Return To The Previous Page
Buy a Package
Number Of Visible Items Remaining : 3 Item

Anticholinergic (antimuscarinic) therapy for reduction of secretions* at the end of life

Anticholinergic (antimuscarinic) therapy for reduction of secretions* at the end of life
Agents Adult dose
Glycopyrrolate (glycopyrronium)[1,2]
  • Preferred over scopolamine (hyoscine)

0.1 to 0.2 mg SubQ or IV every 4 to 6 hours as needed

or

0.1 to 0.2 mg SubQ or IV once; followed after 30 minutes by continuous SubQ or IV continuous infusion of 0.6 to 1.2 mg over 24 hours

or

0.1 mg sublingual every 6 hours as needed (may use 0.5 mL per dose of commercially available 0.2 mg/mL oral solution)
Scopolamine transdermal patch Apply one patch (each delivers 1 mg scopolamine base over 3 days) behind ear for up to 72 hours; if needed for more than 72 hours, remove old patch and place new one behind other ear.
Scopolamine (hyoscine) BUTYLbromide[2-4]
  • If glycopyrrolate is not available, preferred over scopolamine hydrobromide and scopolamine transdermal patch
  • Not available in United States

Refer to NOTE

20 mg SubQ or IV every 4 to 6 hours as needed (maximum 100 mg daily)

or

20 mg SubQ or IV once; followed after 30 minutes by SubQ or IV continuous infusion of 20 to 60 mg over 24 hours
Methscopolamine bromide 2.5 mg orally every 6 hours as needed

Scopolamine (hyoscine) HYDRObromide[1-3]

Parenteral formulation is not available in United States; an oral preparation may be available from a compounding pharmacy

Least preferred alternative due to CNS adverse effects (refer to NOTE)

0.4 mg SubQ every 4 to 6 hours as needed

or

0.4 mg SubQ once followed by SubQ continuous infusion of 1.2 mg over 24 hours
NOTE: Scopolamine (hyoscine) butylbromide and hydrobromide formulations are not equivalent and not interchangeable on a milligram-to-milligram basis. Scopolamine (hyoscine) butylbromide is a quaternary derivative with fewer CNS effects (eg, less risk of delirium and agitation) compared with scopolamine (hyoscine) hydrobromide and transdermal patch. Older adults, children, and patients with advanced kidney or hepatic impairment are particularly susceptible to CNS adverse effects of hyoscine hydrobromide and patch.

CNS: central nervous system; IV: intravenous; SubQ: subcutaneous.

* Also known as "death rattle." Anticholinergic (antimuscarinic) effects may contribute to patient discomfort (eg, dryness, urinary retention) and do not dry secretions already present. Refer to UpToDate content on palliative care in last hours and days of life for guidance on use and limitations of anticholinergic therapy.

¶ Scopolamine is also known as "hyoscine" in many countries.
References:
  1. Hugel H, Ellershaw J, Gambles M. Respiratory tract secretions in the dying patient: a comparison between glycopyrronium and hyoscine hydrobromide. J Palliat Med 2006; 9:279.
  2. Wilcock A, Howard P, Charlesworth S (Eds), Palliative Care Formulary, 8th ed, Pharmaceutical Press 2022.
  3. Bennett M, Lucas V, Brennan M, et al. Using anti-muscarinic drugs in the management of death rattle: evidence-based guidelines for palliative care. Palliat Med 2002; 16:369.
  4. Hughes A, Wilcock A, Corcoron R, et al. Audit of three antimuscarinic drugs for managing retained secretions. Palliat Med 2000; 14:221.

Data from: UpToDate Lexidrug. More information available at https://online.lexi.com/.

Graphic 81557 Version 25.0

Do you want to add Medilib to your home screen?