Methscopolamine (Pamine) - Uses, Dose, Side effects, MOA, Brands

Methscopolamine (Pamine) is an anticholinergic medicine that is used as an adjunctive to other medicines such as proton pump inhibitors (omeprazole, pantoprazole, lansoprazole, and dexlansoprazole) for the treatment of peptic ulcer disease, abdominal cramping, and abdominal pain.

Methscopolamine Uses:

  • Peptic ulcer (adjunctive):

    • It is used as adjunctive therapy for the treatment of peptic ulcer disease.
    • Limitations of use:
      • It has not been shown to be effective in the healing of peptic ulcer disease, reducing the rate of recurrence, or preventing complications.

Methscopolamine Dose in Adults:

Methscopolamine (Pamine) Dose in the treatment of Peptic ulcer (adjunctive):

  • Initial:
    • 2.5 mg orally 30 minutes before meals and 2.5 to 5 mg at bedtime;
    • An initial dose of 5 mg orally may be administered in patients with severe symptoms who require prompt relief of abdominal cramps and abdominal pain.
    • The dose may be titrated up or reduced based on the patient's clinical response and tolerance. A maximum dose of up to 30 mg per day may be used.

Use in Children:

Not indicated.


Pregnancy Risk Factor C

  • No studies have been conducted on animal reproduction.
  • It is possible that it crosses the placental barrier because it is a derivative from scopolamine. Scopolamine has been linked to fetal toxicities.

Methscopolamine use while breastfeeding

  • It's not known if the drug can be found in breastmilk. Anticholinergic medication may affect milk production.
  • If you are a nurse, it is best to use it with caution.

Dose in Kidney Disease:

There are no dosage adjustments provided in the manufacturer’s labeling. It should be used with caution in patients with kidney disease.

Dose in Liver disease:

There are no dosage adjustments provided in the manufacturer’s labeling. It should be used with caution in liver disease.


Side effects of Methscopolamine (Pamine):

  • Cardiovascular:

    • Palpitation
    • Tachycardia
  • Central Nervous System:

    • Headache
    • Insomnia
    • Flushing
    • Nervousness
    • Drowsiness
    • Dizziness
    • Confusion
    • Fever
    • CNS Stimulation May Be Produced With Large Doses
  • Dermatologic:

    • Dry Skin
    • Urticaria
  • Endocrine & Metabolic:

    • Lactation Suppressed
  • Gastrointestinal:

    • Constipation
    • Xerostomia
    • Dry Throat
    • Dysphagia
    • Nausea
    • Vomiting
    • Loss Of Taste
  • Genitourinary:

    • Impotence
    • Urinary Hesitancy
    • Urinary Retention
  • Neuromuscular & Skeletal:

    • Weakness
  • Ocular:

    • Blurred Vision
    • Cycloplegia
    • Ocular Tension Increased
    • Pupil Dilation
  • Respiratory:

    • Dry Nose
  • Miscellaneous:

    • Allergic Reaction
    • Diaphoresis Decreased
    • Hypersensitivity Reactions
    • Anaphylaxis

Contraindications to Methscopolamine (Pamine):

  • Hypersensitivity to methscopolamine or any other component of the formulation;
  • Glaucoma
  • Obstructive Uropathy, such as bladder neck obstruction caused by prostatic hypertrophy.
  • Obstructive disease (as in pyloroduodenal stasis)
  • Paralytic ileus
  • Debilitated or elderly patients may experience a gastrointestinal atony.
  • Unstable cardiovascular health can lead to acute bleeding
  • Grave ulcerative colitis
  • Toxic megacolon complicates ulcerative colitis
  • Myasthenia gravis

Warnings & Precautions

  • CNS effects

    • Patients might experience blurred vision and drowsiness that can affect their mental and physical abilities. Patients who are required to be alert for driving or operating heavy machinery should exercise caution.
  • Diarrhea

    • Diarrhea may occur in patients with incomplete intestinal obstruction, especially those who have ileostomy and colostomy. In such cases, the treatment should be stopped.
  • Heat prostration

    • Heat exhaustion can happen in summer heat. Be careful when exercising with athletes or in hot conditions.
  • Cardiovascular disease

    • It should be used with caution in patients with heart disease, hypertension, coronary artery disease, tachycardia, or tachyarrhythmias.
  • Hepatic impairment

    • Patients suffering from liver disease should be cautious.
  • Hyperthyroidism

    • Hyperthyroid patients should be cautious.
  • Neuropathy

    • Patients with autonomic neuropathy should avoid this.
  • Prostatic hyperplasia

    • Prostatic hyperplasia patients should be cautious about using it as it can worsen their urinary symptoms.
  • Renal impairment

    • Patients with impaired renal function should be cautious when taking the drug.
  • Ulcerative colitis

    • Avoid ulcerative colitis.

Methscopolamine: Drug Interaction

Risk Factor C (Monitor therapy)

Acetylcholinesterase Inhibitors

May diminish the therapeutic effect of Anticholinergic Agents. Anticholinergic Agents may diminish the therapeutic effect of Acetylcholinesterase Inhibitors.

Amantadine

May enhance the anticholinergic effect of Anticholinergic Agents.

Anticholinergic Agents

May enhance the adverse/toxic effect of other Anticholinergic Agents.

Botulinum Toxin-Containing Products

May enhance the anticholinergic effect of Anticholinergic Agents.

Cannabinoid-Containing Products

Anticholinergic Agents may enhance the tachycardic effect of Cannabinoid-Containing Products. Exceptions: Cannabidiol.

Chloral Betaine

May enhance the adverse/toxic effect of Anticholinergic Agents.

Gastrointestinal Agents (Prokinetic)

Anticholinergic Agents may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic).

Glucagon

Anticholinergic Agents may enhance the adverse/toxic effect of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased.

Itopride

Anticholinergic Agents may diminish the therapeutic effect of Itopride.

Mianserin

May enhance the anticholinergic effect of Anticholinergic Agents.

Mirabegron

Anticholinergic Agents may enhance the adverse/toxic effect of Mirabegron.

Nitroglycerin

Anticholinergic Agents may decrease the absorption of Nitroglycerin. Specifically, anticholinergic agents may decrease the dissolution of sublingual nitroglycerin tablets, possibly impairing or slowing nitroglycerin absorption.

Opioid Agonists

Anticholinergic Agents may enhance the adverse/toxic effect of Opioid Agonists. Specifically, the risk for constipation and urinary retention may be increased with this combination.

Ramosetron

Anticholinergic Agents may enhance the constipating effect of Ramosetron.

Thiazide and Thiazide-Like Diuretics

Anticholinergic Agents may increase the serum concentration of Thiazide and Thiazide-Like Diuretics.

Topiramate

Anticholinergic Agents may enhance the adverse/toxic effect of Topiramate.

Risk Factor D (Consider therapy modification)

Pramlintide

May enhance the anticholinergic effect of Anticholinergic Agents. These effects are specific to the GI tract.

Secretin

Anticholinergic Agents may diminish the therapeutic effect of Secretin. Management: Avoid concomitant use of anticholinergic agents and secretin. Discontinue anticholinergic agents at least 5 half-lives prior to administration of secretin.

Risk Factor X (Avoid combination)

Aclidinium

May enhance the anticholinergic effect of Anticholinergic Agents.

Cimetropium

Anticholinergic Agents may enhance the anticholinergic effect of Cimetropium.

Eluxadoline

Anticholinergic Agents may enhance the constipating effect of Eluxadoline.

Glycopyrrolate (Oral Inhalation)

Anticholinergic Agents may enhance the anticholinergic effect of Glycopyrrolate (Oral Inhalation).

Glycopyrronium (Topical)

May enhance the anticholinergic effect of Anticholinergic Agents.

Ipratropium (Oral Inhalation)

May enhance the anticholinergic effect of Anticholinergic Agents.

Levosulpiride

Anticholinergic Agents may diminish the therapeutic effect of Levosulpiride.

Oxatomide

May enhance the anticholinergic effect of Anticholinergic Agents.

Potassium Chloride

Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride.

Potassium Citrate

Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Citrate.

Revefenacin

Anticholinergic Agents may enhance the anticholinergic effect of Revefenacin.

Tiotropium

Anticholinergic Agents may enhance the anticholinergic effect of Tiotropium.

Umeclidinium

May enhance the anticholinergic effect of Anticholinergic Agents.

 

Monitoring parameters:

Observe for anticholinergic side effects. A follow-up endoscopy or upper GI contrast radiology may be required to confirm healing.


How to administer Methscopolamine (Pamine)?

  • Administer about 30 minutes before meals and at bedtime.

Mechanism of action of Methscopolamine (Pamine):

It is a derivative from scopolamine, a quanary ammonium derivative with anticholinergic characteristics. It decreases the volume and acid content of gastric secretions.

The onset of action:

  • About 1 hour

Duration:

  • 4 to 6 hours

Absorption:

  • Poorly and unreliably absorbed

Bioavailability:

  • 10% to 25%

Excretion:

  • Bile and urine;
  • feces (as unabsorbed drug)

International Brand Names of Methscopolamine:

  • Pamine Forte
  • Pamine

Methscopolamine Brand Names in Pakistan:

No Brands Available in Pakistan.

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