hyoscine: clinical use

Prescribing considerations

• Confirm that the intended use is licensed prevention of travel sickness or clearly document and counsel for use outside the licence.
• The patch is licensed for adults and children aged 10 years or older; safety and efficacy are not established below that age.
• Older people and children are more susceptible to anticholinergic toxicity.
• Use caution with urinary outflow obstruction, pyloric stenosis, intestinal obstruction, epilepsy, or hepatic or renal impairment.
• Assess concurrent antimuscarinic and centrally acting medicines and advise against alcohol.
• Warn that cognitive, visual and balance effects may persist after patch removal.

Contraindications and cautions

• Glaucoma or a history of glaucoma
• Hypersensitivity to hyoscine or any patch excipient

Monitoring

• Monitor for hyperthermia, urinary retention, delirium, hallucinations, seizures, reduced consciousness and respiratory effects, especially during use outside the licence or in care settings.
• Review new eye pain, visual loss or glaucomatous halos urgently.
• Monitor application sites and neurocognitive effects.
• Ensure removal before medical scanning because the patch contains aluminium.

Clinical pharmacology

Hyoscine is a belladonna alkaloid and competitive muscarinic acetylcholine-receptor antagonist with central and peripheral effects. The transdermal reservoir system delivers hyoscine through intact skin; absorption continues from the skin after removal, so adverse effects may persist.

Formulation and product differences

• The product is a reservoir transdermal patch rather than an oral tablet or injection.
• The reservoir design must not be cut because this may alter delivery.
• Its aluminium-containing backing requires removal before medical scans.
• Transdermal delivery has a slower onset than oral tablets, and residual absorption can continue after removal.