hyoscyamine (Rx)

Brand and Other Names:Levbid, Levsin, more...Anaspaz, Cystospaz, NuLev, Symax Duotab
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

capsule/tablet, extended release

  • 0.375mg

elixir

  • 0.125mg/5mL

injection solution

  • 0.5mg/mL

oral drops

  • 0.125mg/mL

tablet

  • 0.125mg

Gastrointestinal Disorders

Immediate release: 0.125-0.25 mg PO/SL q4hr PRN; no more than 1.5 mg/day

Extended release: 0.375-0.75 mg PO q12hr; no more than 1.5 mg/day

IM/SC/IV: 0.25-0.5 mg q4hr PRN; no more than 4 times per day

Hypermotility of Lower Urinary Tract

Adjunctive treatment

Immediate release: 0.15-0.3 mg PO/SL q6hr

Extended release: 0.375 mg PO q12hr

Peptic Ulcer Disease

Adjunctive treatment

0.125-0.25 mg PO/SL q4hr PRN; no more than 1.5 mg/day

Irritable Bowel Syndrome

Adjunctive treatment

0.125-0.25 mg PO/SL q4hr PRN; no more than 1.5 mg/day

Dosage Forms & Strengths

capsule/tablet, extended release

  • 0.375mg

elixir

  • 0.125mg/5mL

injection solution

  • 0.5mg/mL

oral drops

  • 0.125mg/mL

tablet

  • 0.125mg

Gastrointestinal Disorders

<2 years (oral drops)

  • 2.3-3.3 kg: 3 drops PO q4hr PRN; no more than 18 drops/day
  • 3.4-4 kg: 4 drops PO q4hr PRN; no more than 24 drops/day
  • 5-6 kg: 5 drops PO q4hr PRN; no more than 30 drops/day
  • 7-9 kg: 6 drops PO q4hr PRN; no more than 36 drops/day
  • 10-14 kg: 8 drops PO q4hr PRN; no more than 48 drops/day
  • ≥15 kg: 11 drops PO q4hr PRN; no more than 66 drops/day

2-12 years (tablet)

  • Immediate release/SL: 0.0625-0.125 mg PO q4hr PRN; no more than 0.75mg/day
  • Extended release: 0.375 PO q12hr; no more than 0.75 mg/day

2-12 years (elixir)

  • 10-19 kg: 1/4 tsp (1.25 mL) PO q4hr PRN
  • 20-39 kg: 1/2 tsp (2.5 mL) PO q4hr PRN
  • 40-49 kg: 3/4 tsp (3.75 mL) PO q4hr PRN
  • ≥50 kg: 1 tsp (5 mL) PO q4hr PRN

IV/IM/SQ

  • >12 years: 0.025-0.5 mg q4hr PRN; no more than 4 times daily

Hypermotility of lower urinary tract

Immediate release: 0.125-0.25 mg PO/SL q6hr

Extended release: 0.375 mg PO q12hr

Dosing considerations

Avoid except in short-term situations to decrease secretions; high incidence of anticholinergic effects (Beers criteria)

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Interactions

Interaction Checker

and hyoscyamine

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      Serious - Use Alternative

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            Contraindicated (0)

              Serious - Use Alternative (7)

              • glucagon

                glucagon increases toxicity of hyoscyamine by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of anticholinergic drugs and glucagon increase the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. .

              • glucagon intranasal

                glucagon intranasal increases toxicity of hyoscyamine by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of anticholinergic drugs and glucagon increase the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. .

              • glycopyrronium tosylate topical

                glycopyrronium tosylate topical, hyoscyamine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration of glycopyrronium tosylate topical with other anticholinergic medications may result in additive anticholinergic adverse effects.

              • pramlintide

                pramlintide, hyoscyamine. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

              • revefenacin

                revefenacin and hyoscyamine both decrease cholinergic effects/transmission. Avoid or Use Alternate Drug. Coadministration may cause additive anticholinergic effects.

              • secretin

                hyoscyamine decreases effects of secretin by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Concomitant use of anticholinergic drugs may cause a hyporesponse to stimulation testing with secretin. Discontinue anticholinergic drugs at least 5 half-lives before administering secretin.

              • umeclidinium bromide/vilanterol inhaled

                hyoscyamine, umeclidinium bromide/vilanterol inhaled. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Concomitant use with other anticholinergic-containing drugs may lead to additive anticholinergic adverse effects.

              Monitor Closely (97)

              • abobotulinumtoxinA

                abobotulinumtoxinA increases effects of hyoscyamine by pharmacodynamic synergism. Use Caution/Monitor. Use of anticholinergic drugs after administration of botulinum toxin-containing products may potentiate systemic anticholinergic effects. .

              • aclidinium

                hyoscyamine and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • amantadine

                hyoscyamine, amantadine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Potential for increased anticholinergic adverse effects.

              • amitriptyline

                hyoscyamine and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • amoxapine

                hyoscyamine and amoxapine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • anticholinergic/sedative combos

                anticholinergic/sedative combos and hyoscyamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • aripiprazole

                hyoscyamine decreases levels of aripiprazole by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                hyoscyamine decreases levels of aripiprazole by pharmacodynamic antagonism. Use Caution/Monitor.

                aripiprazole increases effects of hyoscyamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • atracurium

                atracurium and hyoscyamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • atropine

                atropine and hyoscyamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • atropine IV/IM

                atropine IV/IM and hyoscyamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • belladonna alkaloids

                belladonna alkaloids and hyoscyamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • belladonna and opium

                hyoscyamine and belladonna and opium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • benperidol

                hyoscyamine decreases levels of benperidol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                hyoscyamine decreases levels of benperidol by pharmacodynamic antagonism. Use Caution/Monitor.

                benperidol increases effects of hyoscyamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • benztropine

                benztropine and hyoscyamine both decrease cholinergic effects/transmission. Use Caution/Monitor. Additive anticholinergic adverse effects may be seen with concurrent use.

              • bethanechol

                bethanechol increases and hyoscyamine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • buprenorphine, long-acting injection

                buprenorphine, long-acting injection increases effects of hyoscyamine by pharmacodynamic synergism. Use Caution/Monitor. Coadministration of buprenorphine with anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus.

              • carbachol

                carbachol increases and hyoscyamine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • cevimeline

                cevimeline increases and hyoscyamine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • chlorpromazine

                hyoscyamine decreases levels of chlorpromazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                hyoscyamine decreases levels of chlorpromazine by pharmacodynamic antagonism. Use Caution/Monitor.

                chlorpromazine increases effects of hyoscyamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • cisatracurium

                cisatracurium and hyoscyamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • clomipramine

                hyoscyamine and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • clozapine

                hyoscyamine decreases levels of clozapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                hyoscyamine decreases levels of clozapine by pharmacodynamic antagonism. Use Caution/Monitor.

                clozapine increases effects of hyoscyamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • cyclizine

                cyclizine and hyoscyamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • cyclobenzaprine

                cyclobenzaprine and hyoscyamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • darifenacin

                darifenacin and hyoscyamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • desipramine

                hyoscyamine and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • dicyclomine

                dicyclomine and hyoscyamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • diphenhydramine

                diphenhydramine and hyoscyamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • donepezil

                donepezil increases and hyoscyamine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dosulepin

                hyoscyamine and dosulepin both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • doxepin

                hyoscyamine and doxepin both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • droperidol

                hyoscyamine decreases levels of droperidol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                hyoscyamine decreases levels of droperidol by pharmacodynamic antagonism. Use Caution/Monitor.

                droperidol increases effects of hyoscyamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • echothiophate iodide

                echothiophate iodide increases and hyoscyamine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • fesoterodine

                fesoterodine and hyoscyamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • flavoxate

                flavoxate and hyoscyamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • fluphenazine

                hyoscyamine decreases levels of fluphenazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                hyoscyamine decreases levels of fluphenazine by pharmacodynamic antagonism. Use Caution/Monitor.

                fluphenazine increases effects of hyoscyamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • galantamine

                galantamine increases and hyoscyamine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • glycopyrrolate

                glycopyrrolate and hyoscyamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • glycopyrrolate inhaled

                glycopyrrolate inhaled and hyoscyamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • haloperidol

                hyoscyamine decreases levels of haloperidol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                hyoscyamine decreases levels of haloperidol by pharmacodynamic antagonism. Use Caution/Monitor.

                haloperidol increases effects of hyoscyamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • henbane

                henbane and hyoscyamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • homatropine

                homatropine and hyoscyamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • huperzine A

                huperzine A increases and hyoscyamine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • iloperidone

                hyoscyamine decreases levels of iloperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                hyoscyamine decreases levels of iloperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                iloperidone increases effects of hyoscyamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • imipramine

                hyoscyamine and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • ipratropium

                hyoscyamine and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              • levodopa

                hyoscyamine, levodopa. Other (see comment). Use Caution/Monitor. Comment: Anticholinergic agents may enhance the therapeutic effects of levodopa; however, anticholinergic agents can exacerbate tardive dyskinesia. In high dosage, anticholinergics may decrease the effects of levodopa by delaying its GI absorption. .

              • lofepramine

                hyoscyamine and lofepramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • loxapine

                hyoscyamine decreases levels of loxapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                hyoscyamine decreases levels of loxapine by pharmacodynamic antagonism. Use Caution/Monitor.

                loxapine increases effects of hyoscyamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • loxapine inhaled

                loxapine inhaled increases effects of hyoscyamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

                hyoscyamine decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor.

              • maprotiline

                hyoscyamine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • meclizine

                hyoscyamine and meclizine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • methscopolamine

                hyoscyamine and methscopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • metoclopramide intranasal

                hyoscyamine will decrease the level or effect of metoclopramide intranasal by Other (see comment). Use Caution/Monitor. Coadministration of metoclopramide intranasal with drugs that impair GI motility may decrease systemic absorption of metoclopramide. Monitor for reduced therapeutic effect.

              • neostigmine

                neostigmine increases and hyoscyamine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • nortriptyline

                hyoscyamine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • olanzapine

                hyoscyamine decreases levels of olanzapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                hyoscyamine decreases levels of olanzapine by pharmacodynamic antagonism. Use Caution/Monitor.

                olanzapine increases effects of hyoscyamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • oliceridine

                hyoscyamine increases toxicity of oliceridine by Other (see comment). Use Caution/Monitor. Comment: Anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. Monitor for signs of urinary retention or reduced gastric motility if oliceridine is coadministered with anticholinergics.

              • onabotulinumtoxinA

                onabotulinumtoxinA and hyoscyamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • orphenadrine

                hyoscyamine and orphenadrine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • oxybutynin

                hyoscyamine and oxybutynin both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • oxybutynin topical

                hyoscyamine and oxybutynin topical both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • oxybutynin transdermal

                hyoscyamine and oxybutynin transdermal both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • paliperidone

                hyoscyamine decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                hyoscyamine decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                paliperidone increases effects of hyoscyamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • pancuronium

                hyoscyamine and pancuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • perphenazine

                hyoscyamine decreases levels of perphenazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                hyoscyamine decreases levels of perphenazine by pharmacodynamic antagonism. Use Caution/Monitor.

                perphenazine increases effects of hyoscyamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • physostigmine

                physostigmine increases and hyoscyamine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • pilocarpine

                pilocarpine increases and hyoscyamine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • pilocarpine ophthalmic

                pilocarpine ophthalmic increases and hyoscyamine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • pimozide

                hyoscyamine decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                hyoscyamine decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.

                pimozide increases effects of hyoscyamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • prabotulinumtoxinA

                hyoscyamine, prabotulinumtoxinA. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Use of anticholinergic drugs after administration of botulinum toxin-containing products may potentiate systemic anticholinergic effects.

              • pralidoxime

                hyoscyamine and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • prochlorperazine

                hyoscyamine decreases levels of prochlorperazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                hyoscyamine decreases levels of prochlorperazine by pharmacodynamic antagonism. Use Caution/Monitor.

                prochlorperazine increases effects of hyoscyamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • promethazine

                hyoscyamine decreases levels of promethazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                hyoscyamine decreases levels of promethazine by pharmacodynamic antagonism. Use Caution/Monitor.

                promethazine increases effects of hyoscyamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • propantheline

                hyoscyamine and propantheline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • protriptyline

                hyoscyamine and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • pyridostigmine

                pyridostigmine increases and hyoscyamine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • quetiapine

                hyoscyamine decreases levels of quetiapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                hyoscyamine decreases levels of quetiapine by pharmacodynamic antagonism. Use Caution/Monitor.

                quetiapine increases effects of hyoscyamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • rapacuronium

                hyoscyamine and rapacuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • risperidone

                hyoscyamine decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                hyoscyamine decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                risperidone increases effects of hyoscyamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • rocuronium

                hyoscyamine and rocuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • scopolamine

                hyoscyamine and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • solifenacin

                hyoscyamine and solifenacin both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • succinylcholine

                succinylcholine increases and hyoscyamine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • thioridazine

                hyoscyamine decreases levels of thioridazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                hyoscyamine decreases levels of thioridazine by pharmacodynamic antagonism. Use Caution/Monitor.

                thioridazine increases effects of hyoscyamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • thiothixene

                hyoscyamine decreases levels of thiothixene by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                hyoscyamine decreases levels of thiothixene by pharmacodynamic antagonism. Use Caution/Monitor.

                thiothixene increases effects of hyoscyamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • tiotropium

                hyoscyamine and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • tolterodine

                hyoscyamine and tolterodine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • trazodone

                hyoscyamine and trazodone both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • trifluoperazine

                hyoscyamine decreases levels of trifluoperazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                hyoscyamine decreases levels of trifluoperazine by pharmacodynamic antagonism. Use Caution/Monitor.

                trifluoperazine increases effects of hyoscyamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • trihexyphenidyl

                hyoscyamine and trihexyphenidyl both decrease cholinergic effects/transmission. Use Caution/Monitor. Potential for additive anticholinergic effects.

              • trimipramine

                hyoscyamine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • trospium chloride

                hyoscyamine and trospium chloride both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • umeclidinium bromide

                umeclidinium bromide and hyoscyamine both decrease cholinergic effects/transmission. Use Caution/Monitor. If possible, avoid coadministration of additional anticholinergic agents

              • vecuronium

                hyoscyamine and vecuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • ziprasidone

                hyoscyamine decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                hyoscyamine decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.

                ziprasidone increases effects of hyoscyamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • zotepine

                hyoscyamine decreases levels of zotepine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                hyoscyamine decreases levels of zotepine by pharmacodynamic antagonism. Use Caution/Monitor.

              Minor (3)

              • dimenhydrinate

                dimenhydrinate increases toxicity of hyoscyamine by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

              • donepezil

                donepezil decreases effects of hyoscyamine by pharmacodynamic antagonism. Minor/Significance Unknown.

              • galantamine

                galantamine decreases effects of hyoscyamine by pharmacodynamic antagonism. Minor/Significance Unknown.

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              Adverse Effects

              >10%

              Dry skin

              1-10%

              Blurred vision

              Constipation

              Dysphagia

              Photosensitivity

              <1%

              Headache

              Orthostatic hypotension

              Tachycardia

              Frequency Not Defined

              Xerostomia

              Urinary hesitancy/retention

              HTN

              Dysphagia

              Respiratory depression

              CNS stimulation

              Fever

              Ataxia

              Excitation

              Lethargy

              Palpitations

              Mydriasis

              Cycloplegia

              Increased IOP

              Weakness

              Bloated feeling

              Suppression of lactation

              Impotence

              Anhidrosis

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              Warnings

              Contraindications

              Hypersensitivity to hyoscyamine or related compounds

              Closed-angle glaucoma

              Myasthenia gravis

              Hemorrhage with cardiovascular instability

              Paralytic ileus

              Intestinal atony of elderly/debilitated patient

              Obstructive uropathy

              Toxic megacolon

              GI obstruction

              Tachycardia secondary to cardiac insufficiency or thyrotoxicosis

              Breastfeeding

              Cautions

              Discontinue treatment if diarrhea occurs; it may be a sign of incomplete intestinal obstruction, especially in colostomy or ileostomy

              May cause drowsiness; caution patients about performing a hazardous task, like driving heavy machinery, that requires mental alertness

              Use caution in hot weather or exercise; heat prostration reported in the presence of increased environmental temperature

              Psychosis reported in patients susceptible to anticholinergic effects; usually resolved within 12-48 hr after therapy discontinuation

              Use caution in patients with hyperthyroidism, prostatic hyperplasia, renal impairment, hiatal hernia, or cardiovascular disease, including heart failure, tachyarrhythmias, hypertension, or coronary artery disease; evaluate tachycardia prior to initiating therapy

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              Pregnancy & Lactation

              Pregnancy category: C

              Lactation: Enters breast milk; use not recommended

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Parasympatholytic, atropine-like effects, especially peripherally; blocks the action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands, and CNS

              Absorption

              Bioavailability: Tab (100%), SR (81%)

              Onset: IV/IM/SC (2-3 min), SL (5-20 min), tab/SR (20-30 min)

              Duration: IV/IM/SC/tab/SL (up to 4 hr), SR (12 hr)

              Peak plasma time: Tab/SR (2.5 hr)

              Distribution

              Protein bound: 50%

              Vd: 1.2-1.9 L/kg (adults); 1.1-3.7 L/kg (children aged 4-16 years)

              Metabolism

              Hepatic

              Metabolites: Tropic acid, tropine, hyoscyamine glucuronide

              Elimination

              Half-life: Tab (3.5 hr), SR (5-9 hr)

              Dialyzable: Yes; removed by hemodialysis and peritoneal dialysis

              Excretion: Majority excreted in urine as unchanged drug

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              Images

              No images available for this drug.
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              Patient Handout

              A Patient Handout is not currently available for this monograph.
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              Formulary

              FormularyPatient Discounts

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              Adding plans allows you to:

              • View the formulary and any restrictions for each plan.
              • Manage and view all your plans together – even plans in different states.
              • Compare formulary status to other drugs in the same class.
              • Access your plan list on any device – mobile or desktop.

              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
              Additional Offers
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.