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      Drugs & Diseases

      hyoscyamine (Rx)

      Brand and Other Names:Levbid, Levsin, more...Anaspaz, Cystospaz, NuLev, Symax Duotab
      • Print

      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)

      Next:

      Interactions

      Interaction Checker

      and hyoscyamine

      No Results

         activity indicator 
        No Interactions Found
        Interactions Found

        Contraindicated

          Serious - Use Alternative

            Significant - Monitor Closely

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                 activity indicator 

                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 (98)

                  • 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.

                  • donepezil transdermal

                    donepezil transdermal, hyoscyamine. Either decreases effects of the other by pharmacodynamic antagonism. 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.

                  • hydroxyzine

                    hydroxyzine and hyoscyamine both decrease cholinergic effects/transmission. 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.

                  • 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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                  Formulary

                  FormularyPatient Discounts

                  Adding plans allows you to compare formulary status to other drugs in the same class.

                  To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

                  Create Your List of Plans

                  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.

                  View explanations for tiers and restrictions
                  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.
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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.
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