Hyoscyamine: Pediatric drug information

For additional information see "Hyoscyamine: Drug information" and "Hyoscyamine: Patient drug information"

For abbreviations, symbols, and age group definitions show table

Brand Names: US

Anaspaz;
Ed-Spaz [DSC];
Hyosyne;
Levbid;
Levsin;
Levsin/SL;
NuLev;
Oscimin;
Oscimin SR [DSC];
Symax Duotab [DSC];
Symax-SL [DSC];
Symax-SR [DSC]

Therapeutic Category

Anticholinergic Agent;
Antispasmodic Agent, Gastrointestinal

Dosing: Pediatric

Note: Oral dosage forms (drops and elixirs) are different (ie, 0.125 mg/mL [drops] and 0.125 mg/5 mL [solution]); precaution should be taken to verify and avoid confusion between the different concentrations; dose should be clearly presented with corresponding product formulation.

Bradycardia, drug-induced during surgery

Bradycardia, drug-induced during surgery: Children >2 years and Adolescents: IV: 0.125 mg; repeat as needed

Gastrointestinal and urinary systemic spasms

Gastrointestinal and urinary systemic spasms (including infant colic, biliary and renal colic):

Infants and Children <2 years: Oral: Drops (eg, Hyosyne [0.125 mg/mL]): Do not exceed 6 doses in 24 hours

3.4 to <5 kg: 0.01375 mg (0.11 mL or 4 drops) every 4 hours or as needed; maximum daily dose: 0.0825 mg (0.66 mL or 24 drops)/day

5 to <7 kg: 0.0175 mg (0.14 mL or 5 drops) every 4 hours or as needed; maximum daily dose: 0.105 mg (0.84 mL or 30 drops)/day

7 to <10 kg: 0.02 mg (0.16 mL or 6 drops) every 4 hours or as needed; maximum daily dose: 0.12 mg (0.96 mL or 36 drops)/day

≥10 kg: 0.0275 mg (0.22 mL or 8 drops) every 4 hours or as needed; maximum daily dose: 0.165 mg (1.32 mL or 48 drops)/day

Children 2 to <12 years: Oral:

Drops (eg, Hyosyne [0.125 mg/mL]): 0.03125 mg (0.25 mL) to 0.125 mg (1 mL) every 4 hours or as needed; maximum daily dose: 0.75 mg (6 mL)/day; do not exceed 6 doses in 24 hours

Elixir (eg, Hyosyne [0.125 mg/5 mL]): Do not exceed 6 doses in 24 hours:

10 to <20 kg: 0.03125 mg (1.25 mL) every 4 hours or as needed; maximum daily dose: 0.1875 mg (7.5 mL)/day

20 to <40 kg: 0.0625 mg (2.5 mL) every 4 hours or as needed; maximum daily dose: 0.375 mg (15 mL)/day

40 to <50 kg: 0.09375 mg (3.75 mL) every 4 hours or as needed; maximum daily dose: 0.5625 mg (22.5 mL)/day

≥50 kg: 0.125 mg (5 mL) every 4 hours or as needed; maximum daily dose: 0.75 mg (30 mL)/day

Tablets, immediate release: regular tablet [Levsin], sublingual [Levsin/SL], dispersible [Anaspaz, ED-SPAZ, NuLev]): 0.0625 to 0.125 mg every 4 hours or as needed; maximum daily dose: 0.75 mg/day

Children ≥12 years and Adolescents: Oral:

Immediate release:

Drops (Hyosyne [0.125 mg/mL]): 0.125 mg (1 mL) to 0.25 mg (2 mL) every 4 hours or as needed; maximum daily dose: 1.5 mg (12 mL)/day

Elixir (Hyosyne [0.125 mg/5 mL]): 0.125 mg (5 mL) to 0.25 mg (10 mL) every 4 hours or as needed; maximum daily dose: 1.5 mg (60 mL)/day

Tablet, dispersible:

Anaspaz, ED-SPAZ, NuLev: 0.125 to 0.25 mg every 4 hours or as needed; maximum daily dose: 1.5 mg/day

Oscimin: 0.125 to 0.25 mg 3 to 4 times daily; may increase to every 4 hours as needed; maximum daily dose: 1.5 mg/day

Tablet:

Levsin: 0.125 to 0.25 mg every 4 hours or as needed; maximum daily dose: 1.5 mg/day

Oscimin: 0.125 to 0.25 mg 3 to 4 times daily; may increase to every 4 hours as needed; maximum daily dose: 1.5 mg/day

Tablet, sublingual

Levsin/SL: 0.125 to 0.25 mg every 4 hours or as needed; maximum daily dose: 1.5 mg/day

Oscimin, Symax SL: 0.125 to 0.25 mg 3 to 4 times daily; may increase to every 4 hours as needed; maximum daily dose: 1.5 mg/day

Extended release: Tablet:

Levbid: 0.375 to 0.75 mg every 12 hours; maximum daily dose: 1.5 mg/day

Oscimin SR, Symax Duotab, Symax SR: 0.375 to 0.75 mg every 12 hours or 0.375 mg every 8 hours; maximum daily dose: 1.5 mg/day

Preanesthesia

Preanesthesia: Children >2 years and Adolescents: IM, IV, SubQ: 5 mcg/kg administered 30 to 60 minutes prior to induction of anesthesia or at the time preoperative opioids or sedatives are administered

Reversal of neuromuscular blockage

Reversal of neuromuscular blockage: Children >2 years and Adolescents: IV, IM, SubQ: 0.2 mg for every 1 mg neostigmine (or physostigmine/pyridostigmine equivalent)

Dosing: Kidney Impairment: Pediatric

Dialyzable. There are no dosage adjustments provided in the manufacturer's labeling; use with caution.

Dosing: Liver Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Adult

(For additional information see "Hyoscyamine: Drug information")

GI disorders

GI disorders:

Note: American College of Gastroenterology guidelines recommend against use of antispasmodics such as hyoscyamine for the treatment of global symptoms of irritable bowel syndrome (IBS) (Ref); however, some experts consider as-needed use beneficial for relief of abdominal pain associated with IBS (Ref).

Oral:

Immediate release: 0.125 to 0.25 mg every 4 to 8 hours or as needed; maximum: 1.5 mg/day.

Extended release: 0.375 to 0.75 mg every 12 hours or 0.375 mg every 8 hours; maximum: 1.5 mg/day.

IM, IV, SUBQ: 0.25 to 0.5 mg; may repeat as needed up to 4 times daily, at 4-hour intervals.

Parkinsonism

Parkinsonism:

Note: Due to adverse effects, avoid use in older patients and patients with cognitive impairment (Ref).

Immediate release: Oral: 0.125 to 0.25 mg every 4 hours or as needed; maximum: 1.5 mg/day.

Extended release: Oral: 0.375 to 0.75 mg every 12 hours; maximum: 1.5 mg/day.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling, use with caution.

Dosing: Liver Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Frequency not defined.

Cardiovascular: Flushing, palpitations, tachycardia

Central nervous system: Amnesia (short-term), ataxia, confusion (more common in elderly), dizziness, drowsiness, excitement (more common in elderly), fatigue, hallucination, headache, insomnia, nervousness, psychosis, speech disturbance

Dermatologic: Hypohidrosis, urticaria

Gastrointestinal: Abdominal pain, ageusia, bloating, constipation, diarrhea, dysgeusia, dysphagia, heartburn, nausea, vomiting, xerostomia

Genitourinary: Decreased lactation, impotence, urinary hesitancy, urinary retention

Hypersensitivity: Hypersensitivity reaction

Neuromuscular & skeletal: Weakness

Ophthalmic: Blurred vision, cycloplegia, increased intraocular pressure, mydriasis

Miscellaneous: Fever

Contraindications

Hypersensitivity to belladonna alkaloids or any component of the formulation; glaucoma; obstructive uropathy (eg, bladder neck obstruction due to prostatic hypertrophy); myasthenia gravis; obstructive GI tract disease (eg, achalasia, pyloroduodenal stenosis), paralytic ileus, intestinal atony of elderly or debilitated patients, severe ulcerative colitis, toxic megacolon complicating ulcerative colitis; unstable cardiovascular status; myocardial ischemia. Note: Some extended release products are not recommended in children <12 years of age; refer to manufacturer's labeling.

Warnings/Precautions

Concerns related to adverse effect:

• CNS effects: May cause drowsiness and/or blurred vision, which may impair physical or mental abilities; patients must be cautioned about performing tasks which require mental alertness (eg, operating machinery or driving).

• Diarrhea: May be a sign of incomplete intestinal obstruction, especially in patients with ileostomy or colostomy; treatment should be discontinued if this occurs.

• Heat prostration: May occur in the presence of increased environmental temperature; use caution in hot weather and/or exercise.

• Oral effects: Prolonged use may lead to development of dental caries, periodontal disease, oral candidiasis, or discomfort due to decreased salivation.

• Psychosis: Has been reported in patients with an extreme sensitivity to anticholinergic effects; usually resolves within 12-48 hours after discontinuation.

Disease-related concerns:

• Cardiovascular disease: Use with caution in patients with coronary artery disease, tachyarrhythmias, heart failure, or hypertension; evaluate tachycardia prior to administration. Use is contraindicated in patients with unstable cardiovascular status or myocardial ischemia.

• Hiatal hernia: Use with caution in patients with hiatal hernia with reflux esophagitis.

• Hyperthyroidism: Use with caution in patients with hyperthyroidism.

• Neuropathy: Use with caution in patients with autonomic neuropathy.

• Prostatic hyperplasia: Use with caution in patients with prostatic hyperplasia.

• Renal impairment: Use with caution in patients with renal impairment.

Special populations:

• Pediatric: Use with caution in children with spastic paralysis or brain damage; may be more susceptible to anticholinergic effects.

Dosage form specific issues:

• Benzyl alcohol and derivatives: Some dosage forms may contain sodium benzoate/benzoic acid; benzoic acid (benzoate) is a metabolite of benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC, 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol derivative with caution in neonates. See manufacturer’s labeling.

Warnings: Additional Pediatric Considerations

Large doses of anticholinergics may cause a paradoxical reaction in children characterized by hyperexcitability. Oral dosage forms (drops and elixirs) are different (ie, 0.125 mg/mL [drops] and 0.125 mg/5 mL [solution]); precaution should be taken to verify and avoid confusion between the different concentrations; dose should be clearly presented with corresponding product formulation. Hyosyne oral drops contain 5% v/v alcohol. Hyosyne oral elixir contains 20% v/v alcohol.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Elixir, Oral, as sulfate:

Hyosyne: 0.125 mg/5 mL (473 mL) [contains alcohol, usp; lemon flavor]

Generic: 0.125 mg/5 mL (473 mL)

Solution, Injection, as sulfate [preservative free]:

Levsin: 0.5 mg/mL (1 mL [DSC])

Generic: 0.5 mg/mL (1 mL)

Solution, Oral, as sulfate:

Hyosyne: 0.125 mg/mL (15 mL) [lemon flavor]

Generic: 0.125 mg/mL (15 mL [DSC], 20 mL)

Tablet, Oral, as sulfate:

Levsin: 0.125 mg

Oscimin: 0.125 mg [peppermint flavor]

Generic: 0.125 mg

Tablet Disintegrating, Oral, as sulfate:

Anaspaz: 0.125 mg [scored; contains corn starch, fd&c yellow #6 (sunset yellow), quinoline yellow (d&c yellow #10)]

Ed-Spaz: 0.125 mg [DSC] [scored]

NuLev: 0.125 mg [peppermint flavor]

Generic: 0.125 mg

Tablet Extended Release, Oral, as sulfate:

Symax Duotab: 0.375 mg [DSC] [contains fd&c blue #1 (brilliant blue)]

Tablet Extended Release 12 Hour, Oral, as sulfate:

Levbid: 0.375 mg

Oscimin SR: 0.375 mg [DSC]

Symax-SR: 0.375 mg [DSC]

Generic: 0.375 mg

Tablet Sublingual, Sublingual, as sulfate:

Levsin/SL: 0.125 mg

Oscimin: 0.125 mg [peppermint flavor]

Symax-SL: 0.125 mg [DSC]

Generic: 0.125 mg

Generic Equivalent Available: US

May be product dependent

Pricing: US

Elixir (Hyoscyamine Sulfate Oral)

0.125 mg/5 mL (per mL): $0.63

Solution (Hyoscyamine Sulfate Injection)

0.5 mg/mL (per mL): $129.60

Solution (Hyoscyamine Sulfate Oral)

0.125 mg/mL (per mL): $7.50

Sublingual (Hyoscyamine Sulfate Sublingual)

0.125 mg (per each): $0.57 - $1.10

Sublingual (Levsin/SL Sublingual)

0.125 mg (per each): $3.55

Tablet, 12-hour (Hyoscyamine Sulfate ER Oral)

0.375 mg (per each): $0.99 - $1.65

Tablet, 12-hour (Levbid Oral)

0.375 mg (per each): $6.06

Tablet, orally-disintegrating (Anaspaz Oral)

0.125 mg (per each): $0.30

Tablet, orally-disintegrating (Hyoscyamine Sulfate Oral)

0.125 mg (per each): $0.57 - $1.14

Tablet, orally-disintegrating (NuLev Oral)

0.125 mg (per each): $2.66

Tablets (Hyoscyamine Sulfate Oral)

0.125 mg (per each): $0.57 - $1.02

Tablets (Levsin Oral)

0.125 mg (per each): $3.55

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Administration: Pediatric

Oral: Administration before meals (~30 to 60 minutes) is recommended but not required when used to treat gastrointestinal disorders. Additional product specific details:

Drops (Hyosyne): Use provided dropper to accurately measure dose

Tablet, dispersible:

Anaspaz: Tablets may be used sublingually, chewed, or swallowed whole

Ed-Spaz: Place on top of tongue and allow to dissolve; swallow with saliva

NuLev, Oscimin: Tablets may be chewed or placed on tongue and allowed to disintegrate

Tablet, extended release:

Levbid: Do not crush or chew

Oscimin SR, Symax Duotab, Symax SR: Swallow whole

Tablet, sublingual:

Levsin/SL: Tablets may be used sublingually, chewed, or swallowed whole

Symax SL: Tablets may be used sublingually or swallowed whole

Oscimin: Administer sublingually

Parenteral: May be administered undiluted IM, IV, and SubQ. There is no administration rate information provided in the manufacturer's labeling; some centers have administered over at least 1 minute.

Administration: Adult

Oral:

Elixir (Hyosyne): Administration prior to meals (~30 to 60 minutes) is recommended (but not required) when used to treat gastrointestinal disorders.

Drops (Hyosyne): Administration prior to meals (~30 to 60 minutes) is recommended (but not required) when used to treat gastrointestinal disorders. Use provided dropper to accurately measure dose.

Tablet, regular release (Levsin, Oscimin): Administration prior to meals (~30 to 60 minutes) is recommended (but not required) when used to treat gastrointestinal disorders.

Tablet, dispersible: Administration prior to meals (~30 to 60 minutes) is recommended (but not required) when used to treat GI disorders.

Anaspaz: Tablets may be used sublingually, chewed, or swallowed whole.

Ed-Spaz: Place on top of tongue and allow to dissolve; swallow with saliva.

NuLev, Oscimin: Tablets may be chewed or placed on tongue and allowed to disintegrate.

Tablet, extended release: Administration prior to meals (~30 to 60 minutes) is recommended (but not required) when used to treat GI disorders.

Levbid: Do not crush or chew.

Oscimin SR, Symax Duotab, Symax SR: Swallow whole.

Bariatric surgery: Some institutions may have specific protocols that conflict with these recommendations; refer to institutional protocols as appropriate. Do not cut, crush, or chew. Switch to IR tablet, sublingual tablet, or oral solution.

Tablet, sublingual: Administration prior to meals (~30 to 60 minutes) is recommended (but not required) when used to treat gastrointestinal disorders.

Levsin/SL: Tablets may be used sublingually, chewed, or swallowed whole.

Symax SL: Tablets may be used sublingually or swallowed whole.

Oscimin: Administer sublingually.

IM: May be administered without dilution.

IV: Inject over at least 1 minute. May be administered without dilution.

SubQ: May be administered without dilution.

Storage/Stability

Store at 20°C to 25°C (68°F to 77°F); excursions are permitted between 15°C and 30°C (59°F and 86°F).

Use

Oral:

Gastrointestinal: Treatment of infant colic; aid in the control of acute episodes of gastric secretion, visceral spasm, hypermotility in spastic colitis, pylorospasm and associated abdominal cramps; relieve symptoms in functional intestinal disorders (eg, mild dysenteries, diverticulitis); adjunctive therapy for treatment of peptic ulcer, irritable bowel syndrome, other functional GI disorders, and neurogenic bowel disturbances; adjunctive therapy for symptomatic relief of biliary colic

Urinary: Aid in the control of hypermotility in spastic bladder and cystitis; adjunctive therapy in treatment of neurogenic bladder; adjunctive therapy for symptomatic relief of renal colic

Other: Treatment of acute rhinitis as a "drying agent"; antidote for poisoning by anticholinesterase agents; management of parkinsonism to reduce rigidity and tremors and to control associated sialorrhea and hyperhidrosis

Note: Approved ages and uses for products may vary; consult labeling for specific information.

Drops (eg, Hyosyne): FDA approved in pediatric patients weighing ≥3.4 kg and adults

Elixir (eg, Hyosyne): FDA approved in ages ≥2 years and adults

Extended release tablets (eg, Levbid, Oscimin SR, Symax SR): FDA approved in ages ≥12 years and adults

Extended release biphasic tablets (eg, Symax Duotab): FDA approved in ages ≥12 years and adults

Orally disintegrating tablet (eg, Anaspaz, ED-Spaz, NuLev): FDA approved in ages ≥2 years and adults

Orally disintegrating tablet (eg, Oscimin): FDA approved in ages ≥12 years and adults

Oral tablet (eg, Levsin): FDA approved in ages ≥2 years and adults

Sublingual tablet (eg, Levsin SL): FDA approved in ages ≥2 years and adults

Sublingual tablet (eg, Oscimin, Symax SL): FDA approved in ages ≥12 years and adults

Injection: Adjunct to anesthesia, reduction of drug-induced bradycardia during surgery, and reversal of neuromuscular blockade (FDA approved in ages >2 years and adults); treatment of GI urinary tract disorders caused by spasm, biliary, and renal colic, antidote for poisoning by anticholinesterase agents, reduction of GI motility to facilitate diagnostic procedures and to improve radiologic visibility of the kidneys, and reduction of pain and hypersecretion of pancreatitis (FDA approved in adults)

Medication Safety Issues

Sound-alike/look-alike issues:

Anaspaz may be confused with Anaprox, Antispas

Levbid may be confused with Enbrel, Lithobid, Lopid, Lorabid

Levsin/SL may be confused with Levaquin

Older Adult: High-Risk Medication:

Beers Criteria: Hyoscyamine is identified in the Beers Criteria as a potentially inappropriate medication to be avoided in patients 65 years and older (independent of diagnosis or condition) due to its highly anticholinergic properties and uncertain effectiveness as an antispasmodic (Beers Criteria [AGS 2023]).

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program

Acetylcholinesterase Inhibitors: May decrease therapeutic effects of Agents with Clinically Relevant Anticholinergic Effects. Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects of Acetylcholinesterase Inhibitors. Risk C: Monitor

Aclidinium: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk X: Avoid

Acrivastine: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor

Amantadine: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor

Antacids: May decrease serum concentration of Hyoscyamine. Management: Administer immediate release and sublingual oral hyoscyamine before meals, and antacids after meals, when these agents are given in combination. Risk D: Consider Therapy Modification

Benperidol: Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects of Benperidol. Risk C: Monitor

Benztropine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Benztropine. Risk C: Monitor

Biperiden: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Biperiden. Risk C: Monitor

Bornaprine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Bornaprine. Risk C: Monitor

Botulinum Toxin-Containing Products: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor

Bromperidol: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Bromperidol. Risk C: Monitor

Buclizine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Buclizine. Risk C: Monitor

Cannabinoid-Containing Products: Agents with Clinically Relevant Anticholinergic Effects may increase tachycardic effects of Cannabinoid-Containing Products. Risk C: Monitor

Chlorprothixene: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Chlorprothixene. Risk C: Monitor

Cimetropium: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Cimetropium. Risk X: Avoid

CloZAPine: Agents with Clinically Relevant Anticholinergic Effects may increase constipating effects of CloZAPine. Management: Consider alternatives to this combination whenever possible. If combined, monitor closely for signs and symptoms of gastrointestinal hypomotility and consider prophylactic laxative treatment. Risk D: Consider Therapy Modification

Cyclizine: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor

Darifenacin: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Darifenacin. Risk C: Monitor

Dicyclomine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Dicyclomine. Risk C: Monitor

Dimethindene (Systemic): Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Dimethindene (Systemic). Risk C: Monitor

DroNABinol: Agents with Clinically Relevant Anticholinergic Effects may increase tachycardic effects of DroNABinol. Risk X: Avoid

Eluxadoline: Agents with Clinically Relevant Anticholinergic Effects may increase constipating effects of Eluxadoline. Risk X: Avoid

Fesoterodine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Fesoterodine. Risk C: Monitor

FluPHENAZine: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor

Gastrointestinal Agents (Prokinetic): Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects of Gastrointestinal Agents (Prokinetic). Risk C: Monitor

Gepotidacin: May decrease anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor

Glucagon: Agents with Clinically Relevant Anticholinergic Effects may increase adverse/toxic effects of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased. Risk C: Monitor

Glycopyrrolate (Oral Inhalation): Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Glycopyrrolate (Oral Inhalation). Risk X: Avoid

Glycopyrrolate (Systemic): Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Glycopyrrolate (Systemic). Risk C: Monitor

Glycopyrronium (Topical): May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk X: Avoid

Ipratropium (Nasal): May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor

Ipratropium (Oral Inhalation): May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk X: Avoid

Itopride: Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects of Itopride. Risk C: Monitor

Ketoconazole (Systemic): Hyoscyamine may decrease serum concentration of Ketoconazole (Systemic). Management: Take hyoscyamine at least 2 hours after ingestion of ketoconazole. Monitor for decreased therapeutic effects of ketoconazole if used together with hyoscyamine. Risk D: Consider Therapy Modification

Levosulpiride: Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects of Levosulpiride. Risk X: Avoid

Maprotiline: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Maprotiline. Risk C: Monitor

Melperone: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor

Methotrimeprazine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Methotrimeprazine. Risk C: Monitor

Methscopolamine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Methscopolamine. Risk C: Monitor

Mirabegron: Agents with Clinically Relevant Anticholinergic Effects may increase adverse/toxic effects of Mirabegron. Risk C: Monitor

Nitroglycerin: Agents with Clinically Relevant Anticholinergic Effects may decrease absorption of Nitroglycerin. Specifically, anticholinergic agents may decrease the dissolution of sublingual nitroglycerin tablets, possibly impairing or slowing nitroglycerin absorption. Risk C: Monitor

OLANZapine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of OLANZapine. Risk C: Monitor

Opioid Agonists: Agents with Clinically Relevant Anticholinergic Effects may increase adverse/toxic effects of Opioid Agonists. Specifically, the risk for constipation and urinary retention may be increased with this combination. Risk C: Monitor

Opipramol: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor

Oxatomide: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk X: Avoid

OxyBUTYnin: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of OxyBUTYnin. Risk C: Monitor

Perazine: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor

Perphenazine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Perphenazine. Risk C: Monitor

Potassium Chloride: Agents with Clinically Relevant Anticholinergic Effects may increase ulcerogenic effects of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride. Risk X: Avoid

Potassium Citrate: Agents with Clinically Relevant Anticholinergic Effects may increase ulcerogenic effects of Potassium Citrate. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium citrate. Risk X: Avoid

Pramlintide: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. These effects are specific to the GI tract. Risk X: Avoid

Promethazine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Promethazine. Risk C: Monitor

Propantheline: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Propantheline. Risk C: Monitor

Propiverine: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor

QuiNIDine: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor

Ramosetron: Agents with Clinically Relevant Anticholinergic Effects may increase constipating effects of Ramosetron. Risk C: Monitor

Revefenacin: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Revefenacin. Risk X: Avoid

Rivastigmine: Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects of Rivastigmine. Rivastigmine may decrease therapeutic effects of Agents with Clinically Relevant Anticholinergic Effects. Management: Use of rivastigmine with an anticholinergic agent is not recommended unless clinically necessary. If the combination is necessary, monitor for reduced anticholinergic effects. Risk D: Consider Therapy Modification

Scopolamine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Scopolamine. Risk C: Monitor

Secretin: Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects 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 D: Consider Therapy Modification

Sofpironium: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Sofpironium. Risk X: Avoid

Thiazide and Thiazide-Like Diuretics: Agents with Clinically Relevant Anticholinergic Effects may increase serum concentration of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Thiothixene: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Thiothixene. Risk C: Monitor

Tiapride: Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects of Tiapride. Risk C: Monitor

Tiotropium: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Tiotropium. Risk X: Avoid

Tolterodine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Tolterodine. Risk C: Monitor

Topiramate: Agents with Clinically Relevant Anticholinergic Effects may increase adverse/toxic effects of Topiramate. Risk C: Monitor

Tricyclic Antidepressants: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Tricyclic Antidepressants. Risk C: Monitor

Trimethobenzamide: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Trimethobenzamide. Risk C: Monitor

Trospium: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Trospium. Risk C: Monitor

Umeclidinium: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk X: Avoid

Zuclopenthixol: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Zuclopenthixol. Risk C: Monitor

Pregnancy Considerations

Animal reproduction studies have not been conducted. Hyoscyamine crosses the placenta.

Monitoring Parameters

Pulse, anticholinergic effects, urine output, GI symptoms

Mechanism of Action

Blocks the action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands, and the CNS; increases cardiac output, dries secretions, antagonizes histamine and serotonin

Pharmacokinetics (Adult Data Unless Noted)

Onset of action: 2 to 3 minutes

Duration: Regular release: 4 to 6 hours; Extended release (Levbid, Symax Duotab): 8 to 12 hours

Absorption: Well absorbed

Metabolism: Hepatic

Half-life elimination: Regular release: 2 to 3.5 hours; Extended release (Levbid): ~7 hours

Excretion: Urine

Brand Names: International

International Brand Names by Country

For country code abbreviations (show table)

(AE) United Arab Emirates: Egacen | Levsin;
(EG) Egypt: Spazaway;
(FI) Finland: Egazil;
(FR) France: Duboisine;
(IN) India: Hyocimax s;
(JO) Jordan: Neo Allospasmin;
(NO) Norway: Egazil | Egazil duretter;
(PH) Philippines: Eyosin;
(PK) Pakistan: Acupaz | Anapaz;
(PR) Puerto Rico: Anaspaz | Colidrops | Ed spaz | Hyoscyamine | Hyoscyamine sulfate er | Hyospaz | Hyosyne | Levbid | Nulev | Oscimin | Spacol t/s | Symax;
(SA) Saudi Arabia: Levsin;
(SE) Sweden: Egazil;
(TW) Taiwan: Busacon | Buwecon | Levsin | Powecon | Spalytic | Spasmotin

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Anaspaz (hyoscyamine sulfate) [prescribing information]. Lenexa, KS: B. F. Ascher & Company Inc; received July 2024.
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Ed-Spaz [package insert]. Ripley, MS: Edwards Pharmaceutical Inc; May 2010.
Ed-Spaz tablet (hyoscyamine) [prescribing information]. Largo, FL: Belcher Pharmaceuticals Inc; May 2010.
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Hyosine Elixir oral drops and elixir (hyoscyamine) [prescribing information]. Philadelphia, PA: Lannett Company Inc; March 2024.
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Levbid (hyoscyamine) [prescribing information]. Marietta, GA: Alaven Pharmaceutical LLC; January 2008.
Levbid tablet (hyoscyamine) [prescribing information]. Marietta, GA: Alaven Pharmaceutical LLC; July 2015.
Levsin (hyoscyamine) [prescribing information]. Marietta, GA: Alaven; February 2008.
Levsin injection (hyoscyamine) [prescribing information]. Marietta, GA: Alaven Pharmaceutical LLC; December 2009.
Levsin SL tablet (hyoscyamine) [prescribing information]. Marietta, GA: Alaven Pharmaceutical LLC; May 2013.
Levsin tablet (hyoscyamine) [prescribing information]. Marietta, GA: Alaven Pharmaceutical LLC; May 2013.
NuLev (hyoscyamine) [prescribing information]. Marietta, GA: Alaven Pharmaceutical LLC; April 2009.
Nulev tablet (hyoscyamine) prescribing information]. Marietta, GA: Alaven Pharmaceutical LLC; May 2013.
Oscimin orally disintegrating tablets (hyoscyamine sulfate) [prescribing information]. Canton, MS: Larken Laboratories Inc; June 2017.
Oscimin sublingual tablets (hyoscyamine sulfate) [prescribing information]. Canton, MS: Larken Laboratories Inc; July 2021.
Oscimin tablets (hyoscyamine sulfate) [prescribing information]. Canton, MS: Larken Laboratories Inc; November 2020.
Oscimin tablets (hyoscyamine) prescribing information]. Canton, MS: Larken Laboratories Inc; July 2014.
Oscimin-SR (hyoscyamine sulfate) [prescribing information]. Canton, MS: Larken Laboratories Inc; July 2014.
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Symtax Duotab tablets (hyoscyamine) prescribing information]. Ft. Worth, TX: Capellon Pharmaceuticals LLC; July 2014.
Symax-SL (hyoscyamine sulfate) [prescribing information]. Fort Worth, TX: Capellon Pharmaceuticals LLC; June 2014.
Symax-SR (hyoscyamine sulfate) [prescribing information]. Fort Worth, TX: Capellon Pharmaceuticals LLC; January 2016.
Symtax SR tablet (hyoscyamine) prescribing information]. Ft. Worth, TX: Capellon Pharmaceuticals LLC; May 2016.
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Topic 13369 Version 463.0

خرید پکیج

Hyoscyamine: Pediatric drug information