Withdrawal symptoms after discontinuation of transdermal scopolamine therapy: treatment with meclizine.

PURPOSE: The case of a patient who treated withdrawal symptoms from trans-dermal scopolamine with meclizine is reported. SUMMARY: A 30-year-old woman for whom transdermal scopolamine was prescribed to manage motion sickness during a vacation experienced severe withdrawal symptoms that began 24 hours after patch removal and lasted for several days. Other medications included an oral contraceptive and as-needed zolmitriptan for migraines. She used the scopolamine patches as prescribed, applying one patch behind the ear every 3 days. After 10 consecutive days of wearing the patch and experiencing no motion sickness, she began to develop dry mouth and uncomfortable, dry eyes, which prompted her to remove the patch. After 24 hours without the patch, she developed severe nausea that did not subside during a car ride. Due to the intractable nausea, she applied a new patch, which she wore for 3 consecutive days without recurrence of the nausea. Upon returning from the trip, she removed the last patch. Twelve hours after the last patch was removed, nausea recurred but was not related to motion. She felt better while lying down, but felt nauseated when standing or walking. After 3 days of this nausea, she began taking nonprescription meclizine 25 mg orally every 12 hours. The nausea subsided after two doses, and she was able to resume her normal activities. The nausea did not recur after discontinuation of the meclizine. She had used transdermal scopolamine eight years prior without any withdrawal symptoms. CONCLUSION: Withdrawal symptoms experienced after removal of a transdermal scopolamine patch were successfully treated with oral meclizine.

Facial flushing associated with duloxetine use.

PURPOSE: A case of flushing associated with duloxetine use is presented. SUMMARY: A 43-year-old nonmenopausal woman was prescribed duloxetine 20 mg daily for migraine prophylaxis after the usual medications for treatment and prevention of migraines were used with little or no success. Magnetic resonance imaging and computed tomography ruled out structural causes of migraines. The patient took 20 mg daily for five days and then decided, on her own, to decrease the dosage after experiencing insomnia, a common adverse effect of duloxetine. She opened the 20-mg capsules and took half of the contents to "create" the 10-mg dose, placing the contents of the opened capsule directly onto her tongue. She did this for two weeks and found the migraines to be significantly reduced in number and intensity. At that time, she began to experience what she described as a hot flash and facial flushing. The flushing was not accompanied by itching and did not spread beyond the face. The flushing occurred one to two hours after administering the 10-mg dose and typically resolved the following day. One week later, the patient noticed that the vessels in her face were more prominent. Concomitant therapies included pindolol for hypertension and duloxetine and botulinum toxin type A injections for migraines. The patient weaned herself off duloxetine. Facial flushing continued for one week after discontinuation of the drug. At a one-month follow-up visit, she stated that the flushing had resolved and not occurred since the original episodes. CONCLUSION: A patient treated with duloxetine developed facial flushing, possibly caused by inappropriate administration of the drug.