Hyoscyamine (Lexi-Drugs Multinational)

Pronunciation

(hye oh SYE a meen)

Brand Names: US

Anaspaz; Colidrops [DSC]; Ed-Spaz; HyoMax-SL; Hyosyne; Levbid; Levsin; Levsin/SL; NuLev; Oscimin; Oscimin

SR; Symax Duotab; Symax FasTabs; Symax-SL; Symax-SR

Brand Names: Canada

Levsin

Brand Names: International

Buwecon (TW); Duboisine (FR); Egacene (NL); Egazil Duretter (DK, FI, NO, SE); Eyosin (PH); Levsin

(QA); Levsin SL (HK); Neo-Allospasmin (BG); Nuspas (TW)

Anatomic Therapeutic Chemical (ATC) Classification

A03BA03

Pharmacologic Category

Anticholinergic Agent

Dosing: Adult
Gastrointestinal disorders:
Oral:
Tablet, dispersible:
Anaspaz, ED-SPAZ, NuLev, Symax FasTab: 0.125 to 0.25 mg every 4 hours or as needed; maximum: 1.5 mg daily
Oscimin: 0.125 to 0.25 mg 3 to 4 times daily; may increase to every 4 hours as needed; maximum: 1.5 mg daily
Tablet, extended release:
Levbid: 0.375 to 0.75 mg every 12 hours; maximum: 1.5 mg daily
Oscimin SR, Symax Duotab, Symax SR: 0.375 to 0.75 mg every 12 hours or 0.375 mg every 8 hours; maximum: 1.5 mg daily
Tablet, regular release:
Levsin: 0.125 to 0.25 mg every 4 hours or as needed; maximum: 1.5 mg daily
Oscimin: 0.125 to 0.25 mg 3 to 4 times daily; may increase to every 4 hours as needed; maximum: 1.5 mg daily
Tablet, sublingual (Oscimin, Symax SL): 0.125 to 0.25 mg 3 to 4 times daily; may increase to every 4 hours as needed; maximum:
1.5 mg daily
Drops (Hyosyne [0.125 mg/mL]): 0.125 mg (1 mL) to 0.25 mg (2 mL) every 4 hours or as needed; maximum: 1.5 mg (12 mL)
daily
Elixir (Hyosyne [0.125 mg/5 mL]): 0.125 mg (5 mL) to 0.25 mg (10 mL) every 4 hours or as needed; maximum: 1.5 mg (60 mL)
daily
IM, IV, SubQ: 0.25 to 0.5 mg; may repeat as needed up to 4 times daily, at 4-hour intervals
Diagnostic procedures: IV: 0.25 to 0.5 mg given 5 to 10 minutes prior to procedure
Preanesthesia: IM, IV, SubQ: 5 mcg/kg given 30 to 60 minutes prior to induction of anesthesia or at the time preoperative opioids or
sedatives are administered
To reduce drug-induced bradycardia during surgery: IV: 0.125 mg; repeat as needed
Reverse neuromuscular blockade: IM, IV, SubQ: 0.2 mg for every 1 mg neostigmine (or the physostigmine/pyridostigmine equivalent)
* See Dosage and Administration in AHFS Essentials for additional information.

Dosing: Geriatric
Dosing: Pediatric

Refer to adult dosing.

Dosing: Pediatric
Gastrointestinal disorders:
Children <2 years: Oral: Drops (Hyosyne [0.125 mg/mL]): Dose as listed, based on age and weight (kg); repeat dose every 4 hours or
as needed:
3.4 kg: 4 drops; maximum: 24 drops daily
5 kg: 5 drops; maximum: 30 drops daily
7 kg: 6 drops; maximum: 36 drops daily
10 kg: 8 drops; maximum: 48 drops daily
Children 2 to <12 years: Oral:
Tablets (regular release [Levsin], dispersible [Anaspaz, ED-SPAZ, NuLev, Symax FasTab]): 0.0625 to 0.125 mg every 4 hours or as
needed; maximum: 0.75 mg daily
Drops (Hyosyne [0.125 mg/mL]): 0.03125 mg (0.25 mL) to 0.125 mg (1 mL) every 4 hours or as needed; maximum: 0.75 mg (6
mL) daily
Elixir (Hyosyne [0.125 mg/5 mL]): Dose as listed, based on age and weight (kg); repeat dose every 4 hours or as needed:
10 kg: 0.03125 mg (1.25 mL); maximum: 0.75 mg (30 mL) daily
20 kg: 0.0625 mg (2.5 mL); maximum: 0.75 mg (30 mL) daily
40 kg: 0.09375 mg (3.75 mL); maximum: 0.75 mg (30 mL) daily
50 kg: 0.125 mg (5 mL); maximum: 0.75 mg (30 mL) daily
Children 12 years and Adolescents: Oral: Regular release tablets, dispersible tablets, sublingual tablets, elixir/drops, extended
release tablets: Refer to adult dosing.
Preanesthesia: Children >2 years and Adolescents: IV: Refer to adult dosing.

Dosing: Renal Impairment

No dosage adjustment provided in manufacturers labeling, use with caution.

Dosing: Hepatic Impairment

No dosage adjustment provided in manufacturers labeling.

Use: Labeled Indications

Anesthesia:
Preoperative antimuscarinic: Preoperative antimuscarinic to reduce salivary, tracheobronchial, and pharyngeal secretions; to reduce
volume and acidity of gastric secretions; to block cardiac vagal inhibitory reflexes during induction of anesthesia and intubation
Reversal of neuromuscular blockade and associated muscarinic effects: Protects against peripheral muscarinic effects (such as
bradycardia and excessive secretions produced by halogenated hydrocarbons and cholinergic agents [such as physostigmine,
neostigmine, and pyridostigmine]) given to reverse actions of curariform agents
Antidote for anticholinesterase agent poisoning: Antidote for poisoning by anticholinesterase agents
Biliary and renal colic: Adjunctive therapy with morphine or other opioids for the symptomatic relief of biliary and renal colic
Diagnostic procedures: Reduces GI motility to facilitate diagnostic procedures such as endoscopy or hypotonic duodenography; may also
improve radiologic visibility of the kidneys
GI disorders:
Aid in the control of acute episodes of gastric secretion, visceral spasm, hypermotility in spastic colitis, pylorospasm, and associated
abdominal cramps; relieve symptoms in functional intestinal disorders (eg, mild dysenteries, diverticulitis) and infant colic (elixir
and oral solution)
Adjunctive therapy for treatment in peptic ulcer; irritable bowel syndrome (irritable colon, spastic colon, acute enterocolitis, mucous

colitis) and other functional GI disorders; neurogenic bowel disturbances (including splenic flexure syndrome and neurogenic
colon)
Pancreatitis: Reduce pain and hypersecretion in pancreatitis
Parkinsonism: In parkinsonism, to reduce rigidity and tremors and to control associated sialorrhea and hyperhidrosis
Partial heart block: For use in certain cases of partial heart block associated with vagal activity
Rhinitis: Drying agent in the relief of symptoms of acute rhinitis
Urinary system disorder: To control hypermotility in spastic bladder and cystitis; adjunctive therapy in the treatment of neurogenic
bladder
* See Uses in AHFS Essentials for additional information.

Clinical Practice Guidelines

American Gastroenterological Association (AGA), American Gastroenterological Association Institute Guideline on the Pharmacological
Management of Irritable Bowel Syndrome, 2014

Administration: IM
Administration: IV

May be administered without dilution.

Inject over at least 1 minute. May be administered without dilution.

Administration: Injectable Detail

May be administered undiluted.

Administration: Oral
Elixir (Hyosyne): Administration prior to meals (~30 to 60 minutes) is recommended (but not required) when used to treat gastrointestinal
disorders.
Drops (Hyosyne): Administration prior to meals (~30 to 60 minutes) is recommended (but not required) when used to treat
gastrointestinal disorders. Use provided dropper to accurately measure dose.
Tablet, regular release (Levsin, Oscimin): Administration prior to meals (~30 to 60 minutes) is recommended (but not required) when used
to treat gastrointestinal disorders.
Tablet, dispersible: Administration prior to meals (~30 to 60 minutes) is recommended (but not required) when used to treat
gastrointestinal disorders.
Anaspaz: Tablets may be used sublingually, chewed, or swallowed whole.
Ed-Spaz: Place on top of tongue and allow to dissolve; swallow with saliva.
NuLev, Oscimin, Symax FasTab Chewable Melt: Tablets may be chewed or placed on tongue and allowed to disintegrate.
Tablet, extended release: Administration prior to meals (~30 to 60 minutes) is recommended (but not required) when used to treat
gastrointestinal disorders.
Levbid: Tablets are scored and may be broken in half for dose titration; do not crush or chew.
Oscimin SR, Symax Duotab, Symax SR: Swallow whole.
Tablet, sublingual: Administration prior to meals (~30 to 60 minutes) is recommended (but not required) when used to treat
gastrointestinal disorders.
Levsin/SL: Tablets may be used sublingually, chewed, or swallowed whole.
Symax SL: Tablets may be used sublingually or swallowed whole.
Oscimin: Administer sublingually.

Administration: Subcutaneous
Storage/Stability

May be administered without dilution.

Store at 20C to 25C (68F to 77F); excursions are permitted between 15C and 30C (59F and 86F).

Storage/Stability

Store at 20C to 25C (68F to 77F); excursions are permitted between 15C and 30C (59F and 86F).

Medication Safety Issues

Sound-alike/look-alike issues:
Anaspaz may be confused with Anaprox, Antispas
Levbid may be confused with Enbrel, Lithobid, Lopid, Lorabid
Levsin/SL may be confused with Levaquin
Geriatric Patients: High-Risk Medication:
Beers Criteria: Hyoscyamine is identified in the Beers Criteria as a potentially inappropriate medication to be avoided in patients
65 years and older (independent of diagnosis or condition) due to its highly anticholinergic properties and uncertain
effectiveness as an antispasmodic (Beers Criteria [AGS 2015]).

Contraindications

Hypersensitivity to belladonna alkaloids or any component of the formulation; glaucoma; obstructive uropathy;

myasthenia gravis; obstructive GI tract disease, paralytic ileus, intestinal atony of elderly or debilitated patients, severe ulcerative colitis,
toxic megacolon complicating ulcerative colitis; unstable cardiovascular status; myocardial ischemia. Note: Some extended release
products are not recommended in children <12 years of age; refer to manufacturers labeling.

Warnings/Precautions
Concerns related to adverse effect:
CNS effects: May cause drowsiness and/or blurred vision, which may impair physical or mental abilities; patients must be cautioned
about performing tasks which require mental alertness (eg, operating machinery or driving).
Diarrhea: May be a sign of incomplete intestinal obstruction, especially in patients with ileostomy or colostomy; treatment should be
discontinued if this occurs.
Heat prostration: May occur in the presence of increased environmental temperature; use caution in hot weather and/or exercise.
Oral effects: Prolonged use may lead to development of dental caries, periodontal disease, oral candidiasis, or discomfort due to
decreased salivation.
Psychosis: Has been reported in patients with an extreme sensitivity to anticholinergic effects; usually resolves within 12-48 hours
after discontinuation.
Disease-related concerns:
Cardiovascular disease: Use with caution in patients with coronary artery disease, tachyarrhythmias, heart failure, or hypertension;
evaluate tachycardia prior to administration. Use is contraindicated in patients with unstable cardiovascular status or
myocardial ischemia.
Hiatal hernia: Use with caution in patients with hiatal hernia with reflux esophagitis.
Hyperthyroidism: Use with caution in patients with hyperthyroidism.
Neuropathy: Use with caution in patients with autonomic neuropathy.
Prostatic hyperplasia: Use with caution in patients with prostatic hyperplasia.
Renal impairment: Use with caution in patients with renal impairment.
Special populations:
Pediatric: Use with caution in children with spastic paralysis or brain damage; may be more susceptible to anticholinergic effects.
Dosage form specific issues:
Benzyl alcohol and derivatives: Some dosage forms may contain sodium benzoate/benzoic acid; benzoic acid (benzoate) is a
metabolite of benzyl alcohol; large amounts of benzyl alcohol (99 mg/kg/day) have been associated with a potentially fatal
toxicity (gasping syndrome) in neonates; the gasping syndrome consists of metabolic acidosis, respiratory distress, gasping

respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP
["Inactive" 1997]; CDC, 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors, 2001);
avoid or use dosage forms containing benzyl alcohol derivative with caution in neonates. See manufacturers labeling.
* See Cautions in AHFS Essentials for additional information.

Geriatric Considerations

Avoid long-term use; the potential for toxic reactions is higher than the potential benefit, elderly are

particularly prone to CNS side effects of anticholinergics (eg, confusion, delirium, hallucinations). Side effects often occur before clinical
response is obtained.

Pregnancy Risk Factor: US

Pregnancy Considerations

Crosses the placenta, effects to the fetus not known; use during pregnancy only if clearly needed.

Breast-Feeding Considerations

Excreted in breast milk in trace amounts. May also suppress lactation. Breast-feeding is not

recommended.

Briggs' Drugs in Pregnancy & Lactation

I-Hyoscyamine

Adverse Reactions

Frequency not defined.

Cardiovascular: Flushing, palpitations, tachycardia

Central nervous system: Amnesia (short-term), ataxia, confusion (more common in elderly), dizziness, drowsiness, excitement (more
common in elderly), fatigue, hallucination, headache, insomnia, nervousness, psychosis, speech disturbance
Dermatologic: Hypohidrosis, urticaria
Gastrointestinal: Abdominal pain, ageusia, bloating, constipation, diarrhea, dysgeusia, dysphagia, heartburn, nausea, vomiting, xerostomia
Genitourinary: Decreased lactation, impotence, urinary hesitancy, urinary retention
Hypersensitivity: Hypersensitivity reaction
Neuromuscular & skeletal: Weakness
Ophthalmic: Blurred vision, cycloplegia, increased intraocular pressure, mydriasis
Miscellaneous: Fever
* See Cautions in AHFS Essentials for additional information.

Allergy and Idiosyncratic Reactions

Belladonna Alkaloid Allergy

Metabolism/Transport Effects
Drug Interactions

None known.
Open Interactions

AbobotulinumtoxinA: Anticholinergic Agents may enhance the anticholinergic effect of AbobotulinumtoxinA. Risk C: Monitor therapy
Acetylcholinesterase Inhibitors: May diminish the therapeutic effect of Anticholinergic Agents. Anticholinergic Agents may diminish the
therapeutic effect of Acetylcholinesterase Inhibitors. Risk C: Monitor therapy
Aclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Risk X: Avoid combination
Analgesics (Opioid): Anticholinergic Agents may enhance the adverse/toxic effect of Analgesics (Opioid). Specifically, the risk for
constipation and urinary retention may be increased with this combination. Risk C: Monitor therapy
Antacids: May decrease the serum concentration of Hyoscyamine. Management: Administer immediate release hyoscyamine before
meals and antacids after meals when these agents are given in combination. Risk D: Consider therapy modification

Anticholinergic Agents: May enhance the adverse/toxic effect of other Anticholinergic Agents. Exceptions: Levocabastine (Nasal). Risk C:
Monitor therapy
Cannabinoid-Containing Products: Anticholinergic Agents may enhance the tachycardic effect of Cannabinoid-Containing Products.
Exceptions: Cannabidiol. Risk C: Monitor therapy
Cimetropium: Anticholinergic Agents may enhance the anticholinergic effect of Cimetropium. Risk X: Avoid combination
Eluxadoline: Anticholinergic Agents may enhance the constipating effect of Eluxadoline. Risk X: Avoid combination
Gastrointestinal Agents (Prokinetic): Anticholinergic Agents may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic).
Risk C: Monitor therapy
Glucagon: Anticholinergic Agents may enhance the adverse/toxic effect of Glucagon. Specifically, the risk of gastrointestinal adverse
effects may be increased. Risk X: Avoid combination
Glycopyrrolate: Anticholinergic Agents may enhance the anticholinergic effect of Glycopyrrolate. Risk X: Avoid combination
Glycopyrrolate (Oral Inhalation): Anticholinergic Agents may enhance the anticholinergic effect of Glycopyrrolate (Oral Inhalation). Risk X:
Avoid combination
Ipratropium (Oral Inhalation): May enhance the anticholinergic effect of Anticholinergic Agents. Risk X: Avoid combination
Itopride: Anticholinergic Agents may diminish the therapeutic effect of Itopride. Risk C: Monitor therapy
Levosulpiride: Anticholinergic Agents may diminish the therapeutic effect of Levosulpiride. Risk X: Avoid combination
Mianserin: May enhance the anticholinergic effect of Anticholinergic Agents. Risk C: Monitor therapy
Mirabegron: Anticholinergic Agents may enhance the adverse/toxic effect of Mirabegron. Risk C: Monitor therapy
OnabotulinumtoxinA: Anticholinergic Agents may enhance the anticholinergic effect of OnabotulinumtoxinA. Risk C: Monitor therapy
Potassium Chloride: Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Chloride. Management: Patients on drugs
with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride. Risk X: Avoid
combination
Pramlintide: May enhance the anticholinergic effect of Anticholinergic Agents. These effects are specific to the GI tract. Risk D: Consider
therapy modification
Ramosetron: Anticholinergic Agents may enhance the constipating effect of Ramosetron. Risk C: Monitor therapy
RimabotulinumtoxinB: Anticholinergic Agents may enhance the anticholinergic effect of RimabotulinumtoxinB. Risk C: Monitor therapy
Secretin: Anticholinergic Agents may diminish the therapeutic effect of Secretin. Management: Avoid using drugs with substantial
anticholinergic effects in patients receiving secretin whenever possible. If such agents must be used in combination, monitor closely
for a diminished response to secretin. Risk D: Consider therapy modification
Thiazide and Thiazide-Like Diuretics: Anticholinergic Agents may increase the serum concentration of Thiazide and Thiazide-Like
Diuretics. Risk C: Monitor therapy
Tiotropium: Anticholinergic Agents may enhance the anticholinergic effect of Tiotropium. Risk X: Avoid combination
Topiramate: Anticholinergic Agents may enhance the adverse/toxic effect of Topiramate. Risk C: Monitor therapy
Umeclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Risk X: Avoid combination

Nursing: Physical Assessment/Monitoring

Assess potential for interactions with any drugs that may add to

anticholinergic effects. IV/IM: Have patient void before administration. Monitor for excessive dryness of eyes, nose, mouth, or throat.

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

[DSC] = Discontinued product

Elixir, Oral, as sulfate:
Hyosyne: 0.125 mg/5 mL (473 mL) [contains alcohol, usp; lemon flavor]

Generic: 0.125 mg/5 mL (473 mL)

Solution, Injection, as sulfate:
Levsin: 0.5 mg/mL (1 mL) [contains benzyl alcohol]
Solution, Oral, as sulfate:
Colidrops: 0.125 mg/mL (30 mL [DSC])
Hyosyne: 0.125 mg/mL (15 mL) [lemon flavor]
Generic: 0.125 mg/mL (15 mL)
Tablet, Oral, as sulfate:
Levsin: 0.125 mg
Oscimin: 0.125 mg [peppermint flavor]
Generic: 0.125 mg
Tablet Dispersible, Oral, as sulfate:
Anaspaz: 0.125 mg [scored]
Ed-Spaz: 0.125 mg [scored]
NuLev: 0.125 mg [peppermint flavor]
Oscimin: 0.125 mg [peppermint flavor]
Symax FasTabs: 0.125 mg [mint flavor]
Generic: 0.125 mg
Tablet Extended Release, Oral, as sulfate:
Symax Duotab: 0.375 mg [contains brilliant blue fcf (fd&c blue #1)]
Tablet Extended Release 12 Hour, Oral, as sulfate:
Levbid: 0.375 mg
Oscimin SR: 0.375 mg
Symax-SR: 0.375 mg [scored]
Generic: 0.375 mg
Tablet Sublingual, Sublingual, as sulfate:
HyoMax-SL: 0.125 mg
Levsin/SL: 0.125 mg
Oscimin: 0.125 mg [peppermint flavor]
Symax-SL: 0.125 mg [mint flavor]
Generic: 0.125 mg

Generic Available (US)

May be product dependent

Pricing: US
Elixir (Hyoscyamine Sulfate Oral)
0.125 mg/5 mL (473 mL): $104.99
Solution (Hyoscyamine Sulfate Oral)

0.125 mg/mL (15 mL): $39.99

Solution (Levsin Injection)
0.5 mg/mL (1 mL): $68.49
Sublingual (HyoMax-SL Sublingual)
0.125 mg (100): $85.95
Sublingual (Hyoscyamine Sulfate Sublingual)
0.125 mg (100): $85.00
Sublingual (Levsin/SL Sublingual)
0.125 mg (100): $274.76
Sublingual (Symax-SL Sublingual)
0.125 mg (100): $133.75
Tablet, 12-hour (Hyoscyamine Sulfate ER Oral)
0.375 mg (100): $160.00
Tablet, 12-hour (Levbid Oral)
0.375 mg (100): $468.97
Tablet, 12-hour (Symax-SR Oral)
0.375 mg (100): $161.00
Tablet, controlled release (Symax Duotab Oral)
0.375 mg (90): $247.50
Tablet, orally-disintegrating (Anaspaz Oral)
0.125 mg (100): $25.80
Tablet, orally-disintegrating (Hyoscyamine Sulfate Oral)
0.125 mg (100): $85.00
Tablet, orally-disintegrating (NuLev Oral)
0.125 mg (100): $216.27
Tablet, orally-disintegrating (Symax FasTabs Oral)
0.125 mg (100): $138.75
Tablets (Hyoscyamine Sulfate Oral)
0.125 mg (100): $85.00
Tablets (Levsin Oral)
0.125 mg (100): $274.76
Disclaimer: The pricing data provide a representative AWP and/or AAWP price from a single manufacturer of the brand and/or generic
product, respectively. The pricing data should be used for benchmarking purposes only, and as such should not be used to set or
adjudicate any prices for reimbursement or purchasing functions. Pricing data is updated monthly.

Mechanism of Action

Blocks the action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands, and the

CNS; increases cardiac output, dries secretions, antagonizes histamine and serotonin

Pharmacodynamics/Kinetics

Pharmacodynamics/Kinetics
Onset of action: 2-3 minutes
Duration: Regular release: 4-6 hours; Extended release (Levbid, Symax Duotab): 8-12 hours
Absorption: Well absorbed
Metabolism: Hepatic
Half-life elimination: Regular release: 2-3.5 hours; Extended release (Levbid): ~7 hours
Excretion: Urine

Local Anesthetic/Vasoconstrictor Precautions

Effects on Dental Treatment

No information available to require special precautions

Key adverse event(s) related to dental treatment: Xerostomia (normal salivary flow resumes

upon discontinuation).

Effects on Bleeding

No information available to require special precautions

Related Information
Beers Criteria Potentially Inappropriate Medications for Geriatrics
Oral Medications That Should Not Be Crushed or Altered

Index Terms

l-Hyoscyamine Sulfate; Cystospaz-M; ED-SPAZ; Hyomax-SL; Hyoscyamine Sulfate

References
Ahlfors CE. Benzyl alcohol, kernicterus, and unbound bilirubin. J Pediatr. 2001;139(2):317-319.[PubMed 11487763]
American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 updated Beers Criteria for
potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63(11):2227-2246. doi:10.1111/jgs.13702[PubMed
26446832]
Anaspaz [package insert]. Lenexa, KS: B. F. Ascher amp Company Inc; June 2010.
Boyson SJ, Bethanechol for Anticholinergic Side Effects, Ann Neurol, 1988, 23(4):422-3. [PubMed 3382184]
Centers for Disease Control (CDC). Neonatal deaths associated with use of benzyl alcoholUnited States. MMWR Morb Mortal Wkly Rep.
1982;31(22):290-291. http://www.cdc.gov/mmwr/preview/mmwrhtml/00001109.htm[PubMed 6810084]
Ed-Spaz [package insert]. Ripley, MS: Edwards Pharmaceutical Inc; May 2010.
Hyosine oral drops and elixir [package insert]. Spring Valley, NY: Silarx Pharmaceuticals Inc; April 2007.
"Inactive" ingredients in pharmaceutical products: update (subject review). American Academy of Pediatrics (AAP) Committee on Drugs.
Pediatrics. 1997;99(2):268-278.[PubMed 9024461]
Levbid [package insert]. Marietta, GA: Alaven; January 2008.
Levsin [package insert]. Marietta, GA: Alaven; February 2008
Levsin/SL [package insert]. Marietta, GA: Alaven; February 2008.
NuLev [package insert]. Marietta, GA: Alaven; April 2009.
Oscimin orally disintegrating tablets (hyoscyamine sulfate) [prescribing information]. Canton, MS: Larken Laboratories Inc; June 2014.
Oscimin sublingual tablets (hyoscyamine sulfate) [prescribing information]. Canton, MS: Larken Laboratories Inc; May 2014.
Oscimin tablets (hyoscyamine sulfate) [prescribing information]. Canton, MS: Larken Laboratories Inc; June 2014.
Oscimin-SR (hyoscyamine sulfate) [prescribing information]. Canton, MS: Larken Laboratories Inc; July 2014.
Shutt LE and Bowes JB, Atropine and Hyoscine, Anaesthesia, 1979, 34(5):476-90.[PubMed 382907]

Symax FasTab [package insert]. Fort Worth, TX: Capellon Pharmaceuticals; April 2006.
Symax Duotab (hyoscyamine sulfate) [prescribing information]. Fort Worth, TX: Capellon Pharmaceuticals; June 2014.
Symax-SR [package insert]. Fort Worth, TX: Sovereign Pharmaceuticals; June 2008.
Symax-SL (hyoscyamine sulfate) [prescribing information]. Fort Worth, TX: Capellon Pharmaceuticals; June 2014.

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