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Cholinergic Antagonists: Pharmacokinetics01:24

Cholinergic Antagonists: Pharmacokinetics

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Cholinergic antagonists—such as antimuscarinics—are available in oral, topical, ocular, parenteral, and inhalational formulations. Most antimuscarinics are oral formulations,  while scopolamine is available as a topical patch, and ipratropium and tiotropium are available as inhalation aerosols or powders. Atropine, tropicamide, and cyclopentolate are topically instilled in the eye. Most antimuscarinics are lipid-soluble and readily absorbed from the gastrointestinal tract and...
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Cholinergic Antagonists: Therapeutic Uses01:26

Cholinergic Antagonists: Therapeutic Uses

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Antimuscarinic drugs have various therapeutic applications by inhibiting parasympathetic stimulation in different systems. Here are the key therapeutic uses of antimuscarinics:    
Respiratory Tract: Ipratropium, aclidinium, and tiotropium treat asthma, chronic bronchitis, and chronic obstructive pulmonary disease (COPD). They protect against bronchoconstriction caused by irritants like cigarette smoke, sulfur dioxide, and ozone. They also help reduce nasopharyngeal...
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Local Anesthetics: Adverse Effects01:12

Local Anesthetics: Adverse Effects

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While local anesthetics are generally safe and well-tolerated, they can occasionally cause adverse effects that vary in severity. Local anesthetics can induce toxicity at two distinct levels. They can either produce local effects through direct contact with the neural elements or be absorbed into the bloodstream from the injection site, leading to systemic effects.
Once absorbed into the systemic circulation, local anesthetics can affect the organs that depend on the functioning of sodium...
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Angle Closure Glaucoma: Treatment01:28

Angle Closure Glaucoma: Treatment

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Angle-closure glaucoma, or closed-angle glaucoma, is an eye condition where the iris bulges out and blocks the iridocorneal angle, resulting in a buildup of aqueous humor and increased intraocular pressure. Immediate medical attention is necessary due to the sudden onset of symptoms. The treatment for angle-closure glaucoma includes short-term and long-term approaches. Short-term treatment involves using eye drops like pilocarpine to lower intraocular pressure by increasing aqueous humor...
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Indirect-Acting Cholinergic Agonists: Pharmacological Actions01:30

Indirect-Acting Cholinergic Agonists: Pharmacological Actions

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Indirect-acting cholinergic agonists, also known as anticholinesterases, exert their pharmacological effects by enhancing cholinergic transmission in various body parts, including the neuromuscular junction, autonomic cholinergic synapses, and the brain.
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Direct-Acting Cholinergic Agonists: Therapeutic Uses01:11

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Direct-acting cholinergic agonists have many therapeutic uses in various medical fields. Choline esters, including acetylcholine, have limited clinical utility due to their non-selectivity and short duration of action. Still, acetylcholine and carbachol are applied topically during ophthalmologic surgery to induce miosis. Pilocarpine, a muscarinic and ganglionic stimulator, effectively treats open-angle glaucoma and alleviates xerostomia and dry mouth caused by radiotherapy or Sjögren...
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Related Experiment Video

Updated: Dec 7, 2025

Author Spotlight: Challenges in Developing Dry Eye Animal Models and Future Research Directions
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[Iatrogenic anisocoria after using a scopolamine patch for PONV prophylaxis].

A von Nell1, N Kiefer2, M Amarasekara2

  • 1Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum Dortmund, Beurhausstr. 40, 44137, Dortmund, Deutschland. Antonia.vonnell@klinikumdo.de.

Der Anaesthesist
|September 27, 2020
PubMed
Summary

A scopolamine patch used for postoperative nausea and vomiting (PONV) can cause temporary unilateral mydriasis (anisocoria). This ophthalmological side effect, though rare, should be considered by clinicians when prescribing scopolamine patches.

Keywords:
AccommodationPostoperative nausea and vomitingSide effectTransdermal scopolamineUnilateral mydriasis

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Area of Science:

  • Anesthesiology
  • Ophthalmology
  • Pharmacology

Background:

  • Scopolamine patches are commonly used for preventing postoperative nausea and vomiting (PONV).
  • While effective, scopolamine can have side effects, including ophthalmological complications.
  • This case report details an instance of unilateral mydriasis following scopolamine patch application.

Observation:

  • A 29-year-old female developed unilateral mydriasis (anisocoria) in the left eye after receiving a scopolamine patch for PONV prevention.
  • Neurological, ophthalmological, and MRI investigations were conducted but revealed no underlying pathology.
  • The anisocoria resolved spontaneously within 24 hours without intervention.

Findings:

  • The unilateral mydriasis was suspected to be a pharmacologically induced side effect of the scopolamine patch.
  • Accidental contact of the scopolamine substance with the affected eye is the presumed mechanism.
  • Dysfunctional accommodation is a known, common side effect of scopolamine, affecting over 10% of patients.

Implications:

  • Clinicians should be aware of the potential for ophthalmological side effects like anisocoria when prescribing scopolamine patches.
  • The application of scopolamine patches warrants careful consideration, especially in surgical fields where anisocoria might mimic other complications.
  • This case highlights the importance of considering medication side effects in differential diagnoses.