Appropriate Use of Hyoscyamine Syrup in Pediatric Diseases
Dosage and Administration
Hyoscyamine syrup should be dosed according to age and weight in pediatric patients, with careful measurement to avoid overdose. 1
For pediatric patients using Hyoscyamine Sulfate Oral Drops:
Under 2 years of age: Weight-based dosing
- 3.4 kg (7.5 lb): 4 drops every 4 hours as needed, not exceeding 24 drops in 24 hours
- 5 kg (11 lb): 5 drops every 4 hours as needed, not exceeding 30 drops in 24 hours
- 7 kg (15 lb): 6 drops every 4 hours as needed, not exceeding 36 drops in 24 hours
- 10 kg (22 lb): 8 drops every 4 hours as needed, not exceeding 48 drops in 24 hours
2 to under 12 years of age: 1/4 to 1 mL every 4 hours as needed, not exceeding 6 mL in 24 hours
12 years and older: 1 to 2 mL every 4 hours as needed, not exceeding 12 mL in 24 hours
For Hyoscyamine Sulfate Elixir:
- 2 to under 12 years: Weight-based dosing
- 10 kg (22 lb): 1/4 teaspoon (1.25 mL)
- 20 kg (44 lb): 1/2 teaspoon (2.5 mL)
- 40 kg (88 lb): 3/4 teaspoon (3.75 mL)
- 50 kg (110 lb): 1 teaspoon (5 mL)
Indications
Hyoscyamine syrup is indicated for the following pediatric conditions:
- Treatment of infant colic (elixir and drops) 1
- Adjunctive therapy in irritable bowel syndrome and functional gastrointestinal disorders 1
- Control of visceral spasm and hypermotility in spastic colitis 1
- Management of symptoms in mild dysenteries, diverticulitis, and acute enterocolitis 1
- Adjunctive therapy in neurogenic bladder and bowel disturbances 1
- Reduction of symptoms associated with abdominal cramps 1, 2
Safety Considerations
Careful monitoring is essential when administering hyoscyamine to pediatric patients due to potential adverse effects:
Anticholinergic effects: Common side effects include dry mouth, blurred vision, and urinary retention 3
Central nervous system effects: Hallucinations, confusion, and drowsiness can occur, particularly with overdose 4, 3
Cardiovascular effects: Tachycardia and hypotension have been reported with overdose 4
QT prolongation: Has been observed in cases of overdose 4
Precautions and Contraindications
- Use with caution in young children, particularly those under 6 years of age 2
- Avoid use in patients with glaucoma, obstructive uropathy, or gastrointestinal obstruction
- Monitor for signs of anticholinergic toxicity, especially in young children
- Ensure proper dosing based on weight and age to prevent accidental overdose 4
Monitoring and Follow-up
When administering hyoscyamine to pediatric patients:
- Monitor vital signs, particularly heart rate
- Assess for signs of anticholinergic toxicity (flushing, dry mouth, urinary retention)
- Watch for central nervous system effects (confusion, hallucinations)
- Ensure adequate hydration
- Evaluate treatment response within 24-48 hours
Risk of Overdose
Hyoscyamine overdose in children can present with serious symptoms:
- Confusion and ataxia
- Visual and auditory hallucinations
- Tachycardia and hypotension
- QT prolongation
- Agitation 4
The packaging of hyoscyamine products may be attractive to young children, increasing the risk of accidental ingestion. Proper storage and childproof containers are essential 4.
Comparison to Other Anticholinergics
When compared to other anticholinergic medications used in pediatrics:
- Hyoscyamine has a shorter half-life than atropine
- It has stronger central effects than some other anticholinergics 3
- The risk profile is similar to diphenhydramine, which commonly causes anticholinergic effects in pediatric exposures 5
Conclusion
Hyoscyamine syrup can be effectively used in pediatric patients for specific gastrointestinal conditions, particularly infant colic and abdominal spasms. However, careful dosing based on weight and age is critical to prevent adverse effects. The medication should be used only when clearly indicated, with close monitoring for anticholinergic side effects.