the PACU and Presurgical Holding Unit at Southern Hills Medical Center, Nashville, TN. Address correspondence to Debbie Sandlin, RN, CPAN, 508 Michele Dr, Antioch, TN 37013. © 2002 by American Society of PeriAnesthesia Nurses. 1089-9472/02/1706-0011$35.00/0 doi:10.1053/jpan.2002.36555 427
DEBBIE SANDLIN
428
Fig 1.
Schematic of Transderm Sco p patch. Reprinted with permission from Novartis.
Contraindications and Precautions The TDS is contraindicated in persons who are allergic or hypersensitive to scopolamine or other belladonna alkaloids and in patients with narrow-angle glaucoma. It may be used in wideangle glaucoma patients if closely monitored,
Fig 2.
because increased intraocular pressure may result. The patch should not be used in children and should be used with caution in the elderly population. Scopolamine has also been shown to be excreted in human milk and should therefore be used with caution in lactating women.4
Correct positioning of the Transderm Sco p patch. Reprinted with permission from Novartis.
TRANSDERM SCOPOLAMINE FOR CONTROL OF PONV
Caution should be exercised in patients with pyloric, urinary bladder neck, or intestinal obstruction, as well as in patients with impaired liver or kidney function. Scopolamine may potentially aggravate pre-existing seizure disorders or psychosis, and patients who are taking sedatives, tranquilizers, antihistamines, tricyclic antidepressants, and muscle relaxants should be monitored carefully.
429
though not appropriate for all patient populations, it is an alternative that should be considered by perianesthesia professionals. Additional information about this product can be obtained by contacting Novartis Pharmaceuticals Corporation at One Health Plaza, East Hanover, NJ 07936-1080, or by calling them at 973-7818300. Product information may also be accessed on line at www.transdermscop.com.
Effectiveness Several studies have been conducted to evaluate the efficacy of the TDS. A study by Bailey et al5 concluded that prophylactic TDS is a safe and effective antiemetic for the prevention of PONV in patients undergoing outpatient surgery. Stromberg et al6 concluded that transderm scopolamine was effective in reducing, but not eliminating postoperative nausea. Kotelko et al7 found that the TDS provides a simple, painless, continuously administered dose of scopolamine, which significantly reduced, but did not completely eliminate, the occurrence of nausea, vomiting, or retching postoperatively.
Conclusion Transdermal scopolamine has a unique role in the prevention and management of PONV. Al-
References 1. Gan TJ: Postoperative nausea and vomiting—Can it be eliminated? JAMA 287:1233-1236, 2002 2. Physicians’ Desk Reference (ed 56). Montvale, NJ, Medical Economics Inc, 2002, pp 2302-2304 3. Marley R: Postoperative nausea and vomiting: The outpatient enigma. J PeriAnesth Nurs 11:147-161, 1996 4. Transderm Scop: Prescribing Information. 2000 Novaritis Consumer Health, Inc. East Hanover, NJ, Novartis. Available at www.transdermscop.com. Accessed May 28, 2002 5. Bailey PL, Streisand JB, Pace NL, et al: Transderm scopolamine reduces nausea and vomiting after outpatient laparoscopy. Anesthesiology 72:977-980, 1990 6. Stromberg BV, Reines DH, Ackerly J: Transderm scopolamine for the control of perioperative nausea. Am Surg 57:712715, 1991 7. Kotelko DM, Rottman RL, Wright WC, et al: Transdermal scopolamine decreases nausea and vomiting following cesarean section in patients receiving epidural morphine. Anesthesiology 71:675-678, 1989