What is the usage for Levsin (hyoscyamine)?

Levsin (Hyoscyamine) Usage

Levsin (hyoscyamine sulfate) is an anticholinergic agent primarily used as adjunctive therapy for peptic ulcer disease, irritable bowel syndrome, and various gastrointestinal disorders characterized by visceral spasm and hypermotility. 1

Primary Gastrointestinal Indications

Peptic Ulcer Disease

• Effective as adjunctive therapy to control gastric secretion 1
• Works by reducing acid secretion and gastric motility 2

Irritable Bowel Syndrome and Functional GI Disorders

• Indicated for irritable colon, spastic colon, and mucous colitis 1
• Particularly effective for intermittent use during periods of increased abdominal pain, cramps, and urgency 3
• Sublingual hyoscyamine (0.125 mg) provides rapid relief for infrequent but severe episodes of unpredictable pain 3
• Maximum daily dose is 1.5 mg 4
• For chronic abdominal pain in hypermobile Ehlers-Danlos syndrome and related conditions, hyoscyamine can be used as an antispasmodic 5

Other GI Conditions

• Spastic colitis and hypermotility control 1
• Functional intestinal disorders including mild dysenteries, diverticulitis, and acute enterocolitis 1
• Pylorospasm and associated abdominal cramps 1
• Neurogenic bowel disturbances, including splenic flexure syndrome and neurogenic colon 1

Genitourinary Applications

• Spastic bladder and cystitis management 1
• Neurogenic bladder as adjunctive therapy 1

Pediatric Use

• Infant colic (available as elixir and drops) 1

Additional Therapeutic Uses

Pain Management

• Symptomatic relief of biliary and renal colic when combined with morphine or other narcotics 1

Respiratory Symptoms

• Acts as a "drying agent" for acute rhinitis symptoms 1

Neurological Conditions

• Parkinsonism therapy to reduce rigidity and tremors 1
• Controls associated sialorrhea (excessive salivation) and hyperhidrosis 1

Toxicology

• Treatment of poisoning by anticholinesterase agents 1

Palliative Care Applications

Secretion Management

• Hyoscyamine 0.125 mg PO/ODT/SL every 4 hours as needed (maximum 1.5 mg/day) is a second-line option for managing excessive secretions in palliative care patients 4
• Used as an anticholinergic agent in malignant bowel obstruction when other measures fail 5
• Administration routes include rectal, transdermal, subcutaneous, or intravenous when oral route is not feasible 5

Bowel Obstruction

• Consider as part of pharmacologic management in malignant bowel obstruction alongside other anticholinergics (scopolamine, glycopyrrolate) 5
• Do not use antiemetics that increase gastrointestinal motility (like metoclopramide) concurrently in complete obstruction 5

Procedural Applications

• Reduces duodenal motility to facilitate diagnostic studies such as ERCP 2, 6
• Reaches peak effects in 2-2.5 hours when given orally 2
• Excreted in urine within 24 hours 2

Important Clinical Considerations

Mechanism of Action

• Anticholinergic/antimuscarinic agent that inhibits GI smooth muscle contraction 7
• Readily absorbed through the gastrointestinal tract 2

Common Pitfalls

• Avoid in patients with glaucoma, obstructive uropathy, or gastrointestinal obstruction where anticholinergic effects would be contraindicated 1
• Monitor for typical anticholinergic side effects including dry mouth, urinary retention, constipation, and blurred vision 4
• In elderly or post-stroke patients, hyoscyamine may cause more central nervous system effects compared to glycopyrrolate, which does not cross the blood-brain barrier 4

Dosing Strategy

• For IBS, intermittent use is preferred over continuous daily dosing 3
• Sublingual formulation provides faster onset for acute symptom relief 3
• Oral antispasmodics should generally be used for limited periods during symptom exacerbations rather than indefinitely 3