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Methscopolamine Bromide

Pronunciation: meth-skoe-PAHL-uh-meen BRO-mide
Class: Quarternary anticholinergic

Trade Names

Pamine
- Tablets 2.5 mg

Pamine Forte
- Tablets 5 mg

Pharmacology

Competitively inhibits action of acetylcholine at muscarinic receptor.

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Pharmacokinetics

Absorption

Poorly and unreliably absorbed (10% to 25%).

Elimination

Primarily in urine and bile as well as unabsorbed drug in the feces.

Onset

1 h.

Duration

4 to 6 h.

Indications and Usage

Adjunctive treatment of peptic ulcer.

Contraindications

Glaucoma; obstructive uropathy (eg, bladder neck obstruction); obstructive disease of the GI tract (eg, pyloroduodenal stenosis); paralytic ileus; intestinal atony of the elderly or debilitated patient; unstable CV status in acute hemorrhage; severe ulcerative colitis; toxic megacolon complicating ulcerative colitis; myasthenia gravis; hypersensitivity to any component of the drug.

Dosage and Administration

Adults

PO 2.5 mg one-half h before meals and 2.5 to 5 mg at bedtime. A starting dose of 12.5 mg every day will be clinically effective in most patients. In patients experiencing severe abdominal pain or cramping or symptoms that demand prompt relief, methscopolamine may be started at 20 mg every day, administered in doses of 5 mg one-half h before meals and at bedtime.

Storage/Stability

Store at controlled room temperature (59° to 86°F).

Drug Interactions

Antacids

May interfere with the absorption of methscopolamine.

Antipsychotics, tricyclic antidepressants, drugs with anticholinergic effects

Additive anticholinergic effects may occur.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Cardiovascular

Tachycardia; palpitation.

CNS

Headache; nervousness; mental confusion; drowsiness; dizziness; weakness; insomnia.

Dermatologic

Decreased sweating; urticaria; other dermal manifestations.

EENT

Blurred vision; dilation of pupil; cycloplegia; increased ocular tension; loss of taste.

GI

Nausea; vomiting; constipation; bloated feeling.

Genitourinary

Impotence; suppression of lactation; urinary hesitancy and retention.

Miscellaneous

Severe allergic reaction; drug idiosyncrasies including anaphylaxis; xerostomia.

Precautions

Pregnancy

Category C .

Lactation

Undetermined.

Children

Safety and efficacy not established.

Special Risk Patients

Use with caution in the elderly and in all patients with autonomic neuropathy, hepatic or renal disease, ulcerative colitis (large doses may produce paralytic ileus, precipitating or aggravating toxic megacolon), hyperthyroidism, coronary heart disease, CHF, tachyrhythmia, tachycardia, hypertension, or prostatic hypertrophy.

Diarrhea

May be a symptom of incomplete intestinal obstruction, especially in patients with ileostomy or colostomy. Treatment of diarrhea with drug is inappropriate and possibly harmful.

Heat prostration

Can occur in presence of high environmental temperature.

Overdosage

Symptoms

CNS disturbances (from restlessness and excitement to psychotic behavior), circulatory changes (flushing, fall in BP, circulatory failure), respiratory failure, paralysis, coma.

Patient Information

  • Advise patient to take prescribed dose 30 min before meals and at bedtime.
  • Advise patient that dose may be changed periodically to achieve max benefit.
  • Advise patient to avoid strenuous activity during periods of high temperature or humidity.
  • Advise patient to take sips of water, suck on ice chips or sugarless hard candy, or chew sugarless gum if dry mouth occurs.
  • Advise patient that drug may cause drowsiness or blurred vision and to use caution while driving or performing other tasks requiring mental alertness until tolerance is determined.
  • Advise patient to notify health care provider if symptoms do not improve or appear to be getting worse.
  • Advise patient to stop taking the drug and notify health care provider immediately if any of the following occur: rash, flushing, eye pain, inability to urinate.
  • Advise patient that medication may cause dry mouth, urination difficulties, or constipation and to notify health care provider if they occur and are bothersome.

Copyright © 2009 Wolters Kluwer Health.

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