Levbid (Hyoscyamine) Contraindications and Precautions
- bladder obstruction
- GI obstruction
- ileus
- prostatic hypertrophy
- ulcerative colitis
- urinary tract obstruction
- anticholinergic medications
- autonomic neuropathy
- breast-feeding
- cardiac arrhythmias
- cardiac disease
- children
- closed-angle glaucoma
- contact lenses
- coronary artery disease
- Down’s syndrome
- dysentery
- elderly
- esophagitis
- fever
- gastroenteritis
- gastroesophageal reflux disease (GERD)
- heart failure
- hepatic disease
- hiatal hernia
- hyperthyroidism
- infants
- mitral stenosis
- myasthenia gravis
- neonates
- pregnancy
- pseudomembranous colitis
- pulmonary disease
- renal disease
- renal impairment
- tachycardia
Levbid (Hyoscyamine) Contraindications and Precautions
Hyoscyamine should not be used in patients with a history of hypersensitivity to anticholinergic agents.
The anticholinergic effects of hyoscyamine may be significant and are additive with other anticholinergic medications.
Hyoscyamine decreases bronchial secretions and should be used cautiously in patients with chronic pulmonary disease. Inspissation and formation of bronchial plugs may occur in these patients.
Hyoscyamine should be used cautiously in patients with hepatic disease, renal impairment, or renal disease. The drug is metabolized by the liver and the resultant metabolites as well as unchanged drug are excreted in the kidneys. Further, hyoscyamine can cause urinary retention. Hyoscyamine is therefore contraindicated in patients with bladder obstruction, prostatic hypertrophy, or other urinary tract obstruction because it may aggravate urinary retention.
Hyoscyamine should be avoided in patients with myasthenia gravis because the anticholinergic competes with the small amount of acetylcholine that has potential to act in the body in these patients. However, hyoscyamine may be administered if it is used to reduce the adverse muscarinic effects of a cholinesterase inhibitor. Hyoscyamine should be similarly used with extreme caution in patients with autonomic neuropathy.
Hyoscyamine should be used cautiously in patients with or a predisposition to closed-angle glaucoma. The mydriatic effect of hyoscyamine causes an increase in intraocular pressure thereby precipitating an acute attack of closed-angle glaucoma. Use cautiously in patients with open-angle glaucoma; slight increases in intraocular pressure may require glaucoma therapy adjustments.
Use hyoscyamine cautiously in patients with Down’s syndrome. Abnormal increase in pupillary dilation and acceleration of heart rate may occur.
Hyoscyamine causes tachycardia. Use cautiously in patients with cardiac disease, especially cardiac arrhythmias, congestive heart failure, coronary artery disease, and mitral stenosis. Additionally, increases in heart rate may be undesirable in patients with hyperthyroidism or acute hemorrhage with unstable cardiovascular status.
The anticholinergic effects of hyoscyamine may make the eyes dry. This can cause an increased lens awareness, or blurred vision for wearers of contact lenses.
Hyoscyamine should be used with caution in the elderly. Older patients are more susceptible to anticholinergic effects.
Hyoscyamine can decrease gastric motility and tone. This can aggravate GI obstruction or ileus and/or exacerbate retention in patients with pyloroduodenal obstruction. Hyoscyamine should not be used in patients with GI obstruction (including achalasia), paralytic ileus, or severe ulcerative colitis. Toxic megacolon may be precipitated or aggravated also. Further, hyoscyamine should be administered with extreme caution in persons with suspected or known infectious diarrhea such as dysentery, gastroenteritis, or pseudomembranous colitis. Decreased GI motility may slow down the elimination of the bacteria or toxin from the body and thus prolong the infection.
Hyoscyamine decreases sweat gland activity. Use cautiously in patients with fever.
Hyoscyamine should be used cautiously in patients with gastroesophageal reflux disease (GERD) or hiatal hernia associated with reflux esophagitis. Hyoscyamine decreases gastric motility and relaxes the lower esophageal sphincter. These effects promote gastric retention and aggravate reflux in these patients.
Hyoscyamine should be used cautiously in children. Infants and young children are especially susceptible to the toxic effects of anticholinergic agents. Close supervision is recommended for infants and children with spastic paralysis or brain damage because an increased response to anticholinergics has been noted. Additionally, hyoscyamine sulfate injection contains benzyl alcohol as a preservative and should not be used in neonates and premature infants. Benzyl alcohol has been associated with gasping syndrome, which is a potentially fatal condition characterized by metabolic acidosis and CNS, respiratory, circulatory, and renal dysfunction.
Hyoscyamine is classified pregnancy category C. Hyoscyamine crosses the placenta. The safe use of hyoscyamine during pregnancy has not been established. Intravenous administration of hyoscyamine during pregnancy, especially near term, may produce tachycardia in the fetus. Additionally, hyoscyamine is distributed into breast milk. Although the extent of distribution into breast milk has not been determined, the chronic use of hyoscyamine should be avoided during breast-feeding since infants are usually very sensitive to the effects of anticholinergics.
[ Last revised: 2/21/2005 12:55:00 PM ]
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