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: