Methscopolamine
JFDA label: Restropinal pediatric
Mechanism of Action
Methscopolamine is a quaternary ammonium derivative of scopolamine that exerts anticholinergic effects, which include reducing the volume and total acid content of gastric secretion, inhibiting gastrointestinal motility and salivary secretion, dilation of the pupil, and inhibition of accommodation that results in blurring of vision.
Indications
Approved
- Peptic ulcer (adjunctive)
Contraindications
Source: Lexicomp
- Hypersensitivity to methscopolamine, any component of the formulation, or related drugs Absolute
- intestinal atony of elderly or debilitated patients Absolute
- myasthenia gravis Absolute
- obstructive disease of the GI tract (eg, pyloroduodenal stenosis) Absolute
- obstructive uropathy (eg, bladder neck obstruction due to prostatic hypertrophy) Absolute
- paralytic ileus Absolute
- severe ulcerative colitis Absolute
- toxic megacolon complicating ulcerative colitis Absolute
- unstable cardiovascular status in acute hemorrhage Absolute
Adverse Reactions
Cardiac disorders (2)
Not Known Palpitation · tachycardia
Nervous system disorders (9)
Not Known CNS stimulation may be produced with large doses · confusion · dizziness · drowsiness · fever · flushing · Headache · insomnia · nervousness
Renal and urinary disorders (3)
Not Known Impotence · urinary hesitancy · urinary retention
Metabolism and nutrition disorders (1)
Not Known Lactation suppressed
Gastrointestinal disorders (7)
Not Known Constipation · dry throat · dysphagia · loss of taste · nausea · vomiting · xerostomia
Skin and subcutaneous tissue disorders (2)
Not Known Dry skin · urticaria
Musculoskeletal and connective tissue disorders (1)
Not Known Weakness
General disorders and administration site conditions (4)
Not Known Allergic reaction · anaphylaxis · diaphoresis decreased · hypersensitivity reactions
Other (4)
Not Known Blurred vision · cycloplegia · ocular tension increased · pupil dilation
Respiratory, thoracic and mediastinal disorders (1)
Not Known Dry nose
Dosing
Source: Lexicomp
Warnings & Precautions
Source: Lexicomp
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).
Diarrhea
May be a sign of incomplete intestinal obstruction, especially in patients with ileostomy or colostomy; discontinue treatment if this occurs.
Heat prostration
May occur in the presence of high environmental temperature; use caution in hot weather and/or exercise. Disease-related concerns:
Cardiovascular disease
Use with caution in patients with coronary artery disease, tachyarrhythmias, tachycardia, heart failure or hypertension.
Hepatic impairment
Use with caution in patients with hepatic impairment.
Hyperthyroidism
Use with caution in patients with hyperthyroidism.
Neuropathy
Use with caution in patients with autonomic neuropathy.
Prostatic hyperplasia
Use with caution in patients with prostatic hyperplasia.
Renal impairment
Use with caution in patients with renal impairment.
Ulcerative colitis
Use with caution in patients with ulcerative colitis (large doses may suppress intestinal motility leading to a paralytic ileus); 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:
Elderly
Use with caution in the elderly; increased risk for anticholinergic effects, confusion, and hallucinations.
Pregnancy & Lactation
Pregnancy
Animal reproduction studies have not been conducted. Methscopolamine is a derivative of scopolamine. Scopolamine is reported to cross the placenta; fetal toxicity noted in case reports.
Lactation
It is not known if methscopolamine is excreted in breast milk. Anticholinergics may suppress lactation. The manufacturer recommends that caution be exercised when administering methscopolamine to nursing women.
Monitoring
| Clinical pearl | Follow by upper GI contrast radiology or endoscopy to ensure healing |
|---|
Chemistry & Properties
| Formula | C18H24NO4+ |
|---|---|
| Molecular weight | 318.39 g/mol |
| IUPAC name | [(1S,2S,4R,5R)-9,9-dimethyl-3-oxa-9-azoniatricyclo[3.3.1.02,4]nonan-7-yl] (2S)-3-hydroxy-2-phenylpropanoate |
| CAS | 13265-10-6 |
| PubChem CID | 71183 |
| InChIKey | LZCOQTDXKCNBEE-IKIFYQGPSA-N |
| logP | 1.06 (XLogP 1.3) |
| Polar surface area | 59.06 Ų |
| H-bond acceptors / donors | 4 / 1 |
| Drug-likeness (QED) | 0.51 |
| Lipinski violations | 0 |
SMILES
C[N+]1(C)[C@@H]2C[C@@H](OC(=O)[C@H](CO)c3ccccc3)C[C@H]1[C@@H]1O[C@@H]12Biology & Pharmacokinetics
Pharmacokinetics predicted
| Bioavailability | 70.0% |
|---|---|
| Half-life | 1.79 h |
| Volume of distribution | 3.361 L/kg |
| Protein binding | 18.6% |
| BBB penetrant | No |
Enzyme interactions
| Enzyme | Role | Detail |
|---|---|---|
| CYP2C9 | Substrate | — |
| CYP3A4 | Substrate | — |
Receptor binding (top 2)
| Target | Action | Affinity |
|---|---|---|
| M3 receptor (CHRM3) | Antagonist | pKi 10.4 |
| M1 receptor (CHRM1) | Antagonist | pKi 9.9 |
Transporters
BCRP (Inhibitor)BSEP (Inhibitor)MRP1 (Inhibitor)OATP1B1 (Inhibitor)OATP1B3 (Inhibitor)P-gp (Inhibitor)P-gp (Substrate)
Drug–drug interactions (100+, DDInter)
| Interacting drug | Severity | Management |
|---|---|---|
| Potassium chloride | major | |
| Potassium citrate | major | |
| Topiramate | major | |
| Zonisamide | major | |
| Acebutolol | moderate | |
| Acetylcholine | moderate | |
| Aclidinium | moderate | |
| Acrivastine | moderate | |
| Alfentanil | moderate | |
| Alimemazine | moderate | |
| Amantadine | moderate | |
| Ambenonium | moderate | |
| Amitriptyline | moderate | |
| Amoxapine | moderate | |
| Arbutamine | moderate | |
| Aripiprazole | moderate | |
| Asenapine | moderate | |
| Atenolol | moderate | |
| Atropine | moderate | |
| Azatadine | moderate | |
| Belladonna | moderate | |
| Benzatropine | moderate | |
| Benzhydrocodone | moderate | |
| Betaxolol | moderate | |
| Bethanechol | moderate | |
| Biperiden | moderate | |
| Bisoprolol | moderate | |
| Botulinum Toxin Type B | moderate | |
| Botulinum toxin type A | moderate | |
| Brexpiprazole | moderate | |
| Brompheniramine | moderate | |
| Buprenorphine | moderate | |
| Butorphanol | moderate | |
| Carbamoylcholine (ophthalmic) | moderate | |
| Carbinoxamine | moderate | |
| Cariprazine | moderate | |
| Carteolol | moderate | |
| Carvedilol | moderate | |
| Cevimeline | moderate | |
| Chlorcyclizine | moderate |
Showing 40 of 100+.
Registered Products (1)
| Brand | Form / strength | Pack | Agent | Citizen (JOD) |
|---|---|---|---|---|
| Restropinal pediatric | Injection Nitrate 0.1 mg/ml, 2 mg/ml | 25 ml | Adatco Drug Store | 1.430 |