Levbid (Hyoscyamine) Indications and Dosage
- aspiration prophylaxis
- bradycardia
- duodenal ulcer
- gastric ulcer
- irritable bowel syndrome
- organophosphate insecticide toxicity
Levbid (Hyoscyamine) Indications and Dosage
For adjunctive therapy in gastrointestinal disorders including duodenal ulcer, gastric ulcer, and irritable bowel syndrome:
NOTE: Dosages should be carefully titrated according to the individual patient’s response and tolerance.
Oral dosage (hyoscyamine tablets):
Adults: 0.15-0.3 mg PO, given up to 4 times per day.
Oral dosage (regular-release hyoscyamine sulfate tablets):
Adults and children >= 12 years: 0.125-0.25 mg PO or SL 3-4 times per day or as needed. Maximum dosage is 1.5 mg/day.
Oral dosage (orally disintegrating hyoscyamine sulfate tablets):
Adults and children >= 12 years: 0.125-0.25 mg (1-2 tablets) PO every 4 hours or as needed. Maximum dosage is 1.5 mg/day (12 tablets/day).
Children 2 to < 12 years: 0.0625-0.125 mg (1/2 to 1 tablet) PO every 4 hours or as needed. Maximum dosage is 0.75 mg/day (6 tablets/day).
Oral dosage (extended-release hyoscyamine sulfate capsules):
Adults and children >= 12 years: Approximately 0.375-0.75 mg PO every 12 hours or 0.375 mg PO every 8 hours. Maximum dosage is 1.5 mg/day.
Oral dosage (Symax™ Duotab biphasic tablets containing 0.125 mg immediate release and 0.250 mg sustained release hyoscyamine):
Adults and children >= 12 years: 1-2 tablets PO every 12 hours. May adjust to 1 tablet PO every 8 hours if needed. Maximum dosage is 4 tablets per 24 hours.
Children 2 to < 12 years: 1 tablet PO every 12 hours. Maximum dosage is 2 tablets per 24 hours. Use in children is limited to the ability to swallow tablet whole without posing a choking hazard.
Oral dosage (hyoscyamine sulfate drops):
Children 2 to < 12 years of age and weight approximately 10 kg: Approximately 31.3-33.3 mcg (0.0313-0.0333 mg) PO every 4 hours as needed. Maximum dosage is 750 mcg/day.
Children 2 to < 12 years of age and weight approximately 20 kg: Approximately 62.5 mcg (0.0625 mg) PO every 4 hours as needed. Maximum dosage is 750 mcg/day.
Children 2 to < 12 years of age and weight approximately 40 kg: Approximately 93.8 mcg (0.0938 mg) PO every 4 hours as needed. Maximum dosage is 750 mcg/day.
Children 2 to < 12 years of age and weight approximately 50 kg: Approximately 125 mcg (0.125 mg) PO every 4 hours as needed. Maximum dosage is 750 mcg/day.
Children < 2 years of age and weight approximately 2.3 kg: Approximately 12.5 mcg (0.0125 mg) PO every 4 hours as needed. Maximum dosage is 75 mcg/day.
Children < 2 years of age and weight approximately 3.4 kg: Approximately 16.7 mcg (0.0167 mg) PO every 4 hours as needed. Maximum dosage is 100 mcg/day.
Children < 2 years of age and weight approximately 5 kg: Approximately 20.8 mcg (0.0208 mg) PO every 4 hours as needed. Maximum dosage is 125 mcg/day.
Children < 2 years of age and weight approximately 7 kg: Approximately 25 mcg (0.025 mg) PO every 4 hours as needed. Maximum dosage is 150 mcg/day.
Children < 2 years of age and weight approximately 10 kg: Approximately 31.3-33.3 mcg (0.0313-0.0333 mg) PO every 4 hours as needed. Maximum dosage is 200 mcg/day.
Children < 2 years of age and weight approximately 15 kg: Approximately 45.8 mcg (0.0458 mg) PO every 4 hours as needed. Maximum dosage is 275 mcg/day.
Parenteral dosage (hyoscyamine sulfate):
Adults: 0.25 to 0.5 mg (0.5 to 1 ml) IM or IV. Some patients may require one single dose and others may require administration 2-4 times per day at 4 hour intervals.
For the relaxation of the upper gastrointestinal tract and colon prior to radiologic examination (NOTE: More effective agents are available for this indication):
Parenteral dosage:
Adults: 0.25-0.5 mg IV, IM, or SC 5-10 minutes before diagnostic radiologic procedure.
For the reduction of excessive salivary and respiratory tract secretions (e.g., aspiration prophylaxis) prior to anesthesia (NOTE: Hyoscyamine is generally no longer used for this indication):
Parenteral dosage:
Adults and children >= 2 years: 5 mcg/kg (0.005 mg/kg) IV, IM, or SC 30-60 minutes before induction of anesthesia or at the time other preanesthetic medications are administered.
For intraoperative use to reverse drug-induced bradycardia in adults:
Intravenous dosage:
Adults: 0.125 mg IV; may repeat as necessary.
For blockade of adverse muscarinic effects of anticholinesterase agents (i.e., neostigmine, physostigmine, pyridostigmine) when these agents are used to reverse the neuromuscular blockade produced by curariform agents:
Intravenous dosage:
Adults: 0.3-0.6 mg IV for each 0.5-2 mg of neostigmine or physostigmine or 10-20 mg pyridostigmine administered. Hyoscyamine sulfate is administered concurrently with (in a separate syringe) or a few minutes prior to the anticholinesterase agent. In the presence of bradycardia, hyoscyamine sulfate should be given before the anticholinesterase agent to increase the pulse rate to approximately 80 beats/minute.
For the treatment of organophosphate insecticide toxicity:
Parenteral dosage:
Adults: The usual initial dose is 1-2 mg IM or IV, preferably IV. Additional 1 mg doses may be administered IM or IV every 3-10 minutes until muscarinic signs and symptoms subside; repeat dose if signs and symptoms reappear. Up to 25 mg may be required during the first 24 hours of therapy. Subsequently, 0.5-1 mg PO may be administered at intervals of several hours as maintenance therapy until signs and symptoms completely subside. A cholinesterase reactivator (e.g., pralidoxime) should be administered concomitantly.
Patients with renal impairment:
Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed.
[ Last revised: 5/20/2005 2:14:00 PM ]
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