Nitroglycerin ER is a single entity coronary vasodilator containing controlled release nitroglycerin that was used for treating angina pectoris chest pain due to lack of oxygen supply to the heart muscle. Hyoscyamine Sulfate ER is an antispasmodic medication that has been used to treat various stomach, intestinal and urinary tract disorders that involve cramps, colic or other painful muscle contractions. While the active ingredients in Nitroglycerin ER and Hyoscyamine Sulfate ER had been in products on the market for many years, the Food and Drug Administration FDA made determinations in the late s that resulted in the drugs being ineligible for reimbursement by government health care programs such as Medicaid.
In addition, the FDA found in that Nitroglycerin ER was less than effective and proposed to withdraw that product from the market. The United States alleges that Ethex misrepresented the regulatory status of both drugs and failed to advise CMS that these unapproved drugs did not qualify for coverage under federal health care programs. Codeine; Promethazine: Moderate Additive anticholinergic effects may be seen when anticholinergics are used concomitantly with phenothiazines, including promethazine.
Crofelemer: Moderate Pharmacodynamic interactions between crofelemer and antimuscarinics are theoretically possible. Crofelemer does not affect GI motility mechanisms, but does have antidiarrheal effects. Patients taking medications that decrease GI motility, such as antimuscarinics, may be at greater risk for serious complications from crofelemer, such as constipation with chronic use. Use caution and monitor GI symptoms during coadministration. Cyclizine: Moderate The anticholinergic effects of sedating H1-blockers may be enhanced when combined with other antimuscarinics.
Cyclobenzaprine: Moderate Depending on the specific agent, additive anticholinergic effects may be seen when drugs with antimuscarinic properties like cyclobenzaprine are used concomitantly with other anticholinergics.
Clinicians should note that additive antimuscarinic effects may be seen not only on GI smooth muscle, but also on bladder function, the CNS, the eye, and temperature regulation. Monitor for effects such as constipation and urinary retention. Additive drowsiness may also occur, depending on the interacting agent. Cyproheptadine: Moderate The anticholinergic effects of sedating H1-blockers may be enhanced when combined with other antimuscarinics.
Dasiglucagon: Major The concomitant use of intravenous glucagon and anticholinergics increases the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. Concomitant use is not recommended. Dexbrompheniramine: Moderate The anticholinergic effects of sedating H1-blockers may be enhanced when combined with other antimuscarinics.
Dexbrompheniramine; Pseudoephedrine: Moderate The anticholinergic effects of sedating H1-blockers may be enhanced when combined with other antimuscarinics. Dexchlorpheniramine: Moderate The anticholinergic effects of sedating H1-blockers may be enhanced when combined with other antimuscarinics. Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine: Moderate The anticholinergic effects of sedating H1-blockers may be enhanced when combined with other antimuscarinics.
Dextromethorphan; Diphenhydramine; Phenylephrine: Moderate The anticholinergic effects of sedating H1-blockers may be enhanced when combined with other antimuscarinics. Dextromethorphan; Quinidine: Major Hyoscyamine may increase the absorption of quinidine by decreasing GI motility and thereby enhancing absorption with possible toxicity. Increased monitoring is advised in patients receiving a combination of these drugs. Routine therapeutic monitoring should be continued when an antimuscarinic agent is prescribed with digoxin until the effects of combined use are known.
Dihydrocodeine; Guaifenesin; Pseudoephedrine: Moderate Monitor patients for signs of urinary retention or reduced gastric motility when dihydrocodeine is used concomitantly with an anticholinergic drug. Dimenhydrinate: Moderate The anticholinergic effects of sedating H1-blockers may be enhanced when combined with other antimuscarinics.
Diphenhydramine: Moderate The anticholinergic effects of sedating H1-blockers may be enhanced when combined with other antimuscarinics. Diphenhydramine; Hydrocodone; Phenylephrine: Moderate Monitor patients for signs of urinary retention or reduced gastric motility when hydrocodone is used concomitantly with an anticholinergic drug. Diphenhydramine; Ibuprofen: Moderate The anticholinergic effects of sedating H1-blockers may be enhanced when combined with other antimuscarinics.
Diphenhydramine; Naproxen: Moderate The anticholinergic effects of sedating H1-blockers may be enhanced when combined with other antimuscarinics. Diphenhydramine; Phenylephrine: Moderate The anticholinergic effects of sedating H1-blockers may be enhanced when combined with other antimuscarinics. Diphenoxylate; Atropine: Moderate Diphenoxylate is a synthetic opiate derivative that appears to exert its effect locally and centrally on the smooth mucle cells of the GI tract to inhibit GI motility and slow excess GI propulsion.
Disopyramide: Moderate In addition to its electrophysiologic effects, disopyramide exhibits clinically significant anticholinergic properties. These can be additive with other anticholinergics. Clinicians should be aware that urinary retention, particularly in males, and aggravation of glaucoma are realistic possibilities of using disopyramide with other anticholinergic agents.
Donepezil: Moderate The therapeutic benefits of donepezil, a cholinesterase inhibitor, may be diminished during chronic co-administration with antimuscarinics or medications with potent anticholinergic activity.
When concurrent use is not avoidable, the patient should be monitored for cognitive decline and anticholinergic side effects. Clinicians should generally avoid multiple medications with anticholinergic activity in the patient with dementia. Some of the common selective antimuscarinic drugs for bladder problems, such as oxybutynin, darifenacin, trospium, fesoterodine, tolerodine, or solifenacin , do not routinely cause problems with medications used for dementia, but may cause anticholinergic side effects in some patients.
Atropine may be used to offset bradycardia in cholinesterase inhibitor overdose. Donepezil; Memantine: Moderate The adverse effects of anticholinergics, such as dry mouth, urinary hesitancy or blurred vision may be enhanced with use of memantine; dosage adjustments of the anticholinergic drug may be required when memantine is coadministered.
In addition, preliminary evidence indicates that chronic anticholinergic use in patients with Alzheimer's Disease may possibly have an adverse effect on cognitive function. Therefore, the effectiveness of drugs used in the treatment of Alzheimer's such as memantine, may be adversely affected by chronic antimuscarinic therapy. Moderate The therapeutic benefits of donepezil, a cholinesterase inhibitor, may be diminished during chronic co-administration with antimuscarinics or medications with potent anticholinergic activity.
Doxylamine: Moderate The anticholinergic effects of sedating H1-blockers may be enhanced when combined with other antimuscarinics. Doxylamine; Pyridoxine: Moderate The anticholinergic effects of sedating H1-blockers may be enhanced when combined with other antimuscarinics. Dronabinol: Moderate Use caution if coadministration of dronabinol with anticholinergics is necessary.
Concurrent use of dronabinol, THC with anticholinergics may result in additive drowsiness, hypertension, tachycardia, and possibly cardiotoxicity.
Edrophonium: Major The muscarinic actions of edrophonium chloride can antagonize the antimuscarinic actions of hyoscyamine. Eluxadoline: Major Avoid use of eluxadoline with medications that may cause constipation, such as anticholinergics. Discontinue use of eluxadoline in patients who develop severe constipation lasting more than 4 days.
Erythromycin: Moderate Anticholinergics can antagonize the stimulatory effects of erythromycin on the GI tract when erythromycin is used therapeutically for improving GI motility. Avoid chronic administration of antimuscarinics along with prokinetic agents under most circumstances. Erythromycin; Sulfisoxazole: Moderate Anticholinergics can antagonize the stimulatory effects of erythromycin on the GI tract when erythromycin is used therapeutically for improving GI motility.
Ezogabine: Moderate Caution is advisable during concurrent use of ezogabine and medications that may affect voiding such as anticholinergic agents. Ezogabine has caused urinary retention requiring catheterization in some cases. The anticholinergic effects of antimuscariinic and anticholinergic medications on the urinary tract may be additive. Additive sedation or other CNS effects may also occur.
Fentanyl: Moderate Monitor patients for signs of urinary retention or reduced gastric motility when fentanyl is used concomitantly with an anticholinergic drug. Fluphenazine: Moderate Additive anticholinergic effects may be seen when anticholinergics are used concomitantly with phenothiazines, including fluphenazine.
Fluticasone; Umeclidinium; Vilanterol: Moderate There is the potential for umeclidinium to have additive anticholinergic effects when administered with other anticholinergics or antimuscarinics. Per the manufaturer, avoid concomitant administration of umeclidinium with other anticholinergic medications when possible. Galantamine: Moderate The therapeutic benefits of galantamine, a cholinesterase inhibitor, may be diminished during chronic co-administration with antimuscarinics or medications with potent anticholinergic activity.
Glucagon: Major The concomitant use of intravenous glucagon and anticholinergics increases the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. Glycopyrronium: Moderate Although glycopyrronium is minimally absorbed into the systemic circulation after topical application, there is the potential for glycopyrronium to have additive anticholinergic effects when administered with other antimuscarinics.
Per the manufaturer, avoid concomitant administration of glycopyrronium with other anticholinergic medications. Guaifenesin; Hydrocodone: Moderate Monitor patients for signs of urinary retention or reduced gastric motility when hydrocodone is used concomitantly with an anticholinergic drug.
Guaifenesin; Hydrocodone; Pseudoephedrine: Moderate Monitor patients for signs of urinary retention or reduced gastric motility when hydrocodone is used concomitantly with an anticholinergic drug. Haloperidol: Moderate Additive adverse effects resulting from cholinergic blockade may occur when hyoscyamine is administered concomitantly with haloperidol.
Homatropine; Hydrocodone: Moderate Monitor patients for signs of urinary retention or reduced gastric motility when hydrocodone is used concomitantly with an anticholinergic drug. Hydrocodone: Moderate Monitor patients for signs of urinary retention or reduced gastric motility when hydrocodone is used concomitantly with an anticholinergic drug. Hydrocodone; Ibuprofen: Moderate Monitor patients for signs of urinary retention or reduced gastric motility when hydrocodone is used concomitantly with an anticholinergic drug.
Hydrocodone; Phenylephrine: Moderate Monitor patients for signs of urinary retention or reduced gastric motility when hydrocodone is used concomitantly with an anticholinergic drug.
Hydrocodone; Potassium Guaiacolsulfonate: Moderate Monitor patients for signs of urinary retention or reduced gastric motility when hydrocodone is used concomitantly with an anticholinergic drug. Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine: Moderate Monitor patients for signs of urinary retention or reduced gastric motility when hydrocodone is used concomitantly with an anticholinergic drug.
Hydrocodone; Pseudoephedrine: Moderate Monitor patients for signs of urinary retention or reduced gastric motility when hydrocodone is used concomitantly with an anticholinergic drug. Hydromorphone: Moderate Monitor patients for signs of urinary retention or reduced gastric motility when hydromorphone is used concomitantly with an anticholinergic drug. Hydroxyzine: Moderate The anticholinergic effects of sedating H1-blockers may be enhanced when combined with other antimuscarinics. Ibuprofen; Oxycodone: Moderate Monitor patients for signs of urinary retention or reduced gastric motility when oxycodone is used concomitantly with an anticholinergic drug.
Ipratropium: Moderate Although ipratropium is minimally absorbed into the systemic circulation after inhalation, there is the potential for additive anticholinergic effects when administered with other antimuscarinic or anticholinergic medications. Per the manufacturer, avoid coadministration.
Ipratropium; Albuterol: Moderate Although ipratropium is minimally absorbed into the systemic circulation after inhalation, there is the potential for additive anticholinergic effects when administered with other antimuscarinic or anticholinergic medications.
Itraconazole: Moderate Antimuscarinics can raise intragastric pH. This effect may decrease the oral bioavailability of itraconazole; antimuscarinics should be used cautiously in patients receiving itraconazole.
Levodopa: Minor Through its central antimuscarinic actions, hyoscyamine can potentiate the dopaminergic effects of levodopa. Levorphanol: Moderate Monitor patients for signs of urinary retention or reduced gastric motility when levorphanol is used concomitantly with an anticholinergic drug. Linaclotide: Moderate Anticholinergics can promote constipation and pharmacodynamically oppose the action of drugs used for the treatment of constipation or constipation-associated irritable bowel syndrome, such as linaclotide.
Loperamide: Moderate Loperamide decreases GI motility. Agents that inhibit intestinal motility or prolong intestinal transit time have been reported to induce toxic megacolon. Other drugs that also decrease GI motility may produce additive effects with loperamide if used concomitantly.
These include therapeutic doses of common systemic antimuscarinics e. Loxapine: Moderate Loxapine has anticholinergic activity. The concomitant use of loxapine and other anticholinergic drugs can increase the risk of anticholinergic adverse reactions including exacerbation of glaucoma, constipation, and urinary retention.
Lubiprostone: Moderate Antimuscarinic drugs can promote constipation and pharmacodynamically oppose the action of drugs used for the treatment of constipation, such as lubiprostone. The clinical significance of these potential interactions is uncertain. Lurasidone: Moderate Antipsychotic agents may disrupt core temperature regulation; therefore, caution is recommended during concurrent use of lurasidone and medications with anticholinergic activity such as antimuscarinics.
Concurrent use of lurasidone and medications with anticholinergic activity may contribute to heat-related disorders. Monitor patients for heat intolerance, decreased sweating, or increased body temperature if lurasidone is used with antimuscarinics. Macimorelin: Major Avoid use of macimorelin with drugs that may blunt the growth hormone response to macimorelin, such as antimuscarinic anticholinergic agents.
Healthcare providers are advised to discontinue anticholinergics at least 1 week before administering macimorelin. Use of these medications together may impact the accuracy of the macimorelin growth hormone test. Magnesium Hydroxide: Moderate Antacids may inhibit the oral absorption of anticholinergics. Maprotiline: Moderate Additive anticholinergic effects may be seen when hyoscyamine is used concomitantly with other drugs with moderate to significant anticholinergic effects including maprotiline.
Meclizine: Moderate The anticholinergic effects of sedating H1-blockers may be enhanced when combined with other antimuscarinics. Memantine: Moderate The adverse effects of anticholinergics, such as dry mouth, urinary hesitancy or blurred vision may be enhanced with use of memantine; dosage adjustments of the anticholinergic drug may be required when memantine is coadministered. Meperidine: Moderate Monitor patients for signs of urinary retention or reduced gastric motility when meperidine is used concomitantly with an anticholinergic drug.
Meperidine; Promethazine: Moderate Additive anticholinergic effects may be seen when anticholinergics are used concomitantly with phenothiazines, including promethazine. Moderate Monitor patients for signs of urinary retention or reduced gastric motility when meperidine is used concomitantly with an anticholinergic drug. Methadone: Moderate Monitor patients for signs of urinary retention or reduced gastric motility when methadone is used concomitantly with an anticholinergic drug.
Metoclopramide: Moderate Drugs with significant antimuscarinic activity, such as anticholinergics and antimuscarinics, may slow GI motility and thus may reduce the prokinetic actions of metoclopramide. Monitor patients for an increase in gastrointestinal complaints, such as reflux or constipation. Additive drowsiness may occur as well. The clinical significance is uncertain.
Mirtazapine: Moderate Mirtazapine exhibits weak anticholinergic activity that is not expected to be clinically significant. However, the anticholinergic effects may be additive to the antimuscarinics. Molindone: Moderate Antipsychotics are associated with anticholinergic effects; therefore, additive effects may be seen during concurrent use of molindone and other drugs having anticholinergic activity such as antimuscarinics.
Additive drowsiness or other CNS effects may also occur. Morphine: Moderate Monitor patients for signs of urinary retention or reduced gastric motility when morphine is used concomitantly with an anticholinergic drug. Morphine; Naltrexone: Moderate Monitor patients for signs of urinary retention or reduced gastric motility when morphine is used concomitantly with an anticholinergic drug. Nabilone: Moderate Concurrent use of nabilone with anticholinergics may result in pronounced tachycardia and drowsiness.
Nalbuphine: Moderate Monitor patients for signs of urinary retention or reduced gastric motility when nalbuphine is used concomitantly with an anticholinergic drug. Neostigmine: Major The muscarinic actions of neostigmine can antagonize the antimuscarinic actions of hyoscyamine. Nitrofurantoin: Moderate Antimuscarinics can delay gastric emptying, possibly increasing the bioavailability of nitrofurantoin. Olanzapine: Moderate Additive anticholinergic effects may be seen when olanzapine and anticholinergics are used concomitantly; use with caution.
Use of olanzapine and other drugs with anticholinergic activity can increase the risk for severe gastrointestinal adverse reactions related to hypomotility. Olanzapine exhibits anticholinergic activity. Olanzapine; Fluoxetine: Moderate Additive anticholinergic effects may be seen when olanzapine and anticholinergics are used concomitantly; use with caution.
Olanzapine; Samidorphan: Moderate Additive anticholinergic effects may be seen when olanzapine and anticholinergics are used concomitantly; use with caution.
Oliceridine: Moderate Monitor patients for signs of urinary retention or reduced gastric motility when oliceridine is used with hyoscyamine. Omeprazole; Sodium Bicarbonate: Moderate Antacids may inhibit the oral absorption of antimuscarinics.
Orphenadrine: Moderate Additive anticholinergic effects may be seen when hyoscyamine is used concomitantly with other drugs with moderate to significant anticholinergic effects including orphenadrine.
Oxycodone: Moderate Monitor patients for signs of urinary retention or reduced gastric motility when oxycodone is used concomitantly with an anticholinergic drug. Oxymorphone: Moderate Monitor patients for signs of urinary retention or reduced gastric motility when oxymorphone is used concomitantly with an anticholinergic drug.
Paroxetine: Moderate Of the selective serotonin reuptake inhibiting antidepressants SSRIs , paroxetine is considered the most anticholinergic. Additive anticholinergic effects may be seen when paroxetine is used concomitantly with anticholinergic agents. Additive drowsiness may also occur, depending on the specific anticholinergic used.
Pentazocine: Moderate Monitor patients for signs of urinary retention or reduced gastric motility when pentazocine is used concomitantly with an anticholinergic drug. Pentazocine; Naloxone: Moderate Monitor patients for signs of urinary retention or reduced gastric motility when pentazocine is used concomitantly with an anticholinergic drug. Perphenazine: Moderate Additive anticholinergic effects may be seen when anticholinergics are used concomitantly with phenothiazines, including perphenazine.
Perphenazine; Amitriptyline: Moderate Additive anticholinergic effects may be seen when anticholinergics are used concomitantly with phenothiazines, including perphenazine. Phentermine; Topiramate: Moderate Use caution if carbonic anhydrase inhibitors are administered with anticholinergics and monitor for excessive anticholinergic adverse effects.
Physostigmine: Major The muscarinic actions of physostigmine can antagonize the antimuscarinic actions of hyoscyamine. Potassium: Major Drugs that decrease GI motility may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts.
The use of solid oral dosage forms of potassium chloride is contraindicated in patients taking glycopyrrolate oral solution. In one study, healthy subjects were examined for GI irritation following the administration of oral potassium for at least 7 days.
Glycopyrrolate was coadministered to some subjects in order to study the additional effects of delayed gastric emptying. Therefore, if oral potassium supplementation is necessary in a patient taking antimuscarinics, a liquid formulation should be considered. If a solid formulation is being prescribed, the patient should be counseled on strategies that can be used to avoid GI irritation such as taking potassium products only while seated or standing, remaining upright for 10 minutes after each dose, and ingesting each dose with plenty of fluids.
Pramlintide: Major Pramlintide therapy should not be considered in patients taking medications that alter gastric motility, such as anticholinergics. Pramlintide slows gastric emptying and the rate of nutrient delivery to the small intestine. Medications that have depressive effects on GI could potentiate the actions of pramlintide. Procainamide: Moderate The anticholinergic effects of procainamide may be significant and may be enhanced when combined with anticholinergics.
Anticholinergic agents administered concurrently with procainamide may produce additive antivagal effects on AV nodal conduction, although this is not as well documented for procainamide as for quinidine.
Prochlorperazine: Moderate Additive anticholinergic effects may be seen when anticholinergics are used concomitantly with phenothiazines, including prochlorperazine. Promethazine: Moderate Additive anticholinergic effects may be seen when anticholinergics are used concomitantly with phenothiazines, including promethazine. Promethazine; Dextromethorphan: Moderate Additive anticholinergic effects may be seen when anticholinergics are used concomitantly with phenothiazines, including promethazine.
Promethazine; Phenylephrine: Moderate Additive anticholinergic effects may be seen when anticholinergics are used concomitantly with phenothiazines, including promethazine.
Proton pump inhibitors: Moderate The American College of Gastroenterology states that the effectiveness of proton pump inhibitors PPIs may be theoretically decreased if given with other antisecretory agents e. Pseudoephedrine; Triprolidine: Moderate The anticholinergic effects of sedating H1-blockers may be enhanced when combined with other antimuscarinics. Pyridostigmine: Major The muscarinic actions of pyridostigmine can antagonize the antimuscarinic actions of hyoscyamine.
Pyrilamine: Moderate The anticholinergic effects of sedating H1-blockers may be enhanced when combined with other antimuscarinics. Quetiapine: Moderate When administering systemic anticholinergics and quetiapine together, monitor for additive anticholinergic effects such as constipation, blurred vision, urinary retention, xerostomia, and tachycardia.
Constipation is a commonly reported adverse effect of quetiapine and anticholinergic agents. Constipation in some cases may lead to ileus. Intestinal obstruction has been reported with quetiapine, including fatal cases in patients who were receiving multiple concomitant medications that decrease intestinal motility.
Anticholinergic effects observed during therapeutic use of quetiapine are thought to be associated with norquetiapine, the active metabolite of quetiapine which has demonstrated a moderate to strong in vitro affinity for several muscarinic receptor subtypes.
Quinidine: Major Hyoscyamine may increase the absorption of quinidine by decreasing GI motility and thereby enhancing absorption with possible toxicity. Additive anticholinergic effects may be seen when MAOIs are used concomitantly with antimuscarinics. Remifentanil: Moderate Monitor patients for signs of urinary retention or reduced gastric motility when remifentanil is used concomitantly with an anticholinergic drug.
Revefenacin: Moderate Although revefenacin is minimally absorbed into the systemic circulation after inhalation, there is the potential for additive anticholinergic effects when administered with other antimuscarinics. Avoid concomitant administration with other anticholinergic and antimucarinic medications. Supportive therapy is given as needed, including artificial respiration if required.
Physostigmine may be given by intravenous injection to reverse severe anticholinergic symptoms. Hyoscyamine sulfate is dialyzable. Chronic Overdose There is limited information regarding Chronic Overdose of Hyoscyamine in the drug label.
Pharmacology Hyoscyamine. Category : Drug. Cookies help us deliver our services. By using our services, you agree to our use of cookies. Namespaces Home Page Discussion. Views Read View source View history Help. Adverse Reactions. Drug Interactions.
Use in Specific Populations. Clinical Studies. How Supplied. Patient Counseling Information. Precautions with Alcohol. Brand Names. Look-Alike Names. CAS number. ATC code. A03 BA
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