Scopolamine is an anticholinergic medicine from the belladonna family of plants. It blocks acetylcholine at muscarinic receptors throughout the body, including the pathways in the brain and inner ear that turn motion into nausea, which is why it has been used against seasickness for well over a century and why its side effects, dry mouth, drowsiness, and blurred vision, are the classic anticholinergic ones.
In the United States scopolamine is FDA-approved as a transdermal patch worn behind the ear, which delivers about 1 mg over three days for motion sickness and for nausea and vomiting after surgery, and as an injection. The oral tablets sold in other countries were never kept on the US market. No scopolamine gel, capsule, troche, or nasal spray is manufactured here, so when a prescriber orders one, Bayview compounds scopolamine hydrobromide in that form and strength. These compounded preparations are not FDA-approved, their use is off-label, and a valid prescription is required.
How does it work?
Scopolamine is a competitive inhibitor at postganglionic muscarinic receptors of the parasympathetic nervous system (DailyMed, Transderm Scop label). It is thought to act mainly on M1 receptors in the vestibular nuclei and the vomiting center, interrupting the signal from the balance organs of the inner ear that produces motion sickness (StatPearls, Scopolamine). The same receptor blockade dries saliva and other secretions, slows the gut and bladder, dilates the pupil, and, at higher doses, clouds thinking. Absorbed through the skin, it acts within hours; by mouth or by nasal spray it acts sooner and wears off sooner.
What is it used for?
The approved uses of the patch are the prevention of nausea and vomiting from motion sickness and after surgery (DailyMed, Transderm Scop label). Prescribers order the compounded forms for the same problems when the patch does not fit, for example a patient whose skin reacts to the adhesive, a child or a small adult who needs less than the patch delivers, or a single trip or procedure that does not need a three-day patch. They also order it off-label for persistent nausea in gastroparesis or chemotherapy, for vertigo, and for the drooling that comes with Parkinson's disease and other neurologic conditions, where drying saliva is the point (StatPearls, Scopolamine). Evidence for those uses comes from the manufactured products and from clinical practice, not from trials of compounded gels or capsules. Your prescriber decides whether it fits your situation.
Gel, capsule, troche, or spray?
The transdermal gel is measured with a marked applicator and rubbed into a thin-skinned area, usually the inner wrist or behind the ear, and is the closest compounded equivalent to the patch without the adhesive. Capsules and slow-release capsules are for people who prefer a tablet-like dose or need a longer effect; the troche dissolves in the mouth for someone who cannot swallow; the suspension allows very small or adjustable doses by syringe; the nasal spray acts quickly through the lining of the nose. Your prescriber selects the form and strength; see the strengths section for what Bayview compounds.
How is it used?
Follow the directions on your label exactly. For the gel, measure the dose with the applicator, rub it into clean, dry skin at the site your prescriber named, and wash your hands afterward, because scopolamine on a fingertip can dilate the pupil and blur vision if it reaches the eye (MedlinePlus, Scopolamine Transdermal). For motion sickness, take or apply the dose ahead of travel as directed, commonly an hour before by mouth or several hours before through the skin. Do not take a second dose sooner than your prescriber allowed, and do not combine it with the patch. If you have used it for several days, stopping can bring on dizziness, nausea, headache, and sweating a day or more later; tell your prescriber if that happens (MedlinePlus, Scopolamine Transdermal).
Side effects & safety
Dry mouth is the most common effect; about two thirds of patch users in the motion sickness studies reported it, followed by drowsiness and blurred vision (DailyMed, Transderm Scop label). Dilated pupils, dizziness, constipation, and difficulty urinating are the other typical anticholinergic effects, and the gel can leave mild redness at the site.
Who should not use it?
Do not use scopolamine if you have angle-closure glaucoma or are allergic to scopolamine or other belladonna alkaloids. Talk with your prescriber before using it if you have an enlarged prostate or trouble urinating, a bowel obstruction or severe constipation, a seizure disorder, heart disease, kidney or liver disease, myasthenia gravis, or a history of psychosis, or if you are over 65. It should be avoided in severe preeclampsia. Safety in children has not been established and serious reactions have been reported in children (DailyMed, Transderm Scop label). No information is available on scopolamine during breastfeeding, and anticholinergics can reduce milk supply with longer use (LactMed, Scopolamine); tell your prescriber if you are pregnant or breastfeeding.
How should it be stored?
Store as directed on your label, at room temperature away from heat, light, and moisture, and keep it out of the reach of children and pets; a child who handles the gel or spray can absorb a full adult dose. Do not use it after the beyond-use date, and dispose of unused medication as directed.
Why is this compounded?
The manufactured scopolamine products are the 1 mg three-day patch and an injection; the short-acting oral products sold elsewhere were left off the US market because of their variable blood levels and side effects (StatPearls, Scopolamine). When a prescriber wants a smaller or adjustable dose, a route other than the patch, or scopolamine without adhesive, compounding is the only way to prepare it. As a 503A compounding pharmacy, Bayview prepares each order in small batches under USP standards, pursuant to a prescription for an individual patient. We do not supply it as clinic or office stock, that is the role of a 503B outsourcing facility, which Bayview is not. Compounded preparations are not FDA-approved. Related preparations include Betahistine Capsules, Custom Oral Suspensions, and Omeprazole Suspension. The full list is in our compounded medications catalog.
Clinical details for prescribers
Regulatory status. Scopolamine hydrobromide, a nonselective muscarinic antagonist. FDA-approved presentations: the transdermal system (Transderm Scop, about 1 mg over 3 days) for motion sickness and PONV, and the injection. Oral scopolamine hydrobromide and butylbromide products are marketed outside the US only. Compounded transdermal gel, cream, capsules, troches, suspension, and nasal spray are 503A preparations, not FDA-approved, and off-label. Not a controlled substance.
Formulation & directions. Bayview compounds scopolamine HBr as 0.25 mg/0.1 mL and 0.4 mg/0.1 mL transdermal gel (measured applicator, 10 or 30 mL), 0.25 and 2.5 mg/mL topical cream, 0.2, 0.4, and 1.2 mg capsules, 0.5 and 1 mg slow-release capsules, 0.4 mg troches, 0.1 mg/mL oral suspension, and 0.2% nasal spray. Typical directions: gel 0.1 mL to the inner wrist or postauricular skin every 8 hours as needed, maximum 3 doses in 24 hours; capsules 0.2 to 0.4 mg by mouth 1 hour before travel, repeat once in 8 hours if needed. Write an explicit maximum daily dose on every prescription; the combination capsules with caffeine or chlorpheniramine, and the methscopolamine preparations, are separate items not covered here.
Safety & counseling:
- Contraindicated in angle-closure glaucoma and belladonna alkaloid hypersensitivity; warnings for neuropsychiatric reactions, seizure threshold, eclampsia, urinary retention, GI obstruction, and withdrawal after removal or discontinuation (dizziness, nausea, headache, sweating, confusion at 24 hours or more) (DailyMed, Transderm Scop label).
- Dry mouth in about two thirds of motion-sickness patients; in PONV trials dry mouth 29%, dizziness 12%, somnolence 8%, agitation 6% (DailyMed, Transderm Scop label). Counsel on hand washing after the gel (unilateral mydriasis from finger-to-eye transfer) and on driving.
- Additive effects with other anticholinergics, CNS depressants, and alcohol; increased CNS sensitivity in the elderly; monitor for psychiatric symptoms; discontinue if difficulty urinating develops (StatPearls, Scopolamine). Anticholinergic toxidrome responds to physostigmine in severe cases.
- Pediatric safety and effectiveness not established; serious adverse reactions reported. Lactation: no published data; anticholinergics may inhibit lactation with prolonged use (LactMed, Scopolamine).
- Evidence for the compounded routes is extrapolated from the patch and from practice; no trials of compounded scopolamine gel or capsules were identified. Frame expectations accordingly, particularly for sialorrhea and vertigo.
Non-controlled; ship to patient or office per the order form. Licensed to dispense in RI, MA, CT, NY, NJ, NH, and FL. Background: DailyMed, Transderm Scop label; StatPearls, Scopolamine; LactMed, Scopolamine. Account setup, licensing, and ordering are covered on our for providers page.
This is a prescription compounded medication and is not FDA-approved; its use is off-label. This information is educational and is not medical advice. Your prescriber determines whether it is appropriate and sets the formulation and directions.
