Drugs List

Therapeutic Indications

Uses

Motion sickness

Unlicensed Uses

Excessive respiratory secretions

Contraindications

Glaucoma
History of glaucoma

Precautions and Warnings

Children under 10 years
Down's syndrome
Elderly
Bladder outflow obstruction
Breastfeeding
Cardiovascular disorder
Epileptic disorder
Gastrointestinal obstruction
Hepatic impairment
History of raised intra-ocular pressure
Pregnancy
Prostate disorder
Pyloric obstruction
Renal impairment

Advise patient drowsiness may affect ability to drive or operate machinery
Advise visual disturbances may affect ability to drive or operate machinery
May reduce seizure threshold
Advise patient to wash hands after use
Avoid contact with eyes
Discard used patches safely - fold with adhesive edges together
Remove metal containing patch prior to MRI scan
Wash application site after use
Perform eye tests before treatment
Remove patch if confusional states or hallucinations occur
Advise patient to avoid alcohol during treatment
After removal of patch, side effects may persist for 24 hours or longer

Pregnancy and Lactation

Pregnancy

Use hyoscine with caution in pregnancy.

Hyoscine should only be used in pregnancy if the expected benefits to the mother outweigh the potential risks to the foetus.

Functional effects i.e. on the foetal heart rate, must be considered with systemic use.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use hyoscine with caution in breastfeeding.

As hyoscine is only excreted in breast milk in trace amounts caution should be exercised when administering to a nursing mother.
Hyoscine shows minimal, non-threatening adverse effects, but should be given only if potential benefit justifies the risk.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at www.midlandsmedicines.nhs.uk

Side Effects

Acute glaucoma
Arrhythmias
Attention disturbances
Blurred vision
Bradycardia then tachycardia
Confusion
Constipation
Contact dermatitis
Cycloplegia
Decreased bronchial secretions
Diarrhoea
Difficulty in micturition
Difficulty in swallowing
Disorientation
Disturbances in accommodation
Dizziness
Drowsiness
Dry mouth
Dry skin
Eyelid itching
Eyelid reaction
Fatigue
Flushing
Glaucoma
Hallucinations
Hypersalivation
Impaired concentration
Impaired memory
Irritation (localised)
Loss of balance
Mydriasis
Myopia
Nausea
Palpitations
Photophobia
Pupillary dilatation
Rash
Restlessness
Somnolence
Strabismus
Urinary retention
Visual disturbances
Vomiting
Withdrawal symptoms

Presentation

Transdermal patch containing hyoscine.

Drugs List

Therapeutic Indications

Uses

Motion sickness

Unlicensed Uses

Excessive respiratory secretions

Dosage

Adults

Children

Contraindications

Glaucoma
History of glaucoma

Precautions and Warnings

Children under 10 years
Down's syndrome
Elderly
Bladder outflow obstruction
Breastfeeding
Cardiovascular disorder
Epileptic disorder
Gastrointestinal obstruction
Hepatic impairment
History of raised intra-ocular pressure
Pregnancy
Prostate disorder
Pyloric obstruction
Renal impairment

Advise patient drowsiness may affect ability to drive or operate machinery
Advise visual disturbances may affect ability to drive or operate machinery
May reduce seizure threshold
Advise patient to wash hands after use
Avoid contact with eyes
Discard used patches safely - fold with adhesive edges together
Remove metal containing patch prior to MRI scan
Wash application site after use
Perform eye tests before treatment
Remove patch if confusional states or hallucinations occur
Advise patient to avoid alcohol during treatment
After removal of patch, side effects may persist for 24 hours or longer

Pregnancy and Lactation

Pregnancy

Use hyoscine with caution in pregnancy.

Hyoscine should only be used in pregnancy if the expected benefits to the mother outweigh the potential risks to the foetus.

Functional effects i.e. on the foetal heart rate, must be considered with systemic use.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use hyoscine with caution in breastfeeding.

As hyoscine is only excreted in breast milk in trace amounts caution should be exercised when administering to a nursing mother.
Hyoscine shows minimal, non-threatening adverse effects, but should be given only if potential benefit justifies the risk.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at www.midlandsmedicines.nhs.uk

Counselling

Apply one patch to a clean hairless area of skin behind ear, avoiding cuts or irritation. If a patch becomes accidentally detached, it should be replaced with a fresh one.

Advise patient to wash hands after application of patch. In addition, after removal of the system, the site of application should be washed; these precautions are necessary to minimise any chances of hyoscine being transferred to the eyes.

Advise patient that limited contact with water (e.g. during swimming or washing) should not adversely affect the patch, although it should be kept as dry as possible.

Advise patients that hyoscine may cause drowsiness, dizziness, confusion or visual disturbances which may persist for up to 24 hours or longer after removal of the patch. Patients using the patch should not drive or operate machinery.

Advise patient not to consume alcohol whilst using the patch.

Advise patient to remove the patch immediately if confusion or visual hallucinations occur.

Side Effects

Acute glaucoma
Arrhythmias
Attention disturbances
Blurred vision
Bradycardia then tachycardia
Confusion
Constipation
Contact dermatitis
Cycloplegia
Decreased bronchial secretions
Diarrhoea
Difficulty in micturition
Difficulty in swallowing
Disorientation
Disturbances in accommodation
Dizziness
Drowsiness
Dry mouth
Dry skin
Eyelid itching
Eyelid reaction
Fatigue
Flushing
Glaucoma
Hallucinations
Hypersalivation
Impaired concentration
Impaired memory
Irritation (localised)
Loss of balance
Mydriasis
Myopia
Nausea
Palpitations
Photophobia
Pupillary dilatation
Rash
Restlessness
Somnolence
Strabismus
Urinary retention
Visual disturbances
Vomiting
Withdrawal symptoms

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: July 2014

Reference Sources

Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

Martindale: The Complete Drug Reference, 37th edition (2011) ed. Sweetman, S. Pharmaceutical Press, London.

Medications and Mothers' Milk, 14th Edition (2010) Hale, T. Hale Publishing, Amarillo, Texas.

Summary of Product Characteristics: Scopoderm TTS. Novartis Consumer Health. Revised September 2012.

Summary of Product Characteristics: Scopoderm 1.5mg patch. Novartis Consumer Health. Revised May 2014.

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 25 August 2017