Drug Detail:Hyoscyamine (Hyoscyamine [ hye-oh-sye-a-meen ])
Drug Class: Anticholinergics / antispasmodics
Usual Adult Dose for Anticholinesterase Poisoning
0.125 mg orally disintegrating (ODT)/sublingual tablets/tablets: 1 to 2 tablets orally 3 to 4 times a day
- May increase to 1 to 2 tablets every 4 hours, as needed
0.375 mg extended release (ER) tablets: 1 to 2 tablets orally every 12 hours
- May increase to 1 tablet orally every 8 hours as needed
0.125 mg/mL oral drops: 0.25 to 1 mL orally every 4 hours as needed
- Maximum dose: 6 mL/24 hours
0.125 mg/5 mL oral elixir: 5 to 10 mL orally every 4 hours as needed
- Maximum dose: 60 mL/24 hours
Parenteral: 0.25 to 0.5 mg via IM, IV, or subcutaneous injection ONCE; the dose may be given up to 4 times a day in 4-hour intervals.
Comment: Oral tablets should be given 30 to 60 minutes prior to meals and at bedtime.
Uses:
- Adjunctive peptic ulcer therapy
- Adjunctive therapy for neurogenic bladder and bowel disturbances, including splenic flexure syndrome and neurogenic colon
- Anticholinesterase poisoning
- As a "drying agent" for acute rhinitis symptoms
- Certain cases of partial heart block associated with vagal activity
- Control gastric secretion, visceral spasm and hypermotility in spastic colon or bladder, cystitis, pylorospasm, and associated abdominal cramps
- Functional intestinal disorders, to reduce symptoms such as those seen in mild dysenteries, diverticulitis, and acute enterocolitis
- Parkinsonism, to reduce rigidity and tremors and control sialorrhea and hyperhidrosis
- Symptomatic relief of biliary and renal colic (with morphine or other narcotics)
Usual Adult Dose for Parkinsonian Tremor
0.125 mg orally disintegrating (ODT)/sublingual tablets/tablets: 1 to 2 tablets orally 3 to 4 times a day
- May increase to 1 to 2 tablets every 4 hours, as needed
0.375 mg extended release (ER) tablets: 1 to 2 tablets orally every 12 hours
- May increase to 1 tablet orally every 8 hours as needed
0.125 mg/mL oral drops: 0.25 to 1 mL orally every 4 hours as needed
- Maximum dose: 6 mL/24 hours
0.125 mg/5 mL oral elixir: 5 to 10 mL orally every 4 hours as needed
- Maximum dose: 60 mL/24 hours
Parenteral: 0.25 to 0.5 mg via IM, IV, or subcutaneous injection ONCE; the dose may be given up to 4 times a day in 4-hour intervals.
Comment: Oral tablets should be given 30 to 60 minutes prior to meals and at bedtime.
Uses:
- Adjunctive peptic ulcer therapy
- Adjunctive therapy for neurogenic bladder and bowel disturbances, including splenic flexure syndrome and neurogenic colon
- Anticholinesterase poisoning
- As a "drying agent" for acute rhinitis symptoms
- Certain cases of partial heart block associated with vagal activity
- Control gastric secretion, visceral spasm and hypermotility in spastic colon or bladder, cystitis, pylorospasm, and associated abdominal cramps
- Functional intestinal disorders, to reduce symptoms such as those seen in mild dysenteries, diverticulitis, and acute enterocolitis
- Parkinsonism, to reduce rigidity and tremors and control sialorrhea and hyperhidrosis
- Symptomatic relief of biliary and renal colic (with morphine or other narcotics)
Usual Adult Dose for Peptic Ulcer
0.125 mg orally disintegrating (ODT)/sublingual tablets/tablets: 1 to 2 tablets orally 3 to 4 times a day
- May increase to 1 to 2 tablets every 4 hours, as needed
0.375 mg extended release (ER) tablets: 1 to 2 tablets orally every 12 hours
- May increase to 1 tablet orally every 8 hours as needed
0.125 mg/mL oral drops: 0.25 to 1 mL orally every 4 hours as needed
- Maximum dose: 6 mL/24 hours
0.125 mg/5 mL oral elixir: 5 to 10 mL orally every 4 hours as needed
- Maximum dose: 60 mL/24 hours
Parenteral: 0.25 to 0.5 mg via IM, IV, or subcutaneous injection ONCE; the dose may be given up to 4 times a day in 4-hour intervals.
Comment: Oral tablets should be given 30 to 60 minutes prior to meals and at bedtime.
Uses:
- Adjunctive peptic ulcer therapy
- Adjunctive therapy for neurogenic bladder and bowel disturbances, including splenic flexure syndrome and neurogenic colon
- Anticholinesterase poisoning
- As a "drying agent" for acute rhinitis symptoms
- Certain cases of partial heart block associated with vagal activity
- Control gastric secretion, visceral spasm and hypermotility in spastic colon or bladder, cystitis, pylorospasm, and associated abdominal cramps
- Functional intestinal disorders, to reduce symptoms such as those seen in mild dysenteries, diverticulitis, and acute enterocolitis
- Parkinsonism, to reduce rigidity and tremors and control sialorrhea and hyperhidrosis
- Symptomatic relief of biliary and renal colic (with morphine or other narcotics)
Usual Adult Dose for Irritable Bowel Syndrome
0.125 mg orally disintegrating (ODT)/sublingual tablets/tablets: 1 to 2 tablets orally 3 to 4 times a day
- May increase to 1 to 2 tablets every 4 hours, as needed
0.375 mg extended release (ER) tablets: 1 to 2 tablets orally every 12 hours
- May increase to 1 tablet orally every 8 hours as needed
0.125 mg/mL oral drops: 0.25 to 1 mL orally every 4 hours as needed
- Maximum dose: 6 mL/24 hours
0.125 mg/5 mL oral elixir: 5 to 10 mL orally every 4 hours as needed
- Maximum dose: 60 mL/24 hours
Parenteral: 0.25 to 0.5 mg via IM, IV, or subcutaneous injection ONCE; the dose may be given up to 4 times a day in 4-hour intervals.
Comment: Oral tablets should be given 30 to 60 minutes prior to meals and at bedtime.
Uses:
- Adjunctive peptic ulcer therapy
- Adjunctive therapy for neurogenic bladder and bowel disturbances, including splenic flexure syndrome and neurogenic colon
- Anticholinesterase poisoning
- As a "drying agent" for acute rhinitis symptoms
- Certain cases of partial heart block associated with vagal activity
- Control gastric secretion, visceral spasm and hypermotility in spastic colon or bladder, cystitis, pylorospasm, and associated abdominal cramps
- Functional intestinal disorders, to reduce symptoms such as those seen in mild dysenteries, diverticulitis, and acute enterocolitis
- Parkinsonism, to reduce rigidity and tremors and control sialorrhea and hyperhidrosis
- Symptomatic relief of biliary and renal colic (with morphine or other narcotics)
Usual Adult Dose for Neurogenic Bladder
0.125 mg orally disintegrating (ODT)/sublingual tablets/tablets: 1 to 2 tablets orally 3 to 4 times a day
- May increase to 1 to 2 tablets every 4 hours, as needed
0.375 mg extended release (ER) tablets: 1 to 2 tablets orally every 12 hours
- May increase to 1 tablet orally every 8 hours as needed
0.125 mg/mL oral drops: 0.25 to 1 mL orally every 4 hours as needed
- Maximum dose: 6 mL/24 hours
0.125 mg/5 mL oral elixir: 5 to 10 mL orally every 4 hours as needed
- Maximum dose: 60 mL/24 hours
Parenteral: 0.25 to 0.5 mg via IM, IV, or subcutaneous injection ONCE; the dose may be given up to 4 times a day in 4-hour intervals.
Comment: Oral tablets should be given 30 to 60 minutes prior to meals and at bedtime.
Uses:
- Adjunctive peptic ulcer therapy
- Adjunctive therapy for neurogenic bladder and bowel disturbances, including splenic flexure syndrome and neurogenic colon
- Anticholinesterase poisoning
- As a "drying agent" for acute rhinitis symptoms
- Certain cases of partial heart block associated with vagal activity
- Control gastric secretion, visceral spasm and hypermotility in spastic colon or bladder, cystitis, pylorospasm, and associated abdominal cramps
- Functional intestinal disorders, to reduce symptoms such as those seen in mild dysenteries, diverticulitis, and acute enterocolitis
- Parkinsonism, to reduce rigidity and tremors and control sialorrhea and hyperhidrosis
- Symptomatic relief of biliary and renal colic (with morphine or other narcotics)
Usual Adult Dose for Endoscopy or Radiology Premedication
Parenteral: 0.25 to 0.5 mg via IM, IV, or subcutaneous injection ONCE 5 to 10 minutes prior to the procedure
Uses:
- Facilitating diagnostic procedures (e.g., endoscopy, hypnotic duodenography) by decreasing gastric motility
- To improve radiologic visibility of the kidneys (via IV administration)
Usual Adult Dose for Abdominal Radiological Procedure
Parenteral: 0.25 to 0.5 mg via IM, IV, or subcutaneous injection ONCE 5 to 10 minutes prior to the procedure
Uses:
- Facilitating diagnostic procedures (e.g., endoscopy, hypnotic duodenography) by decreasing gastric motility
- To improve radiologic visibility of the kidneys (via IV administration)
Usual Adult Dose for Gastrointestinal Tract Examination
Parenteral: 0.25 to 0.5 mg via IM, IV, or subcutaneous injection ONCE 5 to 10 minutes prior to the procedure
Uses:
- Facilitating diagnostic procedures (e.g., endoscopy, hypnotic duodenography) by decreasing gastric motility
- To improve radiologic visibility of the kidneys (via IV administration)
Usual Adult Dose for Anesthesia
Parenteral:
- Pre-anesthetic: 0.005 mg/kg via IM, IV, or subcutaneous injection 30 to 60 minutes prior to the anticipated time of anesthesia OR at the same time preanesthetic narcotic/sedatives are given
- During surgery: 0.125 mg IV ONCE, repeated in increments of 0.125 mg as needed to reduce drug-induced bradycardia
- Neuromuscular blockade reversal: 0.2 mg via IM, IV, or subcutaneous injection for every 1 mg of neostigmine (or physostigmine/pyridostigmine equivalent)
Uses:
- Block cardiac vagal inhibitory reflexes during induction of anesthesia and intubation
- Decrease the volume and acidity of gastric secretions
- Preoperative antimuscarinic to decrease pharyngeal, salivary, and tracheobronchial secretions
- Protection against peripheral muscarinic effects, including bradycardia and excessive secretions produced by halogenated hydrocarbons and cholinergic agents (e.g., neostigmine, physostigmine, pyridostigmine) given to reverse curariform agents
Usual Adult Dose for Bronchospasm During Anesthesia
Parenteral:
- Pre-anesthetic: 0.005 mg/kg via IM, IV, or subcutaneous injection 30 to 60 minutes prior to the anticipated time of anesthesia OR at the same time preanesthetic narcotic/sedatives are given
- During surgery: 0.125 mg IV ONCE, repeated in increments of 0.125 mg as needed to reduce drug-induced bradycardia
- Neuromuscular blockade reversal: 0.2 mg via IM, IV, or subcutaneous injection for every 1 mg of neostigmine (or physostigmine/pyridostigmine equivalent)
Uses:
- Block cardiac vagal inhibitory reflexes during induction of anesthesia and intubation
- Decrease the volume and acidity of gastric secretions
- Preoperative antimuscarinic to decrease pharyngeal, salivary, and tracheobronchial secretions
- Protection against peripheral muscarinic effects, including bradycardia and excessive secretions produced by halogenated hydrocarbons and cholinergic agents (e.g., neostigmine, physostigmine, pyridostigmine) given to reverse curariform agents
Usual Adult Dose for Light Anesthesia
Parenteral:
- Pre-anesthetic: 0.005 mg/kg via IM, IV, or subcutaneous injection 30 to 60 minutes prior to the anticipated time of anesthesia OR at the same time preanesthetic narcotic/sedatives are given
- During surgery: 0.125 mg IV ONCE, repeated in increments of 0.125 mg as needed to reduce drug-induced bradycardia
- Neuromuscular blockade reversal: 0.2 mg via IM, IV, or subcutaneous injection for every 1 mg of neostigmine (or physostigmine/pyridostigmine equivalent)
Uses:
- Block cardiac vagal inhibitory reflexes during induction of anesthesia and intubation
- Decrease the volume and acidity of gastric secretions
- Preoperative antimuscarinic to decrease pharyngeal, salivary, and tracheobronchial secretions
- Protection against peripheral muscarinic effects, including bradycardia and excessive secretions produced by halogenated hydrocarbons and cholinergic agents (e.g., neostigmine, physostigmine, pyridostigmine) given to reverse curariform agents
Usual Adult Dose for Reversal of Neuromuscular Blockade
Parenteral:
- Pre-anesthetic: 0.005 mg/kg via IM, IV, or subcutaneous injection 30 to 60 minutes prior to the anticipated time of anesthesia OR at the same time preanesthetic narcotic/sedatives are given
- During surgery: 0.125 mg IV ONCE, repeated in increments of 0.125 mg as needed to reduce drug-induced bradycardia
- Neuromuscular blockade reversal: 0.2 mg via IM, IV, or subcutaneous injection for every 1 mg of neostigmine (or physostigmine/pyridostigmine equivalent)
Uses:
- Block cardiac vagal inhibitory reflexes during induction of anesthesia and intubation
- Decrease the volume and acidity of gastric secretions
- Preoperative antimuscarinic to decrease pharyngeal, salivary, and tracheobronchial secretions
- Protection against peripheral muscarinic effects, including bradycardia and excessive secretions produced by halogenated hydrocarbons and cholinergic agents (e.g., neostigmine, physostigmine, pyridostigmine) given to reverse curariform agents
Usual Pediatric Dose for Anticholinesterase Poisoning
0.125 mg/mL oral drops:
Under 2 years:
3.4 kg: 4 drops orally every 4 hours as needed
- Maximum dose: 24 drops/24 hours
- Maximum dose: 30 drops/24 hours
- Maximum dose: 36 drops/24 hours
- Maximum dose: 48 drops/24 hours
- Maximum dose: 6 mL/24 hours
- Maximum dose: 12 mL/24 hours
0.125 mg/5 mL oral elixir:
2 to under 12 years:
10 kg: 1.25 mL orally every 4 hours as needed
20 kg: 2.5 mL orally every 4 hours as needed
40 kg: 3.75 mL orally every 4 hours as needed
50 kg: 5 mL orally every 4 hours as needed
Maximum dose: 30 mL/24 hours
12 years and older: 5 to 10 mL orally every 4 hours as needed
- Maximum dose: 60 mL/24 hours
0.125 mg ODT/Sublingual Tablets:
2 to 12 years: 0.5 to 1 tablet orally every 4 hours as needed
- Maximum dose: 6 tablets/24 hours
- May increase to 1 to 2 tablets orally every 4 hours, as needed
- Maximum dose: 12 tablets/24 hours
0.125 Tablets:
Under 12 years: Not recommended.
12 years and older: 1 to 2 tablets orally 3 to 4 times a day
- May increase dose to every 4 hours, as needed
- Maximum dose: 12 tablets/24 hours
0.375 mg ER tablets:
Under 12 years: Not recommended.
12 years and older: 1 or 2 tablets orally every 12 hours
- May increase to 1 tablet orally every 8 hours as needed
- Maximum dose: 4 tablets/24 hours
Comment: Oral tablets should be given 30 to 60 minutes prior to meals and at bedtime.
Uses:
- Adjunctive peptic ulcer therapy
- Adjunctive therapy for neurogenic bladder and bowel disturbances, including splenic flexure syndrome and neurogenic colon
- Anticholinesterase poisoning
- As a "drying agent" for acute rhinitis symptoms
- Control gastric secretion, visceral spasm and hypermotility in spastic colon or bladder, cystitis, pylorospasm, and associated abdominal cramps
- Functional intestinal disorders, to reduce symptoms such as those seen in mild dysenteries, diverticulitis, and acute enterocolitis
- Parkinsonism, to reduce rigidity and tremors and control sialorrhea and hyperhidrosis
- Symptomatic relief of biliary and renal colic (with morphine or other narcotics)
- Treatment of infant colic (elixir and drops)
Usual Pediatric Dose for Peptic Ulcer
0.125 mg/mL oral drops:
Under 2 years:
3.4 kg: 4 drops orally every 4 hours as needed
- Maximum dose: 24 drops/24 hours
- Maximum dose: 30 drops/24 hours
- Maximum dose: 36 drops/24 hours
- Maximum dose: 48 drops/24 hours
- Maximum dose: 6 mL/24 hours
- Maximum dose: 12 mL/24 hours
0.125 mg/5 mL oral elixir:
2 to under 12 years:
10 kg: 1.25 mL orally every 4 hours as needed
20 kg: 2.5 mL orally every 4 hours as needed
40 kg: 3.75 mL orally every 4 hours as needed
50 kg: 5 mL orally every 4 hours as needed
Maximum dose: 30 mL/24 hours
12 years and older: 5 to 10 mL orally every 4 hours as needed
- Maximum dose: 60 mL/24 hours
0.125 mg ODT/Sublingual Tablets:
2 to 12 years: 0.5 to 1 tablet orally every 4 hours as needed
- Maximum dose: 6 tablets/24 hours
- May increase to 1 to 2 tablets orally every 4 hours, as needed
- Maximum dose: 12 tablets/24 hours
0.125 Tablets:
Under 12 years: Not recommended.
12 years and older: 1 to 2 tablets orally 3 to 4 times a day
- May increase dose to every 4 hours, as needed
- Maximum dose: 12 tablets/24 hours
0.375 mg ER tablets:
Under 12 years: Not recommended.
12 years and older: 1 or 2 tablets orally every 12 hours
- May increase to 1 tablet orally every 8 hours as needed
- Maximum dose: 4 tablets/24 hours
Comment: Oral tablets should be given 30 to 60 minutes prior to meals and at bedtime.
Uses:
- Adjunctive peptic ulcer therapy
- Adjunctive therapy for neurogenic bladder and bowel disturbances, including splenic flexure syndrome and neurogenic colon
- Anticholinesterase poisoning
- As a "drying agent" for acute rhinitis symptoms
- Control gastric secretion, visceral spasm and hypermotility in spastic colon or bladder, cystitis, pylorospasm, and associated abdominal cramps
- Functional intestinal disorders, to reduce symptoms such as those seen in mild dysenteries, diverticulitis, and acute enterocolitis
- Parkinsonism, to reduce rigidity and tremors and control sialorrhea and hyperhidrosis
- Symptomatic relief of biliary and renal colic (with morphine or other narcotics)
- Treatment of infant colic (elixir and drops)
Usual Pediatric Dose for Urinary Incontinence
0.125 mg/mL oral drops:
Under 2 years:
3.4 kg: 4 drops orally every 4 hours as needed
- Maximum dose: 24 drops/24 hours
- Maximum dose: 30 drops/24 hours
- Maximum dose: 36 drops/24 hours
- Maximum dose: 48 drops/24 hours
- Maximum dose: 6 mL/24 hours
- Maximum dose: 12 mL/24 hours
0.125 mg/5 mL oral elixir:
2 to under 12 years:
10 kg: 1.25 mL orally every 4 hours as needed
20 kg: 2.5 mL orally every 4 hours as needed
40 kg: 3.75 mL orally every 4 hours as needed
50 kg: 5 mL orally every 4 hours as needed
Maximum dose: 30 mL/24 hours
12 years and older: 5 to 10 mL orally every 4 hours as needed
- Maximum dose: 60 mL/24 hours
0.125 mg ODT/Sublingual Tablets:
2 to 12 years: 0.5 to 1 tablet orally every 4 hours as needed
- Maximum dose: 6 tablets/24 hours
- May increase to 1 to 2 tablets orally every 4 hours, as needed
- Maximum dose: 12 tablets/24 hours
0.125 Tablets:
Under 12 years: Not recommended.
12 years and older: 1 to 2 tablets orally 3 to 4 times a day
- May increase dose to every 4 hours, as needed
- Maximum dose: 12 tablets/24 hours
0.375 mg ER tablets:
Under 12 years: Not recommended.
12 years and older: 1 or 2 tablets orally every 12 hours
- May increase to 1 tablet orally every 8 hours as needed
- Maximum dose: 4 tablets/24 hours
Comment: Oral tablets should be given 30 to 60 minutes prior to meals and at bedtime.
Uses:
- Adjunctive peptic ulcer therapy
- Adjunctive therapy for neurogenic bladder and bowel disturbances, including splenic flexure syndrome and neurogenic colon
- Anticholinesterase poisoning
- As a "drying agent" for acute rhinitis symptoms
- Control gastric secretion, visceral spasm and hypermotility in spastic colon or bladder, cystitis, pylorospasm, and associated abdominal cramps
- Functional intestinal disorders, to reduce symptoms such as those seen in mild dysenteries, diverticulitis, and acute enterocolitis
- Parkinsonism, to reduce rigidity and tremors and control sialorrhea and hyperhidrosis
- Symptomatic relief of biliary and renal colic (with morphine or other narcotics)
- Treatment of infant colic (elixir and drops)
Usual Pediatric Dose for Neurogenic Bladder
0.125 mg/mL oral drops:
Under 2 years:
3.4 kg: 4 drops orally every 4 hours as needed
- Maximum dose: 24 drops/24 hours
- Maximum dose: 30 drops/24 hours
- Maximum dose: 36 drops/24 hours
- Maximum dose: 48 drops/24 hours
- Maximum dose: 6 mL/24 hours
- Maximum dose: 12 mL/24 hours
0.125 mg/5 mL oral elixir:
2 to under 12 years:
10 kg: 1.25 mL orally every 4 hours as needed
20 kg: 2.5 mL orally every 4 hours as needed
40 kg: 3.75 mL orally every 4 hours as needed
50 kg: 5 mL orally every 4 hours as needed
Maximum dose: 30 mL/24 hours
12 years and older: 5 to 10 mL orally every 4 hours as needed
- Maximum dose: 60 mL/24 hours
0.125 mg ODT/Sublingual Tablets:
2 to 12 years: 0.5 to 1 tablet orally every 4 hours as needed
- Maximum dose: 6 tablets/24 hours
- May increase to 1 to 2 tablets orally every 4 hours, as needed
- Maximum dose: 12 tablets/24 hours
0.125 Tablets:
Under 12 years: Not recommended.
12 years and older: 1 to 2 tablets orally 3 to 4 times a day
- May increase dose to every 4 hours, as needed
- Maximum dose: 12 tablets/24 hours
0.375 mg ER tablets:
Under 12 years: Not recommended.
12 years and older: 1 or 2 tablets orally every 12 hours
- May increase to 1 tablet orally every 8 hours as needed
- Maximum dose: 4 tablets/24 hours
Comment: Oral tablets should be given 30 to 60 minutes prior to meals and at bedtime.
Uses:
- Adjunctive peptic ulcer therapy
- Adjunctive therapy for neurogenic bladder and bowel disturbances, including splenic flexure syndrome and neurogenic colon
- Anticholinesterase poisoning
- As a "drying agent" for acute rhinitis symptoms
- Control gastric secretion, visceral spasm and hypermotility in spastic colon or bladder, cystitis, pylorospasm, and associated abdominal cramps
- Functional intestinal disorders, to reduce symptoms such as those seen in mild dysenteries, diverticulitis, and acute enterocolitis
- Parkinsonism, to reduce rigidity and tremors and control sialorrhea and hyperhidrosis
- Symptomatic relief of biliary and renal colic (with morphine or other narcotics)
- Treatment of infant colic (elixir and drops)
Usual Pediatric Dose for Anesthesia
Over 2 years:
Parenteral:
- Pre-anesthetic: 0.005 mg/kg via IM, IV, or subcutaneous injection 30 to 60 minutes prior to the anticipated time of anesthesia OR at the same time preanesthetic narcotic/sedatives are given
- During surgery: 0.125 mg IV ONCE, repeated in increments of 0.125 mg as needed to reduce drug-induced bradycardia
- Neuromuscular blockade reversal: 0.2 mg via IM, IV, or subcutaneous injection for every 1 mg of neostigmine (or physostigmine/pyridostigmine equivalent)
Uses:
- Block cardiac vagal inhibitory reflexes during induction of anesthesia and intubation
- Decrease the volume and acidity of gastric secretions
- Preoperative antimuscarinic to decrease pharyngeal, salivary, and tracheobronchial secretions
- Protection against peripheral muscarinic effects, including bradycardia and excessive secretions produced by halogenated hydrocarbons and cholinergic agents (e.g., neostigmine, physostigmine, pyridostigmine) given to reverse curariform agents
Usual Pediatric Dose for Bronchospasm During Anesthesia
Over 2 years:
Parenteral:
- Pre-anesthetic: 0.005 mg/kg via IM, IV, or subcutaneous injection 30 to 60 minutes prior to the anticipated time of anesthesia OR at the same time preanesthetic narcotic/sedatives are given
- During surgery: 0.125 mg IV ONCE, repeated in increments of 0.125 mg as needed to reduce drug-induced bradycardia
- Neuromuscular blockade reversal: 0.2 mg via IM, IV, or subcutaneous injection for every 1 mg of neostigmine (or physostigmine/pyridostigmine equivalent)
Uses:
- Block cardiac vagal inhibitory reflexes during induction of anesthesia and intubation
- Decrease the volume and acidity of gastric secretions
- Preoperative antimuscarinic to decrease pharyngeal, salivary, and tracheobronchial secretions
- Protection against peripheral muscarinic effects, including bradycardia and excessive secretions produced by halogenated hydrocarbons and cholinergic agents (e.g., neostigmine, physostigmine, pyridostigmine) given to reverse curariform agents
Usual Pediatric Dose for Light Anesthesia
Over 2 years:
Parenteral:
- Pre-anesthetic: 0.005 mg/kg via IM, IV, or subcutaneous injection 30 to 60 minutes prior to the anticipated time of anesthesia OR at the same time preanesthetic narcotic/sedatives are given
- During surgery: 0.125 mg IV ONCE, repeated in increments of 0.125 mg as needed to reduce drug-induced bradycardia
- Neuromuscular blockade reversal: 0.2 mg via IM, IV, or subcutaneous injection for every 1 mg of neostigmine (or physostigmine/pyridostigmine equivalent)
Uses:
- Block cardiac vagal inhibitory reflexes during induction of anesthesia and intubation
- Decrease the volume and acidity of gastric secretions
- Preoperative antimuscarinic to decrease pharyngeal, salivary, and tracheobronchial secretions
- Protection against peripheral muscarinic effects, including bradycardia and excessive secretions produced by halogenated hydrocarbons and cholinergic agents (e.g., neostigmine, physostigmine, pyridostigmine) given to reverse curariform agents
Usual Pediatric Dose for Reversal of Neuromuscular Blockade
Over 2 years:
Parenteral:
- Pre-anesthetic: 0.005 mg/kg via IM, IV, or subcutaneous injection 30 to 60 minutes prior to the anticipated time of anesthesia OR at the same time preanesthetic narcotic/sedatives are given
- During surgery: 0.125 mg IV ONCE, repeated in increments of 0.125 mg as needed to reduce drug-induced bradycardia
- Neuromuscular blockade reversal: 0.2 mg via IM, IV, or subcutaneous injection for every 1 mg of neostigmine (or physostigmine/pyridostigmine equivalent)
Uses:
- Block cardiac vagal inhibitory reflexes during induction of anesthesia and intubation
- Decrease the volume and acidity of gastric secretions
- Preoperative antimuscarinic to decrease pharyngeal, salivary, and tracheobronchial secretions
- Protection against peripheral muscarinic effects, including bradycardia and excessive secretions produced by halogenated hydrocarbons and cholinergic agents (e.g., neostigmine, physostigmine, pyridostigmine) given to reverse curariform agents
Renal Dose Adjustments
Sublingual tablets/tablets: Data not available
ODTs/oral drops/elixirs: Use with caution.
Liver Dose Adjustments
Data not available
Precautions
CONTRAINDICATIONS:
- Glaucoma
- Myasthenia gravis
- Myocardial ischemia
- Obstructive uropathy (e.g. bladder neck obstruction from prostatic hypertrophy)
- Obstructive disease of the gastrointestinal tract (e.g. achalasia, pyloroduodenal stenosis)
- Paralytic ileus, intestinal atony of older or debilitated patients
- Unstable cardiovascular status in acute hemorrhage
- Severe ulcerative colitis
- Toxic megacolon with/without complicating ulcerative colitis
Safety and efficacy of ER products have not been established in patients younger than 12 years.
Consult WARNINGS section for additional precautions.
Dialysis
Data not available
Other Comments
Administration advice:
- Tablets (including ER, ODT) should be taken 30 to 60 minutes before meals.
- ER tablets should be swallowed whole.
- Injection solutions should not be diluted prior to administration.
Patient advice:
- Use with caution during exercise or hot weather; overheating may cause heat stroke.
- This drug may cause drowsiness, dizziness, or blurred vision; use caution when driving or performing other tasks requiring mental alertness.
- ER tablets may appear in the stool, but the medication will have been released
