CLINICAL PHARMACOLOGY
Pharmacology
The sole active agent of Transderm Scóp is scopolamine, a belladonna alkaloid with well-known pharmacological properties. It is an anticholinergic agent which acts: i) as a competitive inhibitor at postganglionic muscarinic receptor sites of the parasympathetic nervous system, and ii) on smooth muscles that respond to acetylcholine but lack cholinergic innervation. It has been suggested that scopolamine acts in the central nervous system (CNS) by blocking cholinergic transmission from the vestibular nuclei to higher centers in the CNS and from the reticular formation to the vomiting center1,2. Scopolamine can inhibit the secretion of saliva and sweat, decrease gastrointestinal secretions and motility, cause drowsiness, dilate the pupils, increase heart rate, and depress motor function2.
Pharmacokinetics
Scopolamine’s activity is due to the parent drug. The pharmacokinetics of scopolamine delivered via the system are due to the characteristics of both the drug and dosage form. The system is programmed to deliver in-vivo approximately 1.0 mg of scopolamine at an approximately constant rate to the systemic circulation over 3 days. Upon application to the post-auricular skin, an initial priming dose of scopolamine is released from the adhesive layer to saturate skin binding sites. The subsequent delivery of scopolamine to the blood is determined by the rate controlling membrane and is designed to produce stable plasma levels in a therapeutic range. Following removal of the used system, there is some degree of continued systemic absorption of scopolamine bound in the skin layers.
Absorption: Scopolamine is well-absorbed percutaneously. Following application to the skin behind the ear, circulating plasma levels are detected within 4 hours with peak levels being obtained, on average, within 24 hours. The average plasma concentration produced is 87 pg/mL for free scopolamine and 354 pg/mL for total scopolamine (free + conjugates).
Distribution: The distribution of scopolamine is not well characterized. It crosses the placenta and the blood brain barrier and may be reversibly bound to plasma proteins.
Metabolism: Although not well characterized, scopolamine is extensively metabolized and conjugated with less than 5% of the total dose appearing unchanged in the urine.
Elimination: The exact elimination pattern of scopolamine has not been determined. Following patch removal, plasma levels decline in a log linear fashion with an observed half-life of 9.5 hours. Less than 10% of the total dose is excreted in the urine as parent and metabolites over 108 hours.
Clinical Results: In 195 adult subjects of different racial origins who participated in clinical efficacy studies at sea or in a controlled motion environment, there was a 75% reduction in the incidence of motion-induced nausea and vomiting3.
In two pivotal clinical efficacy studies in 391 adult female patients undergoing cesarean section or gynecological surgery with anesthesia and opiate analgesia, 66% of those treated with Transderm Scóp (compared to only 46% of those receiving placebo) reported no retching/vomiting within the 24-hour period following administration of anesthesia/opiate analgesia. When the need for additional antiemetic medication was assessed during the same period, there was no need for medication in 76% of patients treated with Transderm Scóp as compared to 59% of placebo-treated patients 4, 5.
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