Pamine Forte

Pamine^® 2.5 mg/Pamine^® Forte 5 mg Tablets contain methscopolamine bromide, an anticholinergic, which occurs as white crystals, or as a white odorless crystalline powder. Methscopolamine bromide melts at about 225°C with decomposition. The drug is freely soluble in water, slightly soluble in alcohol, and insoluble in acetone and in chloroform.

The chemical name for methscopolamine bromide is 3-Oxa-9-azoniatricyclo [3.3.1.0^2,4]nonane, 7-(3-hydroxy-1-oxo-2-phenylpropoxy)-9, 9-dimethyl-, bromide, [7(S)-(1α, 2β, 4β, 5α, 7β)]- and the molecular weight is 398.30.

The structural formula is represented below:

Pamine^® 2.5 mg Tablets for oral administration contain 2.5 mg of methscopolamine bromide. Pamine^® Forte 5 mg Tablets for oral administration contain 5 mg of methscopolamine bromide.

Inactive ingredients: microcrystalline cellulose, pregelatinized starch, magnesium stearate.

Contains no lactose.

Methscopolamine bromide is an anticholinergic agent which possesses most of the pharmacologic actions of that drug class. These include reduction in volume and total acid content of gastric secretion, inhibition of gastrointestinal motility, inhibition of salivary excretion, dilation of the pupil and inhibition of accommodation with resulting blurring of vision. Large doses may result in tachycardia.

Adjunctive therapy for the treatment of peptic ulcer.

METHSCOPOLAMINE BROMIDE HAS NOT BEEN SHOWN TO BE EFFECTIVE IN CONTRIBUTING TO THE HEALING OF PEPTIC ULCER, DECREASING THE RATE OF RECURRENCE OR PREVENTING COMPLICATIONS.

Glaucoma; obstructive uropathy (e.g., bladder neck obstruction due to prostatic hypertrophy); obstructive disease of the gastrointestinal tract (e.g., pyloroduodenal stenosis); paralytic ileus; intestinal atony of the elderly or debilitated patient; unstable cardiovascular status in acute hemorrhage; severe ulcerative colitis; toxic megacolon complicating ulcerative colitis; myasthenia gravis.

Pamine^® 2.5 mg/Pamine^® Forte 5 mg is contraindicated in patients who are hypersensitive to methscopolamine bromide or related drugs.

In the presence of high environmental temperature, heat prostration (fever and heat stroke due to decreased sweating) can occur with drug use.

Diarrhea may be an early symptom of incomplete intestinal obstruction, especially in patients with ileostomy or colostomy. In this instance treatment with this drug would be inappropriate and possibly harmful.

Methscopolamine bromide may produce drowsiness or blurred vision. The patient should be cautioned regarding activities requiring mental alertness such as operating a motor vehicle or other machinery or performing hazardous work while taking this drug.

With overdosage, a curare-like action may occur, i.e., neuromuscular blockade leading to muscular weakness and possible paralysis.

The following adverse reactions have been observed, but there is not enough data to support an estimate of frequency.

Cardiovascular: Tachycardia, palpitation.

Allergic: Severe allergic reaction or drug idiosyncrasies including anaphylaxis.

CNS: Headaches, nervousness, mental confusion, drowsiness, dizziness.

Special Senses: Blurred vision, dilation of the pupil, cycloplegia, increased ocular tension, loss of taste.

Renal: Urinary hesitancy and retention.

Gastrointestinal: Nausea, vomiting, constipation, bloated feeling.

Dermatologic: Decreased sweating, urticaria and other dermal manifestations.

Miscellaneous: Xerostomia, weakness, insomnia, impotence, suppression of lactation.

Not applicable.

The symptoms of overdosage with Pamine^® 2.5 mg/Pamine^® Forte 5 mg Tablets progress from intensification of the usual side effects to CNS disturbances (from restlessness and excitement to psychotic behavior), circulatory changes (flushing, fall in blood pressure, circulatory failure), respiratory failure, paralysis, and coma.

Measures to be taken are (1) induction of emesis and (2) injection of physostigmine 0.5 to 2 mg intravenously, and repeated as necessary up to a total of 5 mg. Fever may be treated symptomatically (alcohol sponging, ice packs). Excitement of a degree which demands attention may be managed with sodium thiopental 2% solution given slowly intravenously or chloral hydrate (100-200 mL of a 2% solution) by rectal infusion. In the event of progression of the curare-like effect to paralysis of the respiratory muscles, artificial respiration should be instituted and maintained until effective respiratory action returns.

The oral LD₅₀ in rats is 1,352 to 2,617 mg/kg.

No data is available on the dialyzability of methscopolamine bromide.

The average dosage of Pamine^® Tablets is 2.5 mg one-half hour before meals and 2.5 to 5 mg at bedtime. A starting dose of 12.5 mg daily will be clinically effective in most patients without the production of appreciable side effects.

If the patient is experiencing symptoms such as severe abdominal pain or cramping which demand prompt relief, the drug may be started on a daily dosage of 20 mg, administered in doses of 5 mg one-half hour before meals and at bedtime. If very unpleasant side effects develop promptly, the daily dosage should be reduced. If neither symptomatic relief nor side effects appear, the daily dosage may be increased. Some patients have tolerated 30 mg daily with no unpleasant reactions.

Patients whose dosage has been reduced to eliminate or modify side effects often continue to show adequate response both subjectively in relief of symptoms and objectively as measured by antisecretory effects.

The ultimate aim of therapy is to arrive at a dosage which provides maximal clinical effectiveness with a minimum of unpleasant side effects. Many patients report no side effects on a dosage which gives complete relief of symptoms. On the other hand, some patients have reported severe side effects without appreciable symptomatic relief. Such patients must be considered unsuited for this therapy. Usually they have been or will prove to be similarly intolerant to other anticholinergic drugs. If methscopolamine bromide is to be used in a patient who gives a history of such intolerance, it should be started at a low dosage.

Pamine^® 2.5 mg Tablets are available as white, round tablets, debossed with "PAMINE" on one side, in the following package size:

Bottles of 100 (NDC 10337-061-01)

Pamine^® Forte 5 mg Tablets are available as white, oval tablets, debossed with "PAMINE 5" on one side, in the following package size:

Dose Pack (5 blisters of 12 tablets)
Box of 60 (NDC 10337-062-06)

1. Gilman A, Gilman AB, Goodman LA, eds.
   The Pharmacological Basis of Therapeutics.
   6th ed. New York: MacMillan Publishing Company.1980.
2. American Hospital Formulary Service. American Society of Hospital Pharmacists. Bethesda, Maryland.
3. Domino EF, Corasen G. Central and Peripheral Effects of Muscarinic Cholinergic Blocking Agents in Man. Anesthesiology 1967;28:568-574.
4. Mogensen L, Orinius E. Arrhythmic Complications after Parasympathetic Treatment of Bradyarrhythmias in a Coronary Care Unit. Acta Med Scand 1971;190:495-498.
5. Neeld JB Jr., et al. Cardiac Rate and Rhythm Changes with Atropine and Methscopolamine. Clin Pharmacol Ther 1975;17(3):290-295.

R_x Only

Manufactured for:

PharmaDerm^®
A division of Fougera Pharmaceuticals Inc.

Melville, NY 11747 USA
www.pharmaderm.com

Mfd. by:
Mikart, Inc., Atlanta, GA 30318 USA

IL175B R2/12

NDC 10337-061-01

100 Tablets

Rx Only

Pamine^®

(methscopolamine bromide)

2.5 mg

PharmaDerm^®

NDC 10337-062-06

Dose Pack

Dispense As One Unit

Rx Only

Pamine^®

Forte 5mg

(methscopolamine bromide)

60 Tablets (5 blisters of 12 tablets)

PharmaDerm^®