Hyoscyamine

Indications
 Oral
Visceral spasms
Adult: As base: 0.15-0.3 mg up to 4 times daily. As sulfate: Initially, 125-250 mcg, given orally or sublingually every 4 hr or as needed. Max dose: 1.5 mg/24 hr.
Child: As sulfate: <2 yr: Weighs about 2.3 kg: Approx 12.5 mcg; 3.4 kg: 16.7 mcg; 5 kg: 20.8 mcg; 7 kg: 25 mcg; 10 kg: 31.3-33.3 mcg; 15 kg: 45.8 mcg. Max dose/24 hr: 75, 100, 125, 150, 200 and 275 mcg, respectively. 2 to <12 yr: Weighs about 10 kg: Approx 31.3-33.3 mcg; 20 kg: 62.5 mcg; 40 kg: 93.8 mcg; 50 kg: 125 mcg. Max dose: 750 mcg/24 hr. ≥12 yr: Initially, 125-250 mcg. Max dose: 1.5 mg/24 hr. Doses may be repeated every 4 hr as needed.
Max Dosage: 1.5 mg/day.
Parenteral
Visceral spasms
Adult: As sulfate: 0.25-0.5 mg IM or IV or SC every 4 hr.
Parenteral
Organophosphorus poisoning
Adult: As sulfate: 1-2 mg IV. Additional 1-mg doses may be given IM or IV every 3-10 min until muscarinic signs and symptoms subside and repeated if they reappear.
Intravenous
Block adverse muscarinic effects of anticholinesterase agents
Adult: As sulfate: 0.2 mg for each 1 mg of neostigmine methylsulfate or the equivalent dose of physostigmine salicylate or pyridostigmine bromide given. Administer concurrently with (but in a separate syringe) or a few minutes before the anticholinesterase agent. If there is bradycardia, administer before the anticholinesterase agent to increase the pulse rate to about 80 beats/min.
Parenteral
Preoperative medication
Adult: As sulfate: 5 mcg/kg given IV, IM or SC 30-60 minutes prior to induction of anaesthesia or at the time other preanaesthetic medications are given.
Child: As sulfate: >2 yr: 5 mcg/kg given IV, IM or SC 30-60 min prior to induction of anaesthesia or at the time other preanaesthetic medications are given.
Contraindications
 Glaucoma; obstructive uropathy; myasthenia gravis; obstructive GIT disease, paralytic ileus, intestinal atony of elderly or debilitated patients, severe ulcerative colitis, toxic megacolon; unstable CV status in acute haemorrhage, myocardial ischaemia; lactation.
Warnings / Precautions
 Heat prostration may occur in hot weather. Diarrhoea; psychosis; autonomic neuropathy, coronary heart disease, CHF, cardiac arrhythmias, prostatic hyperplasia, hyperthyroidism, hypertension, renal disease and hiatal hernia associated with reflux oesophagitis; childn with spastic paralysis. May precipitate glaucoma and/or markedly impair memory function in elderly. Pregnancy.
Adverse Reactions
 Palpitations, tachycardia; ataxia, dizziness; urticaria; lactation suppression; bloating, constipation, dry mouth; impotence, urinary hesitancy, urinary retention; weakness; blurred vision, cycloplegia, increased ocular tension, mydriasis; allergic reactions; decreased sweating.
Overdose Reactions
 Symptoms: Dilated and unreactive pupils, blurred vision, hot and dry flushed skin, CNS stimulation, dry mucous membranes, dysphagia, foul breath, reduced or absent bowel sounds, urinary retention, tachycardia, hyperthermia, hypertension, and increased respiratory rate. Management: For life-threatening symptoms, give physostigmine 0.5-2 mg SC or IV slowly; repeat as necessary, up to total of 5 mg. Sulfate salt is dialysable.
Drug Interactions
 Additive toxicity with amantadine, antihistamines, antimuscarinics, haloperidol, phenothiazines, TCAs and MAOIs. Decreased absorption with antacids.
See Below for More hyoscyamine Drug Interactions
Lab Interactions
 May interfere with the gastric secretion test.
Mechanism of Actions
 Hyoscyamine is a tertiary amine antimuscarinic. It blocks the action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands and the CNS. It increases cardiac output, dries secretions and antagonises histamine and serotonin.
Onset: 2-3 min.
Duration: 4-6 hr.
Absorption: Well absorbed.
Distribution: Protein-binding: 50%.
Metabolism: Hepatic.
Excretion: Via urine; 3-5 hr (elimination half-life).
Storage Conditions
 Intravenous: Store at controlled room temperature. Oral: Store at controlled room temperature. Parenteral: Store at controlled room temperature.
ATC Classification
 A03BA03 - hyoscyamine ; Belongs to the class of belladonna alkaloids, tertiary amines. Used in the treatment of functional gastrointestinal disorders.
Storage
 Intravenous: Store at controlled room temperature. Oral: Store at controlled room temperature. Parenteral: Store at controlled room temperature.
Available As
  • Hyoscyamine 0.2292 mg
  • Hyoscyamine HBr 100 mg
  • Hyoscyamus 75 mg

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