Due to interactions with metabolism of other drugs, scopolamine can cause significant unwanted side effects when taken with other medications. Specific attention should be paid to other medications in the same pharmacologic class as scopolamine, also known as anti-cholinergics. The following medications could potentially interact with the metabolism of scopolamine: analgesics/pain medications, ethanol, zolpidem, thiazide diuretics, buprenorphine, anti-cholinergic drugs such as tiotropium, etc.
One of the earlier alkaloids isolated from plant sources, scopolamine has been in use in its purified forms (such as various salts, including hydrochloride, hydrobromide, hydroiodide and sulfate), since its isolation by the German scientist Albert Ladenburg in 1880, and as various preparations from its plant-based form since antiquity and perhaps prehistoric times. Following the description of the structure and activity of scopolamine by Ladenburg, the search for synthetic analogues of and methods for total synthesis of scopolamine and/or atropine in the 1930s and 1940s resulted in the discovery of diphenhydramine, an early antihistamine and the prototype of its chemical subclass of these drugs, and pethidine, the first fully synthetic opioidanalgesic, known as Dolatin and Demerol amongst many other trade names.
Scopolamine was used in conjunction with morphine, oxycodone, or other opioids from before 1900 into the 1960s to put mothers in labor into a kind of "twilight sleep". The analgesia from scopolamine plus a strong opioid is deep enough to allow higher doses to be used as a form of anaesthesia.
Scopolamine mixed with oxycodone (Eukodal) and ephedrine was marketed by Merck as SEE (from the German initials of the ingredients) and Scophedal starting in 1928, and the mixture is sometimes mixed on site on rare occasions in the area of its greatest historical usage, namely Germany and Central Europe.
NASA is currently developing a nasal administration method. With a precise dosage, the NASA spray formulation has been shown to work faster and more reliably than the oral form.
Use in pregnancy
Scopolamine crosses the placenta and is a pregnancy Category C medication, meaning that risk to the fetus cannot be ruled out [Either studies in animals have revealed adverse effects on the fetus (teratogenic or embryocidal effects or other) and there are no controlled studies in women, or studies in women and animals are not available. Drugs should be given only if the potential benefits justify the potential risk to the fetus]. It may cause respiratory depression and/or neonatalhemorrhage when used during pregnancy and some animal studies did report adverse events. Transdermal scopolamine has been used as an adjunct to epidural anesthesia for cesarean delivery without adverse CNS effects on the newborn. Except when used prior to cesarean section, use during pregnancy only if the benefit to the mother outweighs the potential risk to the fetus.
Use in breastfeeding
Scopolamine enters breast milk via secretion. Although no human studies exists to document the safety of scopolamine while nursing, the manufacturer recommends caution be used if scopolamine be administered to a nursing woman.
While it is occasionally used recreationally for its hallucinogenic properties, the experiences are often mentally and physically extremely unpleasant, and frequently physically dangerous, so repeated use is rare.
Use in the elderly population
Scopolamine use in the elderly can increase the likelihood of experiencing adverse effects from the drug. This phenomenon is especially true of the elder population who are also concurrently on several other medications. Avoid scopolamine use in this age group due to potent anticholinergic adverse effects and uncertain effectiveness.
About one in five emergency room admissions for poisoning in Bogotá, Colombia have been attributed to scopolamine. In June 2008, more than 20 people were hospitalized with psychosis in Norway after ingesting counterfeit Rohypnol tablets containing scopolamine.
In 1910, scopolamine was detected in the remains believed to be those of Cora Crippen, wife of Dr. Hawley Harvey Crippen, and was accepted at the time as the cause of her death, since her husband was known to have bought some at the start of the year.
Per the United States State Department (March 4, 2012): "One common and particularly dangerous method that criminals use in order to rob a victim is through the use of drugs. The most common has been scopolamine. Unofficial estimates put the number of annual scopolamine incidents in Colombia at approximately 50,000. Scopolamine can render a victim unconscious for 24 hours or more. In large doses, it can cause respiratory failure and death. It is most often administered in liquid or powder form in foods and beverages. The majority of these incidents occur in night clubs and bars, and usually men, perceived to be wealthy, are targeted by young, attractive women. To avoid becoming a victim of scopolamine, one should never accept food or beverages offered by strangers or new acquaintances or leave food or beverages unattended. Victims of scopolamine or other drugs should seek immediate medical attention."
Scopolamine has been shown in multiple studies to be a potent antidepressant and anxiolytic medication. Two methods of administration have been studied. The first is in-patient sessions where the patients receive an intravenous infusion of a relatively large quantity of scopolamine during a session that lasts 1–2 hours. The patients are monitored during the infusion and released soon after as the effects wear-off quickly. The second route of administration is oral scopolamine in a pill.
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