TRANSDERM SCOP^ (scopolamine 1.5 mg.) 

 MOTION SICKNESS PREVENTION PATCHES. 

 INDICATIONS AND USAGE 



Transdeim Scop is indicated lof prevenlion ol nausea and vomilmg asso- 

 cialed with motion sickness in adults The patch should be applied only 

 to skin in Ihe postauticular atea. 



CONTRAINDICATIONS 



Transderm Scop should not be used in palienis wilh known hyper- 

 sensitivily to scopolamine or any ol Ihe components ol Ihe adhesive 

 matrix making up Ihe therapeutic system, or in patients wilh glaucoma. 

 WARNINGS 



Transderm Scop should not be used in children and should be used with 

 special caulion in the elderly See PRECAUTIONS. 

 Since drowsiness, disorientalion, and contusion may occur with the use 

 ol scopolamine, patients should be warned ol the possibility and cau- 

 tioned against engaging in activities that require mental alerlness. such 

 as driving a motor vehicle or operating dangerous machinery 

 Potentially alarming idiosyncratic reactions may occur with ordinary 

 therapeutic doses ol scopolamine 

 PRECAUTIONS 



General. Scopolamine should be used wilh caulion in patients wilh 

 pyloric obstruction, or urinary bladder neck obstruction. 



Caution should be exercised when administering an antiemetic ot anli- 

 muscarinic drug to patienis suspected ol having intestinal obstruction 

 Transderm Scop should be used wilh special caution in the elderly or in 

 individuals with impaired metabolic, liver or kidney tunclions, because ol 

 the increased likelihood ot CNS elfects 



Infoimatlon for Patients. Since scopolamine can cause temporary 

 dilation of Ihe pupils and blurred vision it il comes in contact with the 

 eyes, patients should be strongly advised to wash their hands thoroughly 

 with soap and water immediately atter handling the patch 



Patienis should be advised lo remove the patch immediately and contact 

 a physician in the unlikely event that they experience symptoms ot acute 

 narrow-angle glaucoma (pain in and reddening ol Ihe eyes accompanied 

 by dilated pupils) 



Patienis should be warned against driving a molor vehicle or operating 



dangerous machinery A patient brochure is available. 



Drug Interactions. Scopolamine should be used with care in patients 

 taking drugs, including alcohol, capable ot causing CNS ellects Special 

 attention should be given to drugs having anticholinergic properties, 

 eg , belladonna alkaloids, antihistamines (including meclizine), and 



antidepressants. 



Carcinogenesis, Mutagenesis, Impairment of Fertility. No long- 

 term studies in animals have been performed to evaluate carcinogenic 

 potential. Fertility studies were performed in lemale rals and revealed no 

 evidence ol impaired lertility or harm to the lelus due to scopolamine 

 hydrobromide administered by daily subcutaneous injection In the high- 

 est dose group (plasma level approximately 500 limes the level achieved 

 in humans using a transdermal system), reduced maternal body weights 

 were observed 



Pregnancy Category C. Teratogenic studies were performed in preg- 

 nant rats and rabbits with scopolamine hydrobromide administered by 

 daily intravenous injection No adverse ellects were recorded in the rals. 

 In the rabbits, the highest dose (plasma level approximately 100 times the 

 level achieved m humans using a transdermal system) ot drug adminis- 

 tered had a marginal embryotoxic effect Transderm Scop should be used 

 during pregnancy only if the anticipated benelil luslilies the potenlial risk 

 to the fetus. 



Nursing Mothers. It is nol known whether scopolamine is excreted in 

 human milk. Because many drugs are excreted in human milk, caution 

 should be exercised when Transderm Scop is administered to a nursing 

 woman 



Pediatric Use. Children are particularly susceptible to Ihe side eftects 



ol belladonna alkaloids. Transderm Scop should not be used in children 

 because it is not known whether this system will release an amount ol 

 scopolamine that could produce serious adverse ellects in children. 

 ADVERSE REACTIONS 



The most IrequenI adverse reaction lo Transderm Scop is dryness ol Ihe 

 mouth. This occurs in about two thirds ol the people. A less Irequent 

 adverse reaclion is drowsiness, which occurs in less than one sixth ol Ihe 

 people. Transient impairment of eye accommodation, including blurred 

 vision and dilation ol the pupils, is also observed 

 Ttie loilowing adverse reaclions have also been reported on inlrequent 

 occasions during the use ol Transderm Scop- disonenlalion, memory 

 disturbances, dizziness, restlessness, hallucinalions; contusion, dirticulty 

 urinating, rashes and erythema, acute narrow-angle glaucoma: and dry 

 itchy, or red eyes 



Drug Withdrawal: Symptoms including dizziness, nausea, vomiting, 

 headache and disturbances ot equilibrium have been reported in a tew 

 patients toflowmg discontinuation of the use ol the Transderm Scop sys- 

 tem These symptoms have occurred most often in patients who have 

 used the systems tor more than three days 



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along Africa's north-soutti axis. Most of 

 the Fertile Crescent founder crops reached 

 Egypt very quickly and then spread as far 

 south as the cool highlands of Ethiopia, 

 beyond which they spread no farther. 

 South Africa's Mediterranean climate 

 would have been ideal for them, but the 

 2,000 miles of tropical conditions between 

 Ethiopia and South Africa posed an insu- 

 perable barrier. Instead, African agricul- 

 mre south of the Sahara was launched by 

 the domestication of such wild plants as 

 sorghum and African yams, which are in- 

 digenous to the Sahel and tropical West 

 Africa and are adapted to the warmth, 

 summer rains, and relatively constant day- 

 lengths of those low latitudes. 



Similarly, the southward spread of Fer- 

 tile Crescent domestic animals through 

 Africa was stopped or slowed by climate 

 and disease, especially by trypanosome 

 diseases carried by tsetse flies. The horse 

 never made it farther south than West 

 Africa's kingdoms north of the equator. 

 Cattle remained stuck for 2,000 years at 

 the northern edge of the Serengeti Plain, 

 while new types of human economies and 

 livestock breeds were being developed. 

 Not until about the time of Christ, some 

 7,000 years after they were domesticated 

 in the Fertile Crescent, did they finally 

 straggle into South Africa along with 

 sheep and goats. Tropical African crops 

 had their own difficulties spreading south 

 in Africa, reaching South Africa with 

 black African farmers (the Bantu) just 

 after the arrival of those Fertile Crescent 

 livestock. However, those tropical African 

 crops were never able to go beyond South 

 Africa's Fish River, stopped by Mediter- 

 ranean conditions to which they were not 

 adapted. 



Because of this. South Africa's indige- 

 nous Khoisan peoples (otherwise known 

 as Hottentots and Bushmen) acquired Uve- 

 stock but remained without agriculture. 

 They became outnumbered and were re- 

 placed northeast of the Fish River by black 

 African farmers, whose southward spread 

 halted there. Only when European settlers 

 arrived by sea in 1652, bringing with them 

 their Fertile Crescent crop package, did 

 agriculture thrive in South Africa's 

 Mediterranean zone. The collisions of all 

 those elements produced the tragedies of 

 modem South Africa: the quick decima- 

 tion of the Khoisan by European germs 

 and guns; a century of wars between Euro- 

 peans and blacks; another century of racial 

 oppression; and now, efforts by Europeans 

 and blacks to seek a new mode of coexis- 

 tence in the former Khoisan lands. 



22 Natural History 5/94 



