Scopolamine Transdermal Patch

Scopolamine transdermal patches are approved for adults to prevent two types of nausea and vomiting:

• Motion sickness: Scopolamine Transdermal System and Transderm Scōp are used to prevent the nausea and vomiting that comes with travel by car, boat, plane, or other movement.
• Post-operative nausea and vomiting (PONV): Transderm Scōp is applied before surgery to prevent nausea and vomiting related to anesthesia, opioid pain medicines, and the surgical procedure itself — for surgeries other than cesarean section.

Scopolamine is an anticholinergic — it blocks the action of a chemical messenger called acetylcholine in the nervous system. Most importantly for nausea, it interrupts the nerve signals traveling from the vestibular system (your inner ear's balance center) to the brain's vomiting center. By blocking those signals, the brain doesn't receive the trigger to make you feel or be sick. The patch format slowly releases the medicine through the skin into the bloodstream over three days, providing steady, long-lasting coverage without needing to swallow a pill.

The patch is applied to the clean, dry, hairless skin behind one ear. For motion sickness, apply it at least 4 hours before protection is needed; one patch lasts up to 3 days. For longer trips, remove the first patch and apply a new one behind the other ear. For surgery prevention, Transderm Scōp is applied the evening before the procedure and removed 24 hours after surgery. Only wear one patch at a time, never cut it, and always follow your prescriber's specific instructions.

The most common side effects vary a little depending on the reason for use:

Seek immediate help for hallucinations, severe confusion, eye pain, high fever without sweating, or difficulty urinating — these are signs of serious reactions that need prompt attention.

• Eye pressure (angle closure glaucoma): Scopolamine can dilate pupils and raise pressure inside the eye, triggering a sudden, painful eye emergency. If you have any type of glaucoma, tell your doctor before using this patch.
• Psychiatric and cognitive effects: Hallucinations, paranoia, agitation, confusion, and even seizures have been reported. Older adults are at higher risk. Remove the patch and seek help if these occur.
• Dangerous overheating (hyperthermia): The patch reduces sweating, which can let your body temperature climb to dangerous levels — especially in hot weather. Fatal cases have occurred. Remove the patch and contact a provider if you stop sweating or feel overheated.
• Withdrawal after removal: After several days of use, removing the patch can cause dizziness, nausea, headache, sweating, and confusion starting 24 hours or more after removal. These symptoms can be severe.
• MRI burns: The patch contains a metallic layer. Always remove it before an MRI scan to prevent skin burns.
• Urinary retention: Scopolamine can make it hard to urinate. Stop using the patch and call your doctor if you have difficulty urinating.
• Pregnancy: Avoid use in severe preeclampsia — eclamptic seizures have been reported in pregnant women given scopolamine in that setting.

Several types of medicines and substances can interact with the scopolamine patch and increase your risk of side effects:

• Sedatives, sleep aids, opioids, and anti-anxiety drugs: Can dramatically increase drowsiness and disorientation — use together with caution or avoid if possible.
• Alcohol: Worsens CNS effects like drowsiness and impaired coordination.
• Other anticholinergic drugs (certain antihistamines, tricyclic antidepressants, muscle relaxants, meclizine, other belladonna alkaloids): Stacking anticholinergic effects raises the risk of confusion, urinary retention, overheating, and bowel slowdown.
• Oral medicines absorbed in the stomach: Scopolamine slows the stomach, which can alter how quickly other oral drugs are absorbed — especially important for medicines with a narrow margin between a working dose and a harmful one.
• Gastric secretion testing: Remove the patch at least 10 days before this type of test, as scopolamine will skew the results.

Not a complete list. The label covers the interactions the manufacturer studied or reported, and our own interaction database does not cover every medicine either. Bring your full medication list, including vitamins and herbal products, to your pharmacist.

• Angle closure glaucoma: Do not use — scopolamine can trigger a dangerous spike in eye pressure.
• Allergy to scopolamine or belladonna alkaloids: Do not use if you've had a reaction to this family of medicines.
• Open-angle glaucoma: Use with caution; your eye pressure should be monitored.
• Seizure history: Talk to your doctor — scopolamine may lower the seizure threshold.
• Prostate enlargement or bladder problems: Higher risk of urinary retention; monitor carefully.
• Suspected intestinal blockage: Use with caution and closer monitoring.
• Pregnancy: Scopolamine crosses the placenta. Avoid in severe preeclampsia due to seizure risk.
• Breastfeeding: Scopolamine passes into breast milk; discuss risks and benefits with your doctor.
• Children: Not approved for pediatric use; serious reactions including hallucinations, hyperthermia, and a fatal case have been reported in children.
• Older adults (65+): Higher risk of confusion, hallucinations, dizziness, and overheating — closer monitoring is recommended.
• Kidney or liver impairment: Increased risk of CNS side effects; more frequent monitoring is advised.

Too much scopolamine — for example from wearing multiple patches at once or from a patch being swallowed — can cause serious anticholinergic toxicity. Signs include rapid heart rate, confusion, hallucinations, seizures, high body temperature, urinary retention, dry flushed skin, and vision disturbances. If this happens, remove all patches immediately and call Poison Control at 1-800-222-1222 or go to an emergency room.

Scopolamine works by blocking muscarinic receptors — the docking sites that the nerve chemical acetylcholine normally binds to — in the parasympathetic nervous system and in the brain. By doing so, it can reduce saliva and sweat production, slow gut movement, dilate the pupils, increase heart rate, cause drowsiness, and suppress the signals that trigger vomiting. These widespread effects explain both its therapeutic benefits and its potential side effects.

After the patch is applied behind the ear, scopolamine begins entering the bloodstream within about 4 hours, with peak blood levels reached on average within 24 hours. The patch is designed to release medicine steadily over 3 days. Once the patch is removed, some scopolamine that has been absorbed into the skin continues to enter the bloodstream, which is why effects — and sometimes withdrawal symptoms — can persist after removal. The drug is broken down in the body and eliminated mainly through the urine, with a half-life (the time it takes blood levels to fall by half) of about 9.5 hours after the patch comes off.

Store upright at 20° to 25°C (68° to 77°F) . Store pouch(es) in an upright position.