HyoscyamineHyoscyamine Sulfate

About Hyoscyamine

Hyoscyamine blocks acetylcholine, the nerve signal that makes the smooth muscle of the gut and bladder contract and the stomach secrete. Its labels list many uses, among them irritable bowel syndrome and other functional bowel problems, bladder spasm, an add-on to peptic ulcer treatment and, for the drops and elixir, infant colic; none of these uses is FDA-approved. For people 12 and older, the 0.125 mg tablets and under-the-tongue tablets are taken one or two at a time every four hours or as needed, up to 12 in 24 hours; children aged 2 to under 12 take half to one tablet, up to 6 in 24 hours, and drops for babies are dosed by weight. The 0.375 mg extended-release tablets are taken one or two every 12 hours, up to four in 24 hours, and are not recommended under age 12.

There is no boxed warning. It is not used with glaucoma, a blocked urinary or digestive tract, paralytic ileus, a slack bowel in older or frail people, severe ulcerative colitis, toxic megacolon, myasthenia gravis or unstable heart and circulation during acute bleeding. It reduces sweating, so heat can bring on fever and heat stroke; it can cause drowsiness, dizziness and blurred vision; and psychosis has occurred in sensitive people, usually clearing within 12 to 48 hours of stopping. Diarrhea can signal a partial bowel blockage, especially after an ileostomy or colostomy, and needs a check. Side effects include dry mouth, trouble passing urine, a fast heartbeat, constipation and, especially in older adults, confusion; it needs caution with heart disease, an irregular heartbeat, high blood pressure, an overactive thyroid, kidney disease or a hiatal hernia with reflux.

The forms are taken differently: regular tablets are swallowed; under-the-tongue tablets can also be swallowed or chewed; orally disintegrating tablets dissolve on the tongue; and extended-release tablets are swallowed whole. The drops (0.125 mg per mL) come in a small bottle with a calibrated dropper, the elixir holds 0.125 mg per 5 mL, and both contain alcohol. Because each company markets its own product without FDA approval, no version has an FDA equivalence rating, and one extended-release label states that it has not been tested for equivalence.

Taking Hyoscyamine

How to take it

The labels say to take it before meals, and antacids, if used, after meals. Swallow regular tablets, and swallow extended-release tablets whole without crushing, chewing or breaking them; under-the-tongue tablets can be dissolved under the tongue, swallowed or chewed, and an orally disintegrating tablet is left to dissolve on the tongue. Measure drops with the dropper that comes with them and the elixir with a dose-measuring device, not a kitchen spoon.

If you miss a dose

If you take it on a schedule, take a missed dose as soon as you can, but skip it if it is almost time for the next one, and do not take two doses at once. If you take it only as needed, stay within the daily limit on your label.

Storage

At room temperature, away from moisture and heat. The labels call for a tight, light-resistant container with a child-resistant closure.

Interactions to know about

Other anticholinergic medicines, amantadine, haloperidol, phenothiazine antipsychotics, MAO inhibitors, tricyclic antidepressants and some antihistamines add to its effects. Antacids can reduce its absorption, and drinking alcohol with it can cause side effects. Do not drive or do hazardous work until you know how it affects you.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Hyoscyamine differs from pharmacy to pharmacy

Hyoscyamine is made and labeled by several companies, each selling its own product without FDA approval. With no FDA equivalence rating, depending on state rules a pharmacy may need the prescriber’s agreement before filling a prescription for one maker’s product with another’s, and a prescription that names a particular brand may have to be ordered in.

Each form has its own set of makers, so a pharmacy may stock one form and not another. When it is taken only as needed, fills are small and the dispensing fee is much of the quote.

Ways to pay less for Hyoscyamine without insurance

• Ask the prescriber to write the prescription as hyoscyamine sulfate in your form and strength rather than a brand name, so the pharmacy can fill it with the version it stocks.
• Compare more than one pharmacy, since each may carry a different maker’s product.
• Ask the prescriber whether an FDA-approved option, such as dicyclomine for irritable bowel syndrome, would suit you.
• If you take it on a fixed schedule every day, ask for a ninety-day supply once the dose is settled.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Hyoscyamine

1. 1.Which company makes my hyoscyamine, and will my refills come from the same one?
2. 2.Is mine the regular, under-the-tongue, dissolving or extended-release form, and how do I take it?
3. 3.Is it safe with my glaucoma, prostate, heart or thyroid condition?
4. 4.What is the most I can take in a day, and what should I watch for in hot weather?

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