Scopolamine (Systemic)

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Patch 72 Hour, Transdermal:

Transderm Scop (1.5 MG): 1 MG/3DAYS (4 ea)

Transderm-Scop (1.5 MG): 1 MG/3DAYS (1 ea, 4 ea [DSC], 10 ea, 24 ea)

Generic: 1 MG/3DAYS (4 ea, 10 ea, 24 ea)

Pharmacology

Mechanism of Action

Blocks the action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands and the CNS; increases cardiac output, dries secretions, antagonizes histamine and serotonin; at usual recommended doses, causes blockade of muscarinic receptors at the cardiac SA-node and is parasympatholytic (ie, blocks vagal activity increasing heart rate)

Pharmacokinetics/Pharmacodynamics

Absorption

Butylbromide: Oral: Quaternary salts are poorly absorbed (local concentrations in the GI tract following oral dosing may be high).

Hydrobromide: IM, SubQ: Rapid.

Distribution

V_d: Butylbromide: 128 L.

Metabolism

Hepatic

Excretion

Butylbromide: IV: Urine (42% to 61% [half as parent drug]), feces (28% to 37%).

Hydrobromide: Injection: Urine (variable; as parent drug and metabolites) (Renner 2005).

Scopolamine base: Transdermal: Urine (<10%, as parent drug and metabolites).

Onset of Action

Butylbromide: Injection: ≤15 minutes.

Hydrobromide: Injection: ~15 minutes (Renner 2005).

Scopolamine base: Transdermal: 6 to 8 hours.

Time to Peak

Butylbromide: Oral: ~2 hours.

Hydrobromide: IM: ~20 minutes; IV: ~5 minutes; SubQ: ~15 minutes (Renner 2005).

Scopolamine base: Transdermal: 24 hours.

Duration of Action

Hydrobromide: Injection: ~4 hours.

Scopolamine base: Transdermal: 72 hours.

Half-Life Elimination

Butylbromide: Terminal: IV: ~5 hours; Oral: ~6 to 11 hours.

Hydrobromide: Injection: ~1 to 3.5 hours (Renner 2005).

Scopolamine base: Transdermal: 9.5 hours.

Protein Binding

Butylbromide: ~4% (albumin).

Use: Labeled Indications

Scopolamine base: Transdermal: Prevention of nausea/vomiting associated with motion sickness and recovery from anesthesia and surgery (other than cesarean section).

Scopolamine hydrobromide [Canadian product]: Injection: Adjunct to anesthesia to produce sedation and amnesia.

Scopolamine butylbromide [Canadian product]: Oral/injection: Treatment of smooth muscle spasm of the genitourinary or GI tract; injection may also be used prior to radiological/diagnostic procedures to prevent spasm.

Contraindications

Injection:

Hyoscine butylbromide [Canadian product]: Hypersensitivity to hyoscine butylbromide, atropinics, or any component of the formulation; untreated narrow-angle glaucoma; megacolon, prostatic hypertrophy with urinary retention; stenotic lesions or mechanical stenosis of the GI tract; myasthenia gravis; tachycardia, angina, heart failure; paralytic or obstructive ileus; IM administration in patients receiving anticoagulant therapy

Scopolamine hydrobromide [Canadian product]: Hypersensitivity to scopolamine or any component of the formulation; glaucoma or predisposition to narrow-angle glaucoma; paralytic ileus; prostatic hypertrophy; pyloric obstruction; tachycardia secondary to cardiac insufficiency or thyrotoxicosis

Oral [Canadian product]: Hypersensitivity to hyoscine butylbromide, atropinics, or any component of the formulation; glaucoma, megacolon, myasthenia gravis, obstructive prostatic hypertrophy

Transdermal: Hypersensitivity to scopolamine, other belladonna alkaloids, or any component of the formulation; narrow-angle glaucoma

Dosage and Administration

Dosing: Adult

Note: Scopolamine (hyoscine) hydrobromide should not be interchanged with scopolamine butylbromide formulations. Dosages are not equivalent.

Scopolamine base:

Preoperative: Transdermal patch: Apply 1 patch to hairless area behind ear the night before surgery; remove 24 hours after surgery.

Motion sickness: Transdermal patch: Apply 1 patch to hairless area behind the ear at least 4 hours prior to exposure and every 3 days as needed.

Scopolamine hydrobromide [Canadian product]:

Sedation, amnesia: IM, IV, SubQ: 0.3 to 0.6 mg 3 to 4 times/day

Scopolamine butylbromide [Canadian product]: Gastrointestinal/genitourinary spasm:

Oral: Acute therapy: 10 to 20 mg/day; prolonged therapy: 10 mg 3 to 5 times/day; maximum: 60 mg/day

IM, IV, SubQ: 10 to 20 mg; maximum: 100 mg/day

Dosing: Geriatric

Avoid use (Beers Criteria [AGS 2019]).

Dosing: Pediatric

Note: Scopolamine injection is no longer available in the US.

Preoperatively and antiemetic: Children: Scopolamine hydrobromide: IM, IV, SubQ: 6 mcg/kg/dose (maximum dose: 0.3 mg/dose); may be repeated every 6 to 8 hours

Motion sickness: Limited data available: Adolescents: Scopolamine base: Transdermal: Apply 1 disc behind the ear at least 4 hours prior to exposure every 3 days as needed (Kliegman 2007)

Reconstitution

Injection:

IM: Butylbromide [Canadian product]: No dilution required.

IV:

Butylbromide [Canadian product]: No dilution is necessary prior to injection.

Hydrobromide: Dilute with an equal volume of sterile water.

Administration

Note: Butylbromide [Canadian product] or hydrobromide [Canadian product] may be administered by IM, IV, or SubQ injection.

IM: Butylbromide: Intramuscular injections should be administered 10 to 15 minutes prior to radiological/diagnostic procedures.

IV:

Butylbromide: No dilution is necessary prior to injection; inject at a rate of 1 mL/minute

Hydrobromide: No dilution is necessary prior to injection.

Oral [Canadian product]: Tablet should be swallowed whole and taken with a full glass of water.

Transdermal: Apply to hairless area of skin behind the ear. Wear only one patch at a time; remove first patch and apply new patch behind the other ear. Wash hands before and after applying the patch to avoid drug contact with eyes. Do not cut the patch. Topical patch is programmed to deliver 1 mg over 3 days. Once applied, do not remove the patch for 3 full days (motion sickness). When used postoperatively for nausea/vomiting, the patch should be removed 24 hours after surgery. If patch becomes displaced, discard and apply a new patch. Once removed, fold the used patch in half with the sticky side together; dispose of used patches in the trash out of reach from children and pets.

Storage

Injection:

Butylbromide [Canadian product]: Store at 15°C to 30°C (59°F to 86°F). Do not freeze. Protect from light and heat. Stable in D₅W, D₁₀W, NS, Ringer's solution, and LR for up to 8 hours.

Hydrobromide [Canadian product]: Store at 15°C to 30°C (59°F to 86°F). Protect from light. Do not freeze.

Tablet [Canadian product]: Store at 15°C to 30°C (59°F to 86°F). Protect from light and heat.

Transdermal system: Store at 20°C to 25°C (68°F to 77°F).

Drug Interactions

Acetylcholinesterase Inhibitors: May diminish the therapeutic effect of Anticholinergic Agents. Anticholinergic Agents may diminish the therapeutic effect of Acetylcholinesterase Inhibitors. Monitor therapy

Aclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination

Alcohol (Ethyl): CNS Depressants may enhance the CNS depressant effect of Alcohol (Ethyl). Monitor therapy

Alizapride: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Amantadine: May enhance the anticholinergic effect of Anticholinergic Agents. Monitor therapy

Anticholinergic Agents: May enhance the adverse/toxic effect of other Anticholinergic Agents. Monitor therapy

Azelastine (Nasal): CNS Depressants may enhance the CNS depressant effect of Azelastine (Nasal). Avoid combination

Blonanserin: CNS Depressants may enhance the CNS depressant effect of Blonanserin. Consider therapy modification

Botulinum Toxin-Containing Products: May enhance the anticholinergic effect of Anticholinergic Agents. Monitor therapy

Brexanolone: CNS Depressants may enhance the CNS depressant effect of Brexanolone. Monitor therapy

Brimonidine (Topical): May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Bromopride: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Bromperidol: May enhance the CNS depressant effect of CNS Depressants. Avoid combination

Buprenorphine: CNS Depressants may enhance the CNS depressant effect of Buprenorphine. Management: Consider reduced doses of other CNS depressants, and avoiding such drugs in patients at high risk of buprenorphine overuse/self-injection. Initiate buprenorphine at lower doses in patients already receiving CNS depressants. Consider therapy modification

Cannabidiol: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Cannabis: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Chloral Betaine: May enhance the adverse/toxic effect of Anticholinergic Agents. Monitor therapy

Chlormethiazole: May enhance the CNS depressant effect of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used. Consider therapy modification

Chlorphenesin Carbamate: May enhance the adverse/toxic effect of CNS Depressants. Monitor therapy

Cimetropium: Anticholinergic Agents may enhance the anticholinergic effect of Cimetropium. Avoid combination

CNS Depressants: May enhance the adverse/toxic effect of other CNS Depressants. Monitor therapy

Dimethindene (Topical): May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Doxylamine: May enhance the CNS depressant effect of CNS Depressants. Management: The manufacturer of Diclegis (doxylamine/pyridoxine), intended for use in pregnancy, specifically states that use with other CNS depressants is not recommended. Monitor therapy

Dronabinol: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Droperidol: May enhance the CNS depressant effect of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Exceptions to this monograph are discussed in further detail in separate drug interaction monographs. Consider therapy modification

Eluxadoline: Anticholinergic Agents may enhance the constipating effect of Eluxadoline. Avoid combination

Esketamine: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Flunitrazepam: CNS Depressants may enhance the CNS depressant effect of Flunitrazepam. Consider therapy modification

Gastrointestinal Agents (Prokinetic): Anticholinergic Agents may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic). Monitor therapy

Glucagon: Anticholinergic Agents may enhance the adverse/toxic effect of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased. Monitor therapy

Glycopyrrolate (Oral Inhalation): Anticholinergic Agents may enhance the anticholinergic effect of Glycopyrrolate (Oral Inhalation). Avoid combination

Glycopyrronium (Topical): May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination

HYDROcodone: CNS Depressants may enhance the CNS depressant effect of HYDROcodone. Management: Avoid concomitant use of hydrocodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Consider therapy modification

HydrOXYzine: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Ipratropium (Oral Inhalation): May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination

Itopride: Anticholinergic Agents may diminish the therapeutic effect of Itopride. Monitor therapy

Kava Kava: May enhance the adverse/toxic effect of CNS Depressants. Monitor therapy

Lemborexant: May enhance the CNS depressant effect of CNS Depressants. Management: Dosage adjustments of lemborexant and of concomitant CNS depressants may be necessary when administered together because of potentially additive CNS depressant effects. Close monitoring for CNS depressant effects is necessary. Consider therapy modification

Levosulpiride: Anticholinergic Agents may diminish the therapeutic effect of Levosulpiride. Avoid combination

Lofexidine: May enhance the CNS depressant effect of CNS Depressants. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs. Monitor therapy

Magnesium Sulfate: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Methotrimeprazine: CNS Depressants may enhance the CNS depressant effect of Methotrimeprazine. Methotrimeprazine may enhance the CNS depressant effect of CNS Depressants. Management: Reduce adult dose of CNS depressant agents by 50% with initiation of concomitant methotrimeprazine therapy. Further CNS depressant dosage adjustments should be initiated only after clinically effective methotrimeprazine dose is established. Consider therapy modification

MetyroSINE: CNS Depressants may enhance the sedative effect of MetyroSINE. Monitor therapy

Mianserin: May enhance the anticholinergic effect of Anticholinergic Agents. Monitor therapy

Minocycline (Systemic): May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Mirabegron: Anticholinergic Agents may enhance the adverse/toxic effect of Mirabegron. Monitor therapy

Nabilone: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Nitroglycerin: Anticholinergic Agents may decrease the absorption of Nitroglycerin. Specifically, anticholinergic agents may decrease the dissolution of sublingual nitroglycerin tablets, possibly impairing or slowing nitroglycerin absorption. Monitor therapy

Opioid Agonists: CNS Depressants may enhance the CNS depressant effect of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Consider therapy modification

Orphenadrine: CNS Depressants may enhance the CNS depressant effect of Orphenadrine. Avoid combination

Oxatomide: May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination

Oxomemazine: May enhance the CNS depressant effect of CNS Depressants. Avoid combination

OxyCODONE: CNS Depressants may enhance the CNS depressant effect of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Consider therapy modification

Paraldehyde: CNS Depressants may enhance the CNS depressant effect of Paraldehyde. Avoid combination

Perampanel: May enhance the CNS depressant effect of CNS Depressants. Management: Patients taking perampanel with any other drug that has CNS depressant activities should avoid complex and high-risk activities, particularly those such as driving that require alertness and coordination, until they have experience using the combination. Consider therapy modification

Piribedil: CNS Depressants may enhance the CNS depressant effect of Piribedil. Monitor therapy

Potassium Chloride: Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride. Avoid combination

Potassium Citrate: Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Citrate. Avoid combination

Pramipexole: CNS Depressants may enhance the sedative effect of Pramipexole. Monitor therapy

Pramlintide: May enhance the anticholinergic effect of Anticholinergic Agents. These effects are specific to the GI tract. Consider therapy modification

Ramosetron: Anticholinergic Agents may enhance the constipating effect of Ramosetron. Monitor therapy

Revefenacin: Anticholinergic Agents may enhance the anticholinergic effect of Revefenacin. Avoid combination

ROPINIRole: CNS Depressants may enhance the sedative effect of ROPINIRole. Monitor therapy

Rotigotine: CNS Depressants may enhance the sedative effect of Rotigotine. Monitor therapy

Rufinamide: May enhance the adverse/toxic effect of CNS Depressants. Specifically, sleepiness and dizziness may be enhanced. Monitor therapy

Secretin: Anticholinergic Agents may diminish the therapeutic effect of Secretin. Management: Avoid concomitant use of anticholinergic agents and secretin. Discontinue anticholinergic agents at least 5 half-lives prior to administration of secretin. Consider therapy modification

Selective Serotonin Reuptake Inhibitors: CNS Depressants may enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Specifically, the risk of psychomotor impairment may be enhanced. Monitor therapy

Sodium Oxybate: May enhance the CNS depressant effect of CNS Depressants. Management: Consider alternatives to combined use. When combined use is needed, consider minimizing doses of one or more drugs. Use of sodium oxybate with alcohol or sedative hypnotics is contraindicated. Consider therapy modification

Suvorexant: CNS Depressants may enhance the CNS depressant effect of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended. Consider therapy modification

Tapentadol: May enhance the CNS depressant effect of CNS Depressants. Management: Avoid concomitant use of tapentadol and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Consider therapy modification

Tetrahydrocannabinol: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Tetrahydrocannabinol and Cannabidiol: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Thalidomide: CNS Depressants may enhance the CNS depressant effect of Thalidomide. Avoid combination

Thiazide and Thiazide-Like Diuretics: Anticholinergic Agents may increase the serum concentration of Thiazide and Thiazide-Like Diuretics. Monitor therapy

Tiotropium: Anticholinergic Agents may enhance the anticholinergic effect of Tiotropium. Avoid combination

Topiramate: Anticholinergic Agents may enhance the adverse/toxic effect of Topiramate. Monitor therapy

Trimeprazine: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Umeclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination

Zolpidem: CNS Depressants may enhance the CNS depressant effect of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol. Consider therapy modification

Test Interactions

Interferes with gastric secretion test. Transdermal system should be discontinued ≥10 days prior to testing.

Adverse Reactions

Adverse reactions reported with transdermal administration.

>10%:

Central nervous system: Drowsiness (8% to 17%), dizziness (12%)

Gastrointestinal: Xerostomia (29% to 67%)

1% to 10%:

Central nervous system: Agitation (6%), confusion (4%)

Ophthalmic: Visual impairment (5%), mydriasis (4%)

Respiratory: Pharyngitis (3%)

Frequency not defined:

Gastrointestinal: Decreased gastrointestinal motility

Genitourinary: Urinary retention

Ophthalmic: Blurred vision

Postmarketing: Acute psychosis, amblyopia, amnesia, angle-closure glaucoma, application site burning, ataxia, delusion, disorientation, disturbance in attention, dysuria, erythema of skin, eye pruritus, eyelid pain, hallucination, headache, paranoid ideation, restlessness, seizure, skin irritation, skin rash, speech disturbance, vertigo, xerophthalmia

Warnings/Precautions

Concerns related to adverse effects:

• Anaphylaxis: Anaphylaxis including episodes of shock has been reported following parenteral administration; observe for signs/symptoms of hypersensitivity following parenteral administration. Patients with a history of allergies or asthma may be at increased risk of hypersensitivity reactions.
• Bradycardia (paradoxical): Lower doses (0.1mg) may have vagal mimetic effects (eg, increase vagal tone causing paradoxical bradycardia); these effects are likely mediated by blockade of muscarinic receptors at the level of the brain.
• CNS effects: May cause drowsiness and/or blurred vision, which may impair physical or mental abilities; patients must be cautioned about performing tasks which require mental alertness (eg, operating machinery or driving).
• Idiosyncratic reaction: Idiosyncratic reactions may rarely occur; patients may experience acute toxic psychosis, agitation, confusion, delusions, hallucinations, paranoid behavior, and rambling speech.
• Visual disturbances: Discontinue if patient reports unusual visual disturbances or pain within the eye.
• Withdrawal: Adverse events (including dizziness, headache, nausea, vomiting) may occur following abrupt discontinuation of large doses or in patients with Parkinson's disease; adverse events may also occur following removal of the transdermal patch although symptoms may not appear until ≥24 hours after removal.

Disease-related concerns:

• Cardiovascular disease: Use with caution in patients with coronary artery disease, tachyarrhythmias, heart failure, or hypertension; evaluate tachycardia prior to administration.
• Gastrointestinal (GI) obstruction: Use with caution in patients with GI obstruction; when used for the treatment of smooth muscle spasm of the GI tract avoid continuous (daily) or prolonged use without evaluating source of abdominal pain. Patients should be instructed to report persistent or worsening abdominal pain with or without other symptoms (eg, nausea/vomiting, irregular bowel movements, bloody stool, hypotension).
• Genitourinary (GU) disease/obstruction: Use with caution in patients with GU obstruction, prostatic hyperplasia, or urinary retention; when used for the treatment of smooth muscle spasm of the GU tract avoid continuous (daily) or prolonged use without evaluating source of the spasm.
• Glaucoma: Use transdermal product with caution in patients with open-angle glaucoma; may increase intraocular pressure; adjust glaucoma therapy as necessary.
• Hepatic impairment: Use with caution in patients with hepatic impairment; adverse CNS effects occur more often in these patients.
• Hiatal hernia: Use with caution in patients with hiatal hernia with reflux esophagitis.
• Hyperthyroidism: Use caution in patients with hyperthyroidism; may have increased risk for arrhythmias.
• Psychosis: Use with caution in patients with a history of psychosis; may exacerbate condition.
• Renal impairment: Use with caution in patients with renal impairment; adverse CNS effects occur more often in these patients.
• Seizure disorders: Use with caution in patients with a history of seizure disorder; may exacerbate condition.
• Ulcerative colitis: Use with caution in patients with ulcerative colitis; may precipitate/aggravate toxic megacolon.

Concurrent drug therapy issues:

• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.

Special populations:

• Pediatric: Use with caution in infants and children since they may be more susceptible to adverse effects.

Dosage form specific issues:

• Fructose: Tablets may contain sucrose; avoid use of tablets in patients who are fructose intolerant.
• Product interchangeability: Scopolamine (hyoscine) hydrobromide should not be interchanged with scopolamine butylbromide formulations; dosages are not equivalent.
• Transdermal patch: May contain conducting metal (eg, aluminum); remove patch prior to MRI.

Monitoring Parameters

Body temperature, heart rate, urinary output, intraocular pressure

Pregnancy

Pregnancy Risk Factor

C

Pregnancy Considerations

Scopolamine crosses the placenta.

Avoid use of transdermal patches in pregnant females with severe preeclampsia; eclamptic seizures have been reported after IV and IM use.

Patient Education

What is this drug used for?

• It is used to help motion sickness.
• It is used to treat GI (gastrointestinal) spasms.
• It is used to prevent upset stomach and throwing up from surgery.
• It is used during surgery.
• It may be given to you for other reasons. Talk with the doctor.

Frequently reported side effects of this drug

• Fatigue
• Dry mouth
• Diarrhea
• Pharyngitis
• Agitation
• Application site irritation

Other side effects of this drug: Talk with your doctor right away if you have any of these signs of:

• Severe dizziness
• Fast heartbeat
• Passing out
• Confusion
• Difficult urination
• Vision changes
• Eye pain
• Severe eye irritation
• Enlarged pupils
• Seizures
• Mood changes
• Behavioral changes
• Difficulty speaking
• Sensing things that seem real but are not
• Trouble with memory
• Shortness of breath
• Sensation of warmth
• Not sweating
• Severe abdominal pain
• Nausea
• Vomiting
• Change in bowel movements
• Bloody stools
• Signs of a significant reaction like wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine.