C₁₇H₂₁NO₄

Scopolamine or Hyoscine is a alcaloid which is naturally found in several plants among Solanacea family. With a similar chemical structure of Atropine, it shows anti-muscarinic and anti-cholinergic effects (decrease in saliva, bronchial, sweat and gastric secretion, tachycardia, pupil dilation, anti-spasmodic effect on the intestine and urinary tract) Most frequently used formulations contain buthylbromurate, methybromurate and hydrobromurate. Skin patches contain purified Scopolamine. Used for prevention of motion-sickness of the traveler and treatment of nausea, post-anesthesia vomiting. Also, as anti-spasmodict and treatment of ophthalmologic disorders.

At latest update, relevant published data on excretion into breast milk were not found.

Less difficulty in breastfeeding has been observed in neonates whose mothers received scopolamine during delivery compared to those who received meperidine. ^{(Hemati 2018).}

Drugs with anticholinergic / antimuscarinic effect can inhibit prolactin secretion ^{(Müller 1983, Masala 1982)}, but the stimulation of suckling of the infant is usually sufficient to ensure the production of breast milk.^{(Messinis 1985)}

Due to a low oral bioavailability ^{(Putcha 1989)}, that minimizes the presence into the infant's plasma from mother's milk ingested, thus, the expert consensus is that the risk of use while breastfeeding is minimal ^{(Hale, Reece 2017, Briggs 2015, Chen 2010, Schaefer 2007).} American Academy of Pediatrics: medication usually compatible with breastfeeding. ^{(AAP 2001)}

Since at small dosage Scopolamine poisoning with alarming symptoms may occur (irritability, delirium, redness of skin, mouth dryness, constipation, urine retention), we would recommend a cautious and moderate use. Avoid use if the infant is younger than 2 months or premature.

OPHTHALMIC USE:

The small dose and poor plasma absorption of most topical ophthalmological preparations (Lahdes 1990) make it unlikely that significant amounts will transfer into breastmilk.

Topical use in the form of eye drops is compatible with breastfeeding.

Systemic absorption can be minimized by pressing on the tear duct (inner canthus of the eye) with a finger for 1-2 minutes. ^{(Bausch 2018)}

No decrease in breast milk production has been reported with regular doses of antimuscarinic eye drops.