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scopolamine

Sold as Transderm Scop. Class: Anticholinergics. First FDA approval 12/31/1979: 47 years on the US market.

This grade answers one narrow question: how strong is the public evidence and safety record behind this drug, and how clean is its money trail and court record? It is not a verdict on whether the drug is right for you.

B

Score breakdown (84/100)

Safety ×35%
B
Evidence ×25%
C
Regulatory ×15%
A
Money & lawsuits ×15%
A
Options ×10%
A

Safety: 83

Evidence: 66

Regulatory history: 88

Money & lawsuits: 100

Options: 100

Independent reviews and post-approval warnings

FDA Drug Safety Communications

Warnings the FDA chose to announce publicly after approval, as opposed to quiet label edits. Class-wide items name the drug's class, not this drug specifically.

What the FDA label says

Approved uses

Scopolamine Transdermal System is indicated in adults for the prevention of: nausea and vomiting associated with motion sickness. post-operative nausea and vomiting (PONV) associated with recovery from anesthesia and/or opiate analgesia and surgery. Scopolamine transdermal system is an anticholinergic indicated in adults for the prevention of: nausea and vomiting associated with motion sickness. ( 1 ) post-operative nausea and vomiting (PONV) associated with recovery from anesthesia and/or opiate analgesia and surgery. ( 1 )

Contraindications

Scopolamine transdermal system is contraindicated in patients with: angle closure glaucoma [see Warnings and Precautions (5.1) ] . hypersensitivity to scopolamine or other belladonna alkaloids or to any ingredient or component in the formulation or delivery system. Reactions have included rash generalized and erythema [see Adverse Reactions (6.2) , Description (11) ] . Angle closure glaucoma. ( 4 , 6.2 ) Hypersensitivity to scopolamine or other belladonna alkaloids or to any ingredient or component of the formulation or delivery system. ( 4 , 7 )

Warnings and precautions

Acute Angle Closure Glaucoma: Monitor for increased intraocular pressure in patients with open-angle glaucoma and adjust glaucoma therapy as needed. Discontinue if signs or symptoms of acute angle closure glaucoma develop. ( 5.1 ) Neuropsychiatric Adverse Reactions : May cause psychiatric and cognitive effects, seizures and impair mental and/or physical abilities. Monitor patients for new or worsening psychiatric symptoms during treatment and during concomitant treatment with other drugs that are associated with similar psychiatric effects. ( 5.2 , 7.1 ) Eclamptic Seizures in Pregnant Women : Avoid use in patients with severe preeclampsia. ( 5.3 ) Gastrointestinal and Urinary Disorders : Consider more frequent monitoring during treatment in patients suspected of having intestinal obstruction; patients with pyloric obstruction, patients with impeded urine flow, or receiving other anticholinergic drugs. Discontinue if patient develops difficulty in urination. ( 5.4 , 7.2 ) Hyperthermia : Serious adverse reactions have been reported postmarketing in adult and pediatric patients, including fatal cases. If symptoms occur, remove the transdermal system, and contact a healthcare provider....

Adverse reactions (label)

The following serious adverse reactions are described elsewhere in labeling: Acute Angle Closure Glaucoma [see Warnings and Precautions (5.1) ] Neuropsychiatric Adverse Reactions [see Warnings and Precautions (5.2) ] Eclamptic Seizures in Pregnant Women [see Warnings and Precautions (5.3) ] Gastrointestinal and Urinary Disorders [see Warnings and Precautions (5.4) ] Hyperthermia [see Warnings and Precautions (5.5) ] Drug Withdrawal/Post-Removal Symptoms [see Warnings and Precautions (5.6) ] Blurred Vision [see Warnings and Precautions (5.7) ] MRI Skin Burns [see Warnings and Precautions (5.8) ] Most common adverse reactions are: Motion Sickness (>15%): dry mouth, drowsiness, blurred vision and dilation of the pupils. ( 6.1 ) PONV (≥ 3%): dry mouth, dizziness, somnolence, agitation, visual impairment, confusion, mydriasis, and pharyngitis. ( 6.1 ) To report SUSPECTED ADVERSE REACTIONS, contact Rhodes Pharmaceuticals LLC at 1-888-873-5329 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to r...

Recent major label changes

Warnings and Precautions, Hyperthermia ( 5.5 ) 4/2025

Source: FDA SPL label for Scopolamine (Rhodes Pharmaceuticals LLC), effective 20260506. Full label on DailyMed.

Side-effect reports sent to the FDA

These are counts of reports people filed, not rates of harm. Anyone can file one, and nobody checks whether the drug was the cause. Millions of doses are taken for every report sent, so the useful part is how this drug compares with the average across all drugs.

7,442reports that mention this drug
7,401of those blame this drug, not another one the person was taking
71%of reports describe a serious outcome, such as a hospital stay (average for all drugs: 57%)
14.9%of reports include a death, from any cause (average for all drugs: 9.1%)

Problems reported most often

Off Label Use · 828Nausea · 707Vomiting · 533Headache · 467Dizziness · 457Drug Ineffective · 430Death · 373Malaise · 324Diarrhoea · 306Fatigue · 295Product Adhesion Issue · 277Product Use In Unapproved Indication · 268Confusional State · 265Vision Blurred · 255Pneumonia · 251

Reports per year

20192020202120222023202420252026
739636512578607550562307

3,463 reports blaming this drug for every million Medicare prescriptions filled, which is 1.3× the typical drug on this site. (1,387 reports in 2024–2026, against 400,551 Medicare fills in one year. This is the one number here that accounts for how many people take the drug.)

Source: the FDA's Adverse Event Reporting System (FAERS). Reports are voluntary and unverified. Drugs that are prescribed a lot, in the news, or in lawsuits attract more reports, so the percentages are compared with the whole database to correct for that partly, not fully.

Recalls and regulatory record

1recall actions on file
1 / 7brand / generic applications
2label changes since 2021
NoREMS program
DateClassFirmReason
04/2022Class IIMckesson Medical-Surgical Inc. Corporate OfficecGMP deviations: Temperature abuse

Class I = reasonable probability of serious harm. Class II = temporary or reversible harm. Class III = unlikely to harm. Most generic recalls are manufacturing or labeling defects for one lot, not a verdict on the molecule.

Evidence base

190randomized trials (PubMed)
11systematic reviews
450registered trials
52%of completed trials posted results
8%terminated or withdrawn
64%industry-funded

Independent Cochrane reviews

Counts measure how much evidence exists and how transparent it is, not how big the benefit is. For that, ask your prescriber: if 100 people like me took this, how many would get better because of it, and how many would be harmed? (Doctors call these the "number needed to treat" and "number needed to harm.") It differs by condition and is the number drug ads leave out. Sources: PubMed, ClinicalTrials.gov.

Money and lawsuits

In 2024, drug companies reported $0 in payments to US physicians and hospitals tied to this drug across 0 transactions.

No pending federal MDL names this drug or its brands.

Not named in any federal pharmaceutical settlement of $100M or more on record.

Sources: CMS Open Payments (Sunshine Act); Judicial Panel on Multidistrict Litigation pending docket list; DOJ settlements as tabulated on Wikipedia with links to the primary record. State-court and individual suits are not included.

Who takes it and what it costs

230,710Medicare Part D patients (2024)
400,551prescriptions filled
$79average cost per fill
$31Mtotal Medicare spend
ProductFills$/fill
Scopolamine398,915$78
Transderm-Scop1,636$178

Same-class alternatives

atropinecyclopentolatehomatropinemethscopolaminetropicamide

Same ATC pharmacological class, graded ones first, best grade at the top. Being in the same class does not make them interchangeable for your condition; it makes them worth asking about.

Questions to ask your prescriber

  1. In 2025 the FDA issued a safety communication about this drug (FDA adds warning about serious risk of heat-related complications with antinausea patch Transderm Scōp (scopol). Does that risk apply to me?
  2. The most-reported problems in FDA's adverse event data are nausea, vomiting, headache. How would we recognize and handle those?
  3. Off-label use is among the most-reported items for this drug. Is my use on-label, and if not, what evidence supports it?
  4. Why this one over atropine, cyclopentolate, homatropine? What would make you pick one of those instead?
  5. What result are we expecting, by when, and what is the plan if it does not happen?
  6. If 100 people like me took this drug, how many would actually get better because of it, and how many would be harmed by it? (Doctors call these the number needed to treat and the number needed to harm.)