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American Journal of Health-System Pharmacy, Vol. 66, Issue 22, 2024-2026
Copyright © 2009. American Society of Health-System Pharmacists, Inc. All rights reserved. 1079-2082/04/0602-1242$06.00

Case Report

Withdrawal symptoms after discontinuation of transdermal scopolamine therapy: Treatment with meclizine

 Priti N. Patel and Danielle C. Ezzo

PRITI N. PATEL, PHARM.D., BCPS, is Assistant Clinical Professor and Director, Drug Information Center, College of Pharmacy and Allied Health Professions, St. John’s University, Queens, NY. DANIELLE C. EZZO, PHARM.D., BCPS, CGP, is Assistant Clinical Professor, College of Pharmacy and Allied Health Professions, St. John’s University, and Clinical Coordinator of Ambulatory Care, Long Island Jewish Medical Center, New Hyde Park, NY.

Address correspondence to Dr. Patel at the College of Pharmacy and Allied Health Professions, St. John’s University, 8000 Utopia Parkway, St. Albert Hall, Room 114, Queens, NY 11439 (patelp2{at}stjohns.edu).


Purpose. The case of a patient who treated withdrawal symptoms from trans-dermal scopolamine with meclizine is reported.

Summary. A 30-year-old woman for whom transdermal scopolamine was prescribed to manage motion sickness during a vacation experienced severe withdrawal symptoms that began 24 hours after patch removal and lasted for several days. Other medications included an oral contraceptive and as-needed zolmitriptan for migraines. She used the scopolamine patches as prescribed, applying one patch behind the ear every 3 days. After 10 consecutive days of wearing the patch and experiencing no motion sickness, she began to develop dry mouth and uncomfortable, dry eyes, which prompted her to remove the patch. After 24 hours without the patch, she developed severe nausea that did not subside during a car ride. Due to the intractable nausea, she applied a new patch, which she wore for 3 consecutive days without recurrence of the nausea. Upon returning from the trip, she removed the last patch. Twelve hours after the last patch was removed, nausea recurred but was not related to motion. She felt better while lying down, but felt nauseated when standing or walking. After 3 days of this nausea, she began taking nonprescription meclizine 25 mg orally every 12 hours. The nausea subsided after two doses, and she was able to resume her normal activities. The nausea did not recur after discontinuation of the meclizine. She had used transdermal scopolamine eight years prior without any withdrawal symptoms.

Conclusion. Withdrawal symptoms experienced after removal of a transdermal scopolamine patch were successfully treated with oral meclizine.

Index terms: Antiemetics; Contraceptives, oral; Drug withdrawal; Meclizine; Motion sickness; Nausea; Parasympatholytic agents; Patches transdermal; Scopolamine; Toxicity; Zolmitriptan

 

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