hyoscyamine (Levbid, Levsin, Anaspaz, Cystospaz, NuLev, Symax Duotab)
Classes: Anticholinergic Agents
Dosing and uses of Levbid, Levsin (hyoscyamine)
Adult dosage forms and 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
Pediatric dosage forms and 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
Geriatric dosage forms and strengths
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)
Levbid, Levsin (hyoscyamine) adverse (side) 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
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
Renal/hepatic impairment
BPH
CHF
Coronary artery disease
HTn
COPd
Hiatal hernia
Reflux esophagitis
Mitral stenosis
Brain damage or spastic paralysis in children
Salivary secretion disorder
Down syndrome
Autonomic neuropathy
Hyperthyroidism
Tachyarrhythmia
Toxin-mediated diarrhea
Elderly (see Beers criteria)
Pregnancy and 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.
Pharmacology of Levbid, Levsin (hyoscyamine)
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
