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Methscopolamine

Pronunciation

(meth skoe POL a meen)

Index Terms

  • Methscopolamine Bromide

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral, as bromide:

Pamine: 2.5 mg [lactose free]

Pamine Forte: 5 mg [lactose free]

Generic: 2.5 mg, 5 mg

Brand Names: U.S.

  • Pamine
  • Pamine Forte

Pharmacologic Category

  • Anticholinergic Agent

Pharmacology

Methscopolamine is a quaternary ammonium derivative of scopolamine that exerts anticholinergic effects, which include reducing the volume and total acid content of gastric secretion, inhibiting gastrointestinal motility and salivary secretion, dilation of the pupil, and inhibition of accommodation that results in blurring of vision.

Absorption

Poorly and unreliably absorbed

Excretion

Bile and urine; feces (as unabsorbed drug)

Onset of Action

~1 hour

Duration of Action

4 to 6 hours

Use: Labeled Indications

Peptic ulcer (adjunctive): Adjunctive therapy for the treatment of peptic ulcer

Limitations of use: Has not been shown to be effective in contributing to the healing of peptic ulcer, decreasing the rate of recurrence, or preventing complications

Contraindications

Hypersensitivity to methscopolamine, any component of the formulation, or related drugs; glaucoma; obstructive uropathy (eg, bladder neck obstruction due to prostatic hypertrophy); obstructive disease of the GI tract (eg, pyloroduodenal stenosis); paralytic ileus; intestinal atony of elderly or debilitated patients; unstable cardiovascular status in acute hemorrhage; severe ulcerative colitis; toxic megacolon complicating ulcerative colitis; myasthenia gravis

Dosing: Adult

Peptic ulcer (adjunctive): Oral: Initial: 2.5 mg 30 minutes before meals and 2.5 to 5 mg at bedtime; for severe symptoms demanding prompt relief (abdominal pain or cramping), may initiate with 5 mg 30 minutes before meals and 5 mg at bedtime; adjust dose (increase or decrease) to patient response (30 mg/day has been tolerated in some patients).

Dosing: Geriatric

Refer to adult dosing.

Dosing: Renal Impairment

There are no dosage adjustments provided in the manufacturer’s labeling; use with caution.

Dosing: Hepatic Impairment

There are no dosage adjustments provided in the manufacturer’s labeling; use with caution.

Administration

Administer 30 minutes before meals and at bedtime.

Dietary Considerations

Take 30 minutes before meals and at bedtime.

Storage

Store at 15°C to 30° C (59° F to 86° F).

Drug Interactions

AbobotulinumtoxinA: Anticholinergic Agents may enhance the anticholinergic effect of AbobotulinumtoxinA. Monitor therapy

Acetylcholinesterase Inhibitors: May diminish the therapeutic effect of Anticholinergic Agents. Anticholinergic Agents may diminish the therapeutic effect of Acetylcholinesterase Inhibitors. Monitor therapy

Aclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination

Analgesics (Opioid): Anticholinergic Agents may enhance the adverse/toxic effect of Analgesics (Opioid). Specifically, the risk for constipation and urinary retention may be increased with this combination. Monitor therapy

Anticholinergic Agents: May enhance the adverse/toxic effect of other Anticholinergic Agents. Monitor therapy

Cannabinoid-Containing Products: Anticholinergic Agents may enhance the tachycardic effect of Cannabinoid-Containing Products. Exceptions: Cannabidiol. Monitor therapy

Cimetropium: Anticholinergic Agents may enhance the anticholinergic effect of Cimetropium. Avoid combination

Eluxadoline: Anticholinergic Agents may enhance the constipating effect of Eluxadoline. Avoid combination

Gastrointestinal Agents (Prokinetic): Anticholinergic Agents may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic). Monitor therapy

Glucagon: Anticholinergic Agents may enhance the adverse/toxic effect of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased. Avoid combination

Glycopyrrolate (Oral Inhalation): Anticholinergic Agents may enhance the anticholinergic effect of Glycopyrrolate (Oral Inhalation). Avoid combination

Ipratropium (Oral Inhalation): May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination

Itopride: Anticholinergic Agents may diminish the therapeutic effect of Itopride. Monitor therapy

Levosulpiride: Anticholinergic Agents may diminish the therapeutic effect of Levosulpiride. Avoid combination

Mianserin: May enhance the anticholinergic effect of Anticholinergic Agents. Monitor therapy

Mirabegron: Anticholinergic Agents may enhance the adverse/toxic effect of Mirabegron. Monitor therapy

OnabotulinumtoxinA: Anticholinergic Agents may enhance the anticholinergic effect of OnabotulinumtoxinA. Monitor therapy

Oxatomide: May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination

Potassium Chloride: Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride. Avoid combination

Pramlintide: May enhance the anticholinergic effect of Anticholinergic Agents. These effects are specific to the GI tract. Consider therapy modification

Ramosetron: Anticholinergic Agents may enhance the constipating effect of Ramosetron. Monitor therapy

RimabotulinumtoxinB: Anticholinergic Agents may enhance the anticholinergic effect of RimabotulinumtoxinB. Monitor therapy

Secretin: Anticholinergic Agents may diminish the therapeutic effect of Secretin. Management: Avoid using drugs with substantial anticholinergic effects in patients receiving secretin whenever possible. If such agents must be used in combination, monitor closely for a diminished response to secretin. Consider therapy modification

Thiazide and Thiazide-Like Diuretics: Anticholinergic Agents may increase the serum concentration of Thiazide and Thiazide-Like Diuretics. Monitor therapy

Tiotropium: Anticholinergic Agents may enhance the anticholinergic effect of Tiotropium. Avoid combination

Topiramate: Anticholinergic Agents may enhance the adverse/toxic effect of Topiramate. Monitor therapy

Umeclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination

Adverse Reactions

Frequency not defined.

Cardiovascular: Palpitation, tachycardia

Central nervous system: Headache, insomnia, flushing, nervousness, drowsiness, dizziness, confusion, fever, CNS stimulation may be produced with large doses

Dermatologic: Dry skin, urticaria

Endocrine & metabolic: Lactation suppressed

Gastrointestinal: Constipation, xerostomia, dry throat, dysphagia, nausea, vomiting, loss of taste

Genitourinary: Impotence, urinary hesitancy, urinary retention

Neuromuscular & skeletal: Weakness

Ocular: Blurred vision, cycloplegia, ocular tension increased, pupil dilation

Respiratory: Dry nose

Miscellaneous: Allergic reaction, diaphoresis decreased, hypersensitivity reactions, anaphylaxis

Warnings/Precautions

Concerns related to adverse effects:

• CNS effects: May cause drowsiness and/or blurred vision, which may impair physical or mental abilities; patients must be cautioned about performing tasks which require mental alertness (eg, operating machinery or driving).

• Diarrhea: May be a sign of incomplete intestinal obstruction, especially in patients with ileostomy or colostomy; discontinue treatment if this occurs.

• Heat prostration: May occur in the presence of high environmental temperature; use caution in hot weather and/or exercise.

Disease-related concerns:

• Cardiovascular disease: Use with caution in patients with coronary artery disease, tachyarrhythmias, tachycardia, heart failure or hypertension.

• Hepatic impairment: Use with caution in patients with hepatic impairment.

• Hyperthyroidism: Use with caution in patients with hyperthyroidism.

• Neuropathy: Use with caution in patients with autonomic neuropathy.

• Prostatic hyperplasia: Use with caution in patients with prostatic hyperplasia.

• Renal impairment: Use with caution in patients with renal impairment.

• Ulcerative colitis: Use with caution in patients with ulcerative colitis (large doses may suppress intestinal motility leading to a paralytic ileus); may precipitate/aggravate toxic megacolon.

Concurrent drug therapy issues:

• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.

Special populations:

• Elderly: Use with caution in the elderly; increased risk for anticholinergic effects, confusion, and hallucinations.

Monitoring Parameters

Follow by upper GI contrast radiology or endoscopy to ensure healing

Pregnancy Risk Factor

C

Pregnancy Considerations

Animal reproduction studies have not been conducted. Methscopolamine is a derivative of scopolamine. Scopolamine is reported to cross the placenta; fetal toxicity noted in case reports.

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience headache, dry mouth, change in taste, nausea, insomnia, or anxiety. Have patient report immediately to prescriber severe dizziness, passing out, severe loss of strength and energy, tachycardia, arrhythmia, confusion, diarrhea, severe constipation, vomiting, urinary retention, or lack of sweat (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.

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