Levsin

Medical Editor: John P. Cunha, DO, FACOEP Last updated on RxList: 3/15/2022

Drug Summary

What Is Levsin?

Levsin (hyoscyamine) is one of the principal anticholinergic/antispasmodic components of belladonna alkaloids used to treat different stomach and intestinal disorders, including peptic ulcer and irritable bowel syndrome. Levsin is also used to control muscle spasms in the bladder, kidneys, or digestive tract, and to reduce stomach acid. Levsin is sometimes used to reduce tremors and rigid muscles in people with symptoms of Parkinson's disease, and is also used as a drying agent to control excessive salivation, runny nose, or excessive sweating. Levsin is available in generic form.

What Are Side Effects of Levsin?

Common side effects of Levsin include:

  • dizziness,
  • drowsiness,
  • nervousness,
  • blurred vision,
  • dry mouth,
  • vision problems,
  • headache,
  • trouble sleeping (insomnia),
  • constipation,
  • nausea,
  • vomiting,
  • bloating,
  • heartburn,
  • changes in taste,
  • problems with urination,
  • impotence,
  • loss of interest in sex,
  • trouble having an orgasm,
  • flushing,
  • dry skin, and
  • decreased sweating.

Tell your doctor if you experience unlikely but serious side effects of Levsin including:

  • mental/mood changes (e.g., confusion, unusual excitement),
  • fast/irregular heartbeat,
  • loss of coordination, or
  • slurred speech.

Dosage for Levsin

Dosage of Levsin for adults and children 12 years of age and older: 1 to 2 tablets every four hours or as needed. Do not exceed 12 tablets in 24 hours. Pediatric patients 2 to under 12 years of age: ½ to 1 tablet every four hours or as needed. Do not exceed 6 tablets in 24 hours.

What Drugs, Substances, or Supplements Interact with Levsin?

Levsin may interact with amantadine, haloperidol, MAO inhibitors, phenothiazines, or antidepressants. Tell your doctor all medications you use.

Levsin During Pregnancy and Breastfeeding

Levsin should be used only when prescribed during pregnancy. This drug passes into breast milk. Consult your doctor before breastfeeding.

Additional Information

Our Levsin (hyoscyamine) Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.

Description for Levsin

Levsin® tablets (hyoscyamine sulfate tablets USP) contain 0.125 mg hyoscyamine sulfate formulated for oral administration.

Levsin® (hyoscyamine) is one of the principal anticholinergic/antispasmodic components of belladonna alkaloids. The empirical formula is (C17H23NO3)2•H2SO4•2H2O and the molecular weight is 712.85. Chemically, it is benzeneacetic acid, a-(hydroxymethyl)-, 8-methyl-8-azabicyclo [3.2.1.] oct-3-yl ester, [3(S)-endo]-, sulfate (2:1), dihydrate with the following structure:

Levsin® (hyoscyamine sulfate) Structural Formula Illustration

Each tablet also contains as inactive ingredients: FD&C blue #1, lactose monohydrate, magnesium stearate, mannitol, starch and stearic acid.

Uses for Levsin

Levsin® (hyoscyamine) 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). Levsin® (hyoscyamine) 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.

Dosage for Levsin

Dosage may be adjusted according to the conditions and severity of symptoms.

Adults and pediatric patients 12 years of age and older: 1 to 2 tablets every four hours or as needed. Do not exceed 12 tablets in 24 hours.

Pediatric patients 2 to under 12 years of age: ½ to 1 tablet every four hours or as needed. Do not exceed 6 tablets in 24 hours.

HOW SUPPLIED

Levsin® tablets (hyoscyamine sulfate tablets USP) 0.125 mg are round, blue colored tablets that are imprinted with “AP” on one side and “112” on the other.

Bottles of 100 tablets NDC 68220-112-10
Bottles of 500 tablets NDC 68220-112-50

Store at controlled room temperature 20°- 25°C (68° - 77°F); excursions permitted to15°- 30°C (59°- 86°F). Please refer to current USP.

Dispense in tight, light-resistant containers as defined in USP/NF with a child-resistant closure.

KEEP OUT OF REACH OF CHILDREN

Also available as:

Levsin® Dosage Strength Package Size NDC
Tablets 0.125mg 100 68220-112-10
Tablets 0.125mg 500 68220-112-50
Sub-lingual Tablets 0.125mg 100 68220-113-10
Sub-lingual Tablets 0.125mg 500 68220-113-50
Elixir 0.125mg/5 mL Pint 0091-4532-16
Drops 0.125mg/mL 15mL 0091-4538-15
Injection 0.5mg/mL Box of 5-1mL 0091-1536-05
Levbid® extended- 0.375mg 100 68220-115-10
release tablets 0.375mg 500 68220-115-50

Address medical inquiries to: Alaven Pharmaceutical LLC, 2260 Northwest Parkway, Suite A Marietta, GA 30067 Or call toll free 1-888-317-0001. Rev. 02/08.

Side Effects for Levsin

All of the following adverse reactions have been reported with hyoscyamine sulfate. Adverse reactions may include dryness of the mouth; urinary hesitancy and retention; blurred vision; tachycardia; palpitations; mydriasis; increased ocular tension; loss of taste; headache; nervousness; drowsiness; weakness; fatigue; dizziness; insomnia; nausea; vomiting; impotence; constipation; bloated feeling; abdominal pain; diarrhea; allergic reactions or drug idiosyncrasies; urticaria and other dermal manifestations; ataxia; speech disturbance; some degree of mental confusion and/or excitement (especially in elderly persons); short-term memory loss; hallucinations; and decreased sweating.

Drug Interactions for Levsin

Additive adverse effects resulting from cholinergic blockade may occur when Levsin® (hyoscyamine) is administered concomitantly with other antimuscarinics, amantadine, haloperidol, phenothiazines, monoamine oxidase (MAO) inhibitors, tricyclic antidepressants or some antihistamines.

Antacids may interfere with the absorption of Levsin® (hyoscyamine) . Administer Levsin® (hyoscyamine) before meals; antacids after meals.

Warnings for Levsin

In the presence of high environmental temperature, heat prostration can occur with drug use (fever and heat stroke due to decreased sweating). Diarrhea may be an early symptom of incomplete intestinal obstruction especially in patients with ileostomy or colostomy. In this instance, treatment with this drug would be inappropriate and possibly harmful. Like other anticholinergic agents, Levsin® (hyoscyamine) may produce drowsiness, dizziness or blurred vision. In this event, the patient should be warned not to engage in activities requiring mental alertness such as operating a motor vehicle or other machinery or to perform hazardous work while taking this drug.

Psychosis has been reported in sensitive individuals given anticholinergic drugs including hyoscyamine sulfate. CNS signs and symptoms include confusion, disorientation, short-term memory loss, hallucinations, dysarthria, ataxia, euphoria, anxiety, fatigue, insomnia, agitation and mannerisms, and inappropriate affect. These CNS signs and symptoms usually resolve within 12 to 48 hours after discontinuation of the drug.

Precautions for Levsin

General

Use with caution in patients with: autonomic neuropathy, hyperthyroidism, coronary heart disease, congestive heart failure, cardiac arrhythmias, hypertension, and renal disease. Investigate any tachycardia before giving any anticholinergic drug since they may increase the heart rate. Use with caution in patients with hiatal hernia associated with reflux esophagitis.

Carcinogenesis, Mutagenesis, Impairment of Fertility

No long-term studies in animals have been performed to determine the carcinogenic, mutagenic or impairment of fertility potential of Levsin® (hyoscyamine) ; however, 40 years of marketing experience with hyoscyamine sulfate shows no demonstrable evidence of a problem.

Pregnancy–Pregnancy Category C

Animal reproduction studies have not been conducted with Levsin® (hyoscyamine) . It is also not known whether Levsin® (hyoscyamine) can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Levsin® (hyoscyamine) should be given to a pregnant woman only if clearly needed.

Nursing Mothers

Levsin® (hyoscyamine) is excreted in human milk. Caution should be exercised when Levsin® (hyoscyamine) is administered to a nursing woman.

Geriatric Use

Reported clinical experience has not identified differences in safety between patients aged 65 and over and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.

This drug is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function.

Overdose Information for Levsin

The signs and symptoms of overdose are headache, nausea, vomiting, blurred vision, dilated pupils, hot dry skin, dizziness, dryness of the mouth, difficulty in swallowing, and CNS stimulation.

Measures to be taken are immediate lavage of the stomach and injection of physostigmine 0.5 to 2 mg intravenously and repeated as necessary up to a total of 5 mg. Fever may be treated symptomatically (tepid water sponge baths, hypothermic blanket). Excitement to a degree which demands attention may be managed with sodium thiopental 2% solution given slowly intravenously or chloral hydrate (100-200 mL of a 2% solution) by rectal infusion. In the event of progression of the curare-like effect to paralysis of the respiratory muscles, artificial respiration should be instituted and maintained until effective respiratory action returns.

In rats, the LD50 for hyoscyamine is 375 mg/kg. Levsin® (hyoscyamine) is dialyzable.

Contraindications for Levsin

Glaucoma; obstructive uropathy (for example, bladder neck obstruction due to prostatic hypertrophy); obstructive disease of the gastrointestinal tract (as in achalasia, pyloroduodenal stenosis); paralytic ileus, intestinal atony of elderly or debilitated patients; unstable cardiovascular status in acute hemorrhage; severe ulcerative colitis; toxic megacolon complicating ulcerative colitis; myasthenia gravis.

Clinical Pharmacology for Levsin

Levsin® (hyoscyamine) inhibits specifically the actions of acetylcholine on structures innervated by postganglionic cholinergic nerves and on smooth muscles that respond to acetylcholine but lack cholinergic innervation. These peripheral cholinergic receptors are present in the autonomic effector cells of the smooth muscle, cardiac muscle, the sinoatrial node, the atrioventricular node, and the exocrine glands. At therapeutic doses, it is completely devoid of any action on autonomic ganglia. Levsin® (hyoscyamine) inhibits gastrointestinal propulsive motility and decreases gastric acid secretion. Levsin® (hyoscyamine) also controls excessive pharyngeal, tracheal and bronchial secretions.

Levsin® (hyoscyamine) is absorbed totally and completely by sublingual administration as well as oral administration. Once absorbed, Levsin® (hyoscyamine) disappears rapidly from the blood and is distributed throughout the entire body. The half-life of Levsin® (hyoscyamine) is 2 to 3½ hours. Levsin® (hyoscyamine) is partly hydrolyzed to tropic acid and tropine but the majority of the drug is excreted in the urine unchanged within the first 12 hours. Only traces of this drug are found in breast milk. Levsin® (hyoscyamine) passes the blood brain barrier and the placental barrier.

Patient Information for Levsin

Like other anticholinergic agents, Levsin® (hyoscyamine) may produce drowsiness, dizziness, or blurred vision. In this event, the patient should be warned not to engage in activities requiring mental alertness such as operating a motor vehicle or other machinery or to perform hazardous work while taking this drug.

Use of Levsin® (hyoscyamine) may decrease sweating resulting in heat prostration, fever or heat stroke; febrile patients or those who may be exposed to elevated environmental temperatures should use caution.

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