ANTI-CHOLINERGICS

Scopolamine is an important drug in terminal care. It dries up secretions and usually prevents terminal respiratory bubbling. It is also powerfully sedative. The usual dose is 0.4mg to 0.6mg IM every 4 hours.

Scopolamine is available as a trans-dermal patch. The patch is applied to the hairless area of skin behind the ear. It contains 1.5mg of scopolamine, delivers 0.5mg per day over 3 days, and is principally intended for the control of motion sickness, when it should be applied 4 hours before the effect is required. (Carers should wash their hands after applying a patch, to avoid inadvertent contact with eyes and possible temporary blurred vision.)

Since the usual dose of scopolamine in terminal care is 0.4mg to 0.6mg IM every 4 hours (or 2mg to 4mg per 24 hours by continuous subcutaneous infusion), and one trans-dermal patch delivers only 0.5mg per 24 hours, it may be necessary to use 3 to 5 trans-dermal patches simultaneously to achieve an adequate dosage.

Atropine is indicated if an anti-cholinergic effect is required without sedation – for example, to decrease salivation in patients with amyotrophic lateral sclerosis (ALS).

The author and publisher have taken precautions to ensure that the information in this book is error-free. However, readers must be guided by their own personal and professional standards of good practice in evaluating and applying recommendations made herein. The contents of this book represent the views and experience of the author, and not necessarily those of the publisher.