Hyoscyamine

While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy.

Related Terms

  • Anaspaz®, Anisodus tanguticus, anticholinergics, Atropa belladonna, atropine, belladonna, bellafolin, Cystospaz®, Cystospaz-M®, Datura stramonium, Datura wrightii, deadly nightshade, Egazil®, epoxide, Gastrosed®, henbane, hydroxyhyoscyamine, hyoscyamine beta-hydroxylase (H6H), hyoscyamine butylbromide, hyoscyamine sulfate, Hyoscyamus niger, Hyoscyamus reticulates, Hyoscyamini sulfas, Hyoscyaminum sulfuricum, iosciamina solfato (Italian), jimson weed, Levbid®, Levsin®, L-hyoscyamine, Mandragora officinarum, mandrake, scopolamine, Solanaceae (family).

  • Combination product examples: Belloid (hyoscyamine sulphate, ergotoxine, butabarbital), Donnatal® (atropine sulfate, hyoscyamine sulfate, phenobarbital, scopolamine hydrobromide), scopolia extract (SE) (hyoscyamine, scopolamine).

  • Note: This monograph does not include atropine. Atropine is a racemic mixture of D- and L-hyoscyamine.

Background

  • Hyoscyamine is a chemical found in certain plants of the Solanaceae family, including henbane (Hyoscyamus niger), mandrake (Mandragora officinarum), and deadly nightshade (Atropa belladonna). High amounts of hyoscyamine are present in the stems and leaves of young jimson weed (Datura stramonium) plants.

  • Extracts of the henbane plant containing hyoscyamine have been used for thousands of years to treat depression. The dried leaves of hyoscyamine-containing plants were smoked for the relief of acute asthma. Jimson weed, which contains high amounts of hyoscyamine, has been commonly used by Native Americans and Native Mexicans as a hallucinogen during various rituals. Hyoscyamine and other belladonna alkaloids were used to treat Parkinson’s disease in the early 1900s.

  • Hyoscyamine has been used to relieve symptoms of various gastrointestinal disorders, including spasms, peptic ulcers, irritable bowel syndrome, pancreatitis, colic, and cystitis.

  • At this time, high-quality human trials supporting the use of hyoscyamine for any indication are lacking. In general, the use of hyoscyamine has been replaced by therapies with fewer adverse effects.

Scientific Evidence

Uses

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Colonoscopy preparation

There is conflicting evidence from available trials to support the use of hyoscyamine to stop colon spasms during colonoscopy. Additional research is needed in this area.

Diagnostic procedure

Some studies have found that hyoscyamine may be of use in certain diagnostic procedures involving the gastrointestinal system. Further research is needed in this area.

Enema (colon surgery preparation)

Hyoscyamine has been taken by mouth to assess its effectiveness in the reduction of abdominal discomfort and colonic spasm during a barium enema. Further research is needed in this area.

Gastrointestinal motility

The ability of hyoscyamine to inhibit intestinal motility during diagnostic procedures has been studied. Further research is needed in this area.

Inflammation

Topical application of Unguentum lymphaticum® (UL) (containing hyoscyamine) may be beneficial in patients with stage II postinflammatory obstructive lymphedema. Additional research is necessary in this area.

Myasthenia gravis

Myasthenia gravis is an autoimmune disorder of the nervous system. In limited research, treatment with hyoscyamine resulted in complete resolution of atrioventricular (AV) heart block. Additional research is needed in this area.

Nocturnal enuresis

Combination therapy using hyoscyamine and desmopressin acetate appears safe for treating nocturnal enuresis (bedwetting) in older children who have had no success with other treatments. Additional research is needed.

Preparation for surgery

Chlorprothixene and intramuscular hyoscyamine given to children before anesthesia may be useful before surgery. Further research is needed in this area.

Ulcers

Several single and combination therapies utilizing hyoscyamine for ulcers have been used. Further research is necessary.

Urinary incontinence

Anticholinergics are commonly used for the treatment of urinary frequency, urgency, and urge incontinence in elderly women. Hyoscyamine has been shown to benefit patients with this condition, but larger studies are necessary to confirm these findings.

Ureteral colic pain

At this time, evidence supporting the use of hyoscyamine for ureteral colic pain is lacking.

*Key to grades:

Tradition

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious and should be evaluated by a qualified health care professional.

  • Anesthesia, antidepressant, antispasmodic (gastric spasm), asthma, bladder disorders, blood disorders (mastocytosis), cystitis, diarrhea, diverticulitis, dysmenorrhea, ears (vestibular dysfunction), hallucinogenic, heart conditions, infantile colic, intestinal disorders, irritable bowel syndrome, motion sickness, nausea and vomiting during pregnancy, pancreatitis, Parkinson’s disease, peptic ulcer disease, renal colic, rhinitis, ulcerative colitis, urinary tract disorders, vertigo.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (18 years and older)

  • It has been reported that the highest tolerable dose of L-hyoscyamine in sustained-release tablets varies from 0.4 to 2.8 milligrams every eight hours.

  • For colonoscopy preparation, two hyoscyamine tablets (0.125 milligrams per tablet) have been placed under the tongue and taken by mouth 10 minutes before sigmoidoscopy. A 0.25 milligram hyoscyamine spray (IB-Stat®, Inkine Pharmaceutical) has been taken by mouth under the tongue 15-30 minutes before colonoscopy. Hyoscyamine (0.25 milligrams) has been taken by mouth 20-40 minutes before colonoscopy. Hyoscyamine sulfate (0.5 milligrams; Levsin®) has been given intravenously before colonoscopy. Hyoscyamine (0.25 milligrams) has also been administered intravenously 20-40 minutes before colonoscopy.

  • For diagnostic procedures, 40 milligrams of hyoscyamine butylbromide has been given intravenously immediately before injection of 160 milliliters of intravenous contrast medium for helical computed tomography (CT) of the pancreas.

  • For enema (colon surgery preparation), a 0.125 milligram L-hyoscyamine sulfate tablet has been placed under the tongue and taken by mouth 15-30 minutes before the examination.

  • For gastrointestinal motility, 0.5 milligrams of L-hyoscyamine has been taken by mouth under the tongue before endoscopic retrograde cholangiopancreatography. Intravenous Levsin® has been given before endoscopic retrograde cholangiopancreatography (information on the dose is lacking).

  • For ulcers, L-hyoscyamine has been taken by mouth in a sustained-release form three times daily for one year at varying doses. In patients with duodenal ulcers, sustained-release L-hyoscyamine was taken by mouth at 2.7 milligrams daily without the appearance of side effects, compared to regular L-hyoscyamine tablets (1.6 milligrams daily).

  • For ureteral colic pain, a single dose of 0.125 milligrams of hyoscyamine sulfate has been placed under the tongue and taken by mouth.

  • For urinary incontinence, 0.375 milligrams of sustained-release hyoscyamine has been taken by mouth twice daily for a minimum of one month.

Children (under 18 years old)

  • There is no proven safe or effective dose of hyoscyamine in children.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

  • Avoid with known allergy or hypersensitivity to hyoscyamine or anticholinergic drugs.

Side Effects and Warnings

  • Patients are advised to drink water often when using hyoscyamine, as it may cause dry mouth.

  • Hyoscyamine may cause fever, flushing, tachycardia (fast heartbeat), agitation, dry mucous membranes, dilated pupils, constipation, and urinary retention. Other possible adverse effects include blurred vision, diarrhea, diminished sweating, drowsiness, flushed dry skin (in infants), headache, impotence, increased tendon reflexes, injection site irritation, irritability (in infants), loss of libido, melena (black, tarry stool), nausea and vomiting, night sweats, respiratory disturbances (including respiratory depression), urinary hesitancy, vaginal dryness, and weakness.

  • Hyoscyamine may cause low or high blood pressure and may increase the risk of adverse effects and altered drug effects. Caution is advised in patients taking drugs, herbs, or supplements that lower blood pressure.

  • Use cautiously in patients using central nervous system (CNS) depressants, as concurrent use of hyoscyamine and CNS depressants may cause additive CNS depressant effects.

  • Use cautiously in patients with hyperthyroidism or mild liver or kidney disease or in the elderly.

  • Avoid in children, as high doses of hyoscyamine have caused gastroesophageal reflux, coma, restlessness, hallucinations, convulsions, involuntary movements, and ataxia, especially in infants.

  • Avoid in patients with liver, kidney, or lung insufficiency.

  • Avoid in patients with 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, unstable cardiovascular status in acute hemorrhage, severe ulcerative colitis or toxic megacolon complicating ulcerative colitis, myasthenia gravis, in debilitated patients, or in pregnant or lactating patients.

  • Avoid with known allergy or hypersensitivity to hyoscyamine or anticholinergic drugs.

Pregnancy and Breastfeeding

  • Hyoscyamine is not recommended in pregnant or breastfeeding patients, due to insufficient available evidence. Scientific information on hyoscyamine’s effects on lactation is currently lacking.

Interactions

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

Interactions with Drugs

  • Hyoscyamine may affect blood pressure. Caution is advised in patients taking medications that also affect blood pressure.

  • Hyoscyamine may also interact with alcohol, aluminum, anticholinergics, anti-inflammatory agents, calcium, central nervous system depressants, cisapride, magnesium, or topiramate.

Interactions with Herbs and Dietary Supplements

  • Hyoscyamine may affect blood pressure. Caution is advised in patients taking herbs or supplements that affect blood pressure.

  • Hyoscyamine may also interact with aluminum, anticholinergic herbs, anti-inflammatory herbs, belladonna, calcium, central nervous system depressants, magnesium, or potassium chloride.

Author Information

  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

References

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

  1. Balikova M. Collective poisoning with hallucinogenous herbal tea. Forensic Sci Int 2002;128(1-2):50-52. View Abstract
  2. Boumba VA, Mitselou A, Vougiouklakis T. Fatal poisoning from ingestion of Datura stramonium seeds. Vet HumToxicol 2004;46(2):81-82. View Abstract
  3. Chaptini LA, Janec EM, Seltzer G, et al. Sublingual hyoscyamine spray as premedication for colonoscopy: a randomized double-blinded placebo-controlled trial. Am J Surg 2008;196(1):51-55. View Abstract
  4. Chew ML, Mulsant BH, Pollock BG, et al. Anticholinergic activity of 107 medications commonly used by older adults. J Am Geriatr Soc 2008;56(7):1333-1341. View Abstract
  5. Church JM. Warm water irrigation for dealing with spasm during colonoscopy: simple, inexpensive, and effective. Gastrointest Endosc 2002;56(5):672-674. View Abstract
  6. D’Souza AO, Smith MJ, Miller LA, et al. Persistence, adherence, and switch rates among extended-release and immediate-release overactive bladder medications in a regional managed care plan. J Manag Care Pharm 2008;14(3):291-301. View Abstract
  7. Foley P. Beans, roots and leaves: a brief history of the pharmacological therapy of parkinsonism. Wurzbg Medizinhist Mitt 2003;22:215-234. View Abstract
  8. Gehi A, Benatar M, Langberg J. Treatment of pyridostigmine-induced AV block with hyoscyamine in a patient with myasthenia gravis. J Cardiovasc Electrophysiol 2008;19(2):214-216. View Abstract
  9. Jones JB, Giles BK, Brizendine EJ, et al. Sublingual hyoscyamine sulfate in combination with ketorolac tromethamine for ureteral colic: a randomized, double-blind, controlled trial. Ann Emerg Med 2001;37(2):141-146. View Abstract
  10. Liu T, Zhu P, Cheng KD, et al. Molecular cloning, expression and characterization of hyoscyamine 6beta-hydroxylase from hairy roots of Anisodus tanguticus. Planta Med 2005;71(3):249-253. View Abstract
  11. Lynch CR, Khandekar S, Lynch SM, et al. Sublingual L-hyoscyamine for duodenal antimotility during ERCP: a prospective randomized double-blinded study. Gastrointest Endosc 2007;66(4):748-752. View Abstract
  12. Marneros A, Gutmann P, Uhlmann F. Self-amputation of penis and tongue after use of Angel’s Trumpet. Eur.Arch.Psychiatry Clin Neurosci 2006;256(7):458-459. View Abstract
  13. Miraldi E, Masti A, Ferri S, et al. Distribution of hyoscyamine and scopolamine in Datura stramonium. Fitoterapia 2001;72(6):644-648. View Abstract
  14. Pavlov A, Berkov S, Weber J, et al. Hyoscyamine biosynthesis in Datura stramonium hairy root in vitro systems with different ploidy levels. Appl Biochem Biotechnol 2009;157(2):210-25. View Abstract
  15. Wang PS, Levin R, Zhao SZ, et al. Urinary antispasmodic use and the risks of ventricular arrhythmia and sudden death in older patients. J Am Geriatr Soc 2002;50(1):117-124. View Abstract

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.