What is Hyoscyamine (Levsin)?

From the Guidelines

Hyoscyamine should be used with caution in patients, particularly in the context of palliative care, where maintaining gut function is not the primary goal, as it can help manage symptoms such as excessive secretions and cramping, but its use must be balanced against potential side effects and interactions, as noted in the most recent guidelines 1. When considering the use of hyoscyamine, it's essential to weigh its benefits against its potential risks, especially in vulnerable populations such as the elderly or those with certain comorbid conditions. The medication's anticholinergic properties can lead to side effects like dry mouth, blurred vision, urinary retention, and constipation, which can significantly impact a patient's quality of life. In the context of palliative care, as discussed in the guidelines from 2016 1, hyoscyamine can be considered for managing symptoms when gut function cannot be maintained, alongside other medications like octreotide. However, the decision to use hyoscyamine should be made with careful consideration of the patient's overall clinical status, potential for improvement in quality of life, and life expectancy. Key points to consider when prescribing hyoscyamine include:

• Starting with a low dose and titrating as needed to minimize side effects
• Monitoring for signs of anticholinergic toxicity, especially in elderly patients
• Being aware of potential drug interactions, particularly with other anticholinergic agents
• Discussing the risks and benefits with the patient and their family, including the potential for improved symptom management but also the risk of adverse effects. Given the potential for significant side effects and the importance of individualizing treatment in palliative care, the use of hyoscyamine should be guided by the most recent clinical guidelines and a thorough assessment of the patient's condition, as outlined in the 2016 palliative care guidelines 1.

From the FDA Drug Label

Hyoscyamine sulfate is effective as adjunctive therapy in the treatment of peptic ulcer. It can also be used to control gastric secretion, visceral spasm and hypermotility in spastic colitis, spastic bladder, cystitis, pylorospasm, and associated abdominal cramps May be used in functional intestinal disorders to reduce symptoms such as those seen in mild dysenteries, diverticulitis, and acute enterocolitis. For use as adjunctive therapy in the treatment of irritable bowel syndrome (irritable colon, spastic colon,mucous colitis) and functional gastrointestinal disorders Also used as adjunctive therapy in the treatment of neurogenic bladder and neurogenic bowel disturbances (including the splenic flexure syndrome and neurogenic colon). Also used in the treatment of infant colic (elixir and drops) Hyoscyamine sulfate is indicated along with morphine or other narcotics in symptomatic relief of biliary and renal colic; as a “drying agent” in the relief of symptoms of acute rhinitis; in the therapy of parkinsonism to reduce rigidity and tremors and to control associated sialorrhea and hyperhidrosis. May be used in the therapy of poisoning by anticholinesterase agents.

The main uses of Hyoscyamine are:

• Adjunctive therapy for peptic ulcer
• Controlling gastric secretion, visceral spasm, and hypermotility
• Treating irritable bowel syndrome and functional gastrointestinal disorders
• Treating neurogenic bladder and bowel disturbances
• Relieving symptoms of biliary and renal colic
• Treating parkinsonism and poisoning by anticholinesterase agents
• Treating infant colic 2

From the Research

Hyoscyamine Studies

• Hyoscyamine is an anticholinergic drug that has been studied for its effects on gastric emptying and salivary secretion 3.
• A study published in 1981 found that hyoscyamine delayed gastric emptying, whereas pirenzepine, a selective anticholinergic drug, slightly accelerated gastric emptying when compared with placebo 3.
• The same study found that hyoscyamine significantly inhibited salivary secretion, whereas pirenzepine did not inhibit salivary secretion as much as hyoscyamine 3.

Hyoscyamine in Colonoscopy

• Hyoscyamine has been studied as a premedication for colonoscopy to reduce colonic motility and spasm 4, 5.
• A study published in 2008 found that sublingual hyoscyamine spray significantly reduced procedural difficulty scores and colonic motility scores compared with placebo 4.
• However, another study published in 1999 found no difference between hyoscyamine and placebo in terms of insertion time, patient's assessment of pain, and physician assessment of spasm 5.
• The 1999 study also found that women had higher procedure duration and analgesic requirement, and reported more pain than did men 5.