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Hyoscyamine sulfate IV E (hi g h- oh- S I G H -a hmeen ) CLASSIFICATION(S): Cholinergic blocking drug PREGNANCY CATEGORY: C Rx: Anaspaz, Cystospaz, ED-SPAZ, HyoMax–FT, IB-Stat, Levbid, Levsin, Levsin Drops, Levsin/SL, Levsinex Timecaps, Mar-Spas, Neosol, NuLev, Symax Duotab, Symax FasTab, Symax-SL, Symax-SR. SEE ALSO CHOLINERGIC BLOCKING AGENTS, CHAPTER 2. USES (1) To control gastric secretion, visceral spasm, and hypermotility in spastic colitis, spastic bladder, cystitis, pylorospasm, and associated abdominal cramps. (2) Relieve symptoms in functional intestinal disorders (e.g., mild dysenteries and diverticulitis), infant colic, biliary colic. (3) Adjunct to treat peptic ulcer. (4) Irritable bowel syndrome (e.g., irritable colon, spastic colon, mucous colitis, acute enterocolitis, functional GI disorders). (5) Neurogenic bowel disturbances, including splenic flexure syndrome and neurogenic colon. (6) Reduce pain and hypersecretion in pancreatitis. (7) As a drying agent to relieve symptoms of acute rhinitis. (8) In Parkinsonism to reduce rigidity and tremors and to control associated sialorrhea and hyperhidrosis. (9) Treat poisoning by anticholinesterase agents. (10) Treat cystitis or renal colic. (11) Certain cases of partial heart block associated with vagal activity. (12) Preoperative medication to reduce salivary, tracheobronchial, and pharyngeal secretions. (13) Parenterally to reduce duoendal motility to facilitate the diagnostic radiologic procedure, hypotonic duodenography. May also improve radiologic visibility of the kidneys. ACTION/KINETICS Action One of the belladonna alkaloids; acts by blocking the action of acetylcholine at Bold Italic = life threatening side effect the postganglionic nerve endings of the parasympathetic nervous system. Pharmacokinetics 1 t /2: 3.5 hr for tablets, 7 hr for extendedrelease capsules, and 9 hr for extendedrelease tablets. Majority of the drug is excreted in the urine unchanged. SPECIAL CONCERNS • Heat prostration may occur if taken in the presence of high environmental temperatures. • Use with caution during lactation. SIDE EFFECTS Most Common Dry mouth, drowsiness, flushing of face, headache, blurred vision, photosensitivity, constipation, decreased sweating, thirst. See Cholinergic Blocking Agents, Chapter 2, for a complete list of possible side effects. HOW SUPPLIED Capsules, Extended-Release: 0.375 mg; Capsules, Timed-Release: 0.375 mg; Drops: 0.125 mg/mL; Injection: 0.5 mg/mL; Oral Spray: 0.125 mg/mL; Tablets: 0.125 mg, 0.15 mg; Tablets, Chewable: 0.125 mg; Tablets, Controlled Release: 0.25 mg; Tablets, Extended-Release / Tablets, Sustained-Release: 0.375 mg (includes Duotab containing 0.125 mg immediate-release and 0.5 mg extended-release); Tablets, Oral Disintegrating: 0.125 mg; Tablets, Sublingual: 0.125 mg, 0.25 mg. DOSAGE • CAPSULES, EXTENDED-RELEASE; TABLETS, EXTENDED-RELEASE; TABLETS, TIMED-RELEASE Adults and children over 12 years of age: 0.375–0.750 mg q 12 hr, not to exceed 1.5 mg in 24 hr. • DROPS Adults and children over 12 years of age: 0.125–0.25 mg (5–10 mL) q 4 hr, not to exceed 1.5 mg (12 mL) in 24 hr. Children, 2 to 12 years of age: 0.031–0.125 mg (0.22–1 mL) q 4 hr or as needed, not to exceed 0.75 mg (6 mL) in 24 hr. Children, under 2 years of age: 3.4 kg: 4 drops q 4 hr, not to exceed 24 drops in 24 hr; 5 kg: 5 drops q 4 hr, not to exceed 30 drops in 24 hr; 7 kg: 6 drops q 4 hr, not to exceed 36 drops in 24 hr; 10 kg: 8 drops q 4 hr, not to exceed 48 drops in 24 hr. ■ = black box warning W = Available in Canada • INJECTION GI disorders. Adults: 0.25–0.5 mg (0.5–1 mL). Some clients need only one dose while others require doses 2, 3, or 4 times per day at 4 hr intervals. Diagnostic procedures. Adults: 0.25–0.5 mg (0.5–1 mL) given IV 5 to 10 min prior to the procedure. Preanesthetic medication. Adults and children over 2 years of age: 0.005 mg/kg 30–60 min prior to the time of induction of anesthesia. May also be given at the time the preanesthetic sedative or narcotic is given. During surgery to reduce drug-induced bradycardia. Adults and children over 2 years of age: Increments of 0.125 mg (0.25 mL) IV repeated as needed. Reverse neuromuscular blockade. Adults and children over 2 years of age: 0.2 mg (0.4 mL) for every 1 mg neostigmine or equivalent dose of physostigmine or pyridostigmine. • ORAL SPRAY Children, 12 years and younger: 1–2 mL (1 or 2 sprays) q 4 hr as needed, up to 12 mL/day (12 sprays/day). • TABLETS; TABLETS, CHEWABLE; TABLETS, SUBLINGUAL Adults and children over 12 years of age: 0.125–0.25 mg q 4 hr or as needed, not to exceed 1.5 mg in 24 hr. • TABLETS, ORAL DISINTEGRATING 0.125 mg: Adults and children over 12 years: 1 or 2 tablets q 4 hr, up to 12/ day or 2 tablets 4 times per day. Chil1 dren, 2 to less than 12 years: /2–1 tablet q 4 hr, up to 6 per day. 0.25 mg: Adults and children over 1 12 years: /2–1 tablet 3–4 times per day, 30 min to 1 hr before meals and at bedtime. This dosage form is not recommended for children under 12 years old. NURSING CONSIDERATIONS E Do not confuse Levbid or Levsin with Lithobid (lithium), Lopid (an antihyperlipidemic), or Lorabid (a beta-lactam antibiotic). ADMINISTRATION/STORAGE 1. May take hyoscyamine SL tablets sublingually, PO, or chewed. May take hyoscyamine tablets PO or SL. C = see color insert H = Herbal 2. Depending on the use, may give injection SC, IM, or IV. IV 3. Visually inspect the injectable form for particulate matter/ discoloration. ASSESSMENT 1. Note reasons for therapy, type, onset, characteristics of S&S. 2. List other agents trialed, outcome. Reduce dose in elderly. 3. Determine evidence of glaucoma, bladder neck or GI tract obstruction. Assess for hyperthyroidism, CAD, CHF, cardiac arrhythmias, hypertension, renal disease, and hiatal hernia associated with reflux esophagitis. 4. Assess elimination/output, abdomen, UGI, CT/US abdomen to R/O pathology. CLIENT/FAMILY TEACHING 1. Take as prescribed; avoid antacids within 1 hr of taking drug (decreases effectiveness). 2. Do not perform activities that require mental alertness until drug effects realized; dizziness, drowsiness, and blurred vision may occur. 3. Report any loss of symptom control so provider can adjust dose and frequency of administration. Report diarrhea as it may be symptom of intestinal obstruction, especially with a colostomy or ileostomy. 4. Avoid excessive temperatures and activity; drug impairs heat regulation and may decrease perspiration, which may cause fever, heat prostration, or stroke. 5. Males with enlarged prostrate may experience urinary retention/hesitancy; report if persistent or bothersome. 6. Stop drug and report any mental confusion, impaired gait, disorientation, or hallucinations. 7. Avoid alcohol and CNS depressants. Use dark glasses when outside to prevent blurred vision. 8. Keep all F/U to assess response and for adverse SE. OUTCOMES/EVALUATE • 앗 GI motility • Control of epigastric pain/spasm IV = Intravenous E = sound alike drug