People’s Pharmacy: Scopolamine after surgery leads to delirium

Q. I read recently in your column about an amnesia reaction to scopolamine. I would like to share my husband’s scopolamine story.

When he has had surgery in the past, the doctors have applied a scopolamine patch before the operation to prevent nausea and vomiting due to anesthesia and surgery. He’s never had a problem previously, but the patch was not removed following his most recent surgery.

A day later, he became agitated and confused and had to be readmitted to the hospital. He completely lost touch with reality. Ultimately, an astute pharmacist diagnosed a scopolamine overdose. After two days of terror for me, they removed the patch, and his personality was restored.

Our hospital had never experienced this type of reaction. Thanks to an attentive pharmacist and a cooperative hospitalist, our anesthesiologists are now advised of the possibility of scopolamine overdose if the patch is not removed before discharge.

A. Scopolamine (Transderm Scop) is a powerful anticholinergic drug. That means it dries up mucus secretions and helps prevent nausea and vomiting. Doctors often prescribe it prior to surgery or to control motion sickness. The official prescribing information states: “Remove the transdermal system 24 hours following surgery.”

Side effects may include agitation, confusion, blurred vision, dry mouth and memory problems. Some people can experience delusions, paranoia and hallucinations. Thank goodness for the alert pharmacist who recognized symptoms of scopolamine overdose.

Q. My father and his father had heart attacks at an early age. That is why I paid attention when I read that Lp(a) is an important risk factor for heart disease that runs in families. When I asked my doctor to order a blood test, she said that only a cardiologist can do that. Since I do not have one, what else can I do?

A. Any doctor could order a blood test for lipoprotein a, also known as Lp(a). It is a major risk factor for heart disease and calcification of heart valves.

If your doctor is not cooperative, you could order this test yourself. Other readers report doing so online through HealthLabs.com or PrivateMDLabs.com at a cost of around $50.

In the past, some doctors have been reluctant to test for this blood lipid because there was no drug that they could prescribe to lower it. That is beginning to change. Drugs for this purpose are now in clinical trials.

You can learn more about Lp(a), test results and several approaches to reducing it a bit in our “eGuide to Cholesterol Control and Heart Health.” This online resource may be found under the Health eGuides tab at www.PeoplesPharmacy.com.

Q. Last spring, I developed bad allergies. I tried using antihistamines, but they made my dry eye syndrome worse. What benefits I got wore off before bedtime. The stuffy nose interfered with my sleep.

Then I read about NasalCrom. It brought relief right after the first treatment. By the second night, I had undisturbed sleep. I am glad to have discovered this over-the-counter nasal spray for my allergies.

A. NasalCrom (cromolyn) works differently from antihistamines to calm allergic reactions. It stabilizes mast cells in the nose. These cells are highly reactive to allergens such as pollen or cat dander. The drug works best when used preventively before symptoms become overwhelming. Side effects may include sneezing, nasal irritation or alteration of taste.

In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, Fla., 32803, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”