Before Using This Medicine
In deciding to use a medicine, the risks of taking the
medicine must be weighed against the good it will do. This is
a decision you and your doctor will make. For anticholinergics/antispasmodics
the following should be considered:
Allergies—Tell your doctor if you have ever had any unusual
or allergic reaction to any of the natural belladonna
alkaloids (atropine, belladonna, hyoscyamine, and
scopolamine), or any related products. Also, tell your health
care professional if you are allergic to any other substances,
such as foods, preservatives, or dyes.
Pregnancy—If you are pregnant or if you may become
pregnant, make sure your doctor knows if your medicine
contains any of the following:
* Atropine—Atropine has not been shown to cause birth
defects or other problems in animals. However, when injected
into humans during pregnancy, atropine has been reported to
increase the heartbeat of the fetus.
* Belladonna—Studies on effects in pregnancy have not been
done in either humans or animals.
* Clidinium—Clidinium has not been studied in pregnant women.
However, clidinium has not been shown to cause birth defects
or other problems in animal studies.
* Dicyclomine—Dicyclomine has been associated with a few cases
of human birth defects but dicyclomine has not been confirmed
as the cause.
* Glycopyrrolate—Glycopyrrolate has not been studied in
pregnant women. However, glycopyrrolate did not cause birth
defects in animal studies, but did decrease the chance of
becoming pregnant and the newborn's chance of surviving after
weaning.
* Hyoscyamine—Studies on effects in pregnancy have not been
done in either humans or animals. However, when injected into
humans during pregnancy, hyoscyamine has been reported to
increase the heartbeat of the fetus.
* Mepenzolate—Mepenzolate has not been studied in pregnant
women. However, studies in animals have not shown that
mepenzolate causes birth defects or other problems.
* Propantheline—Studies on effects in pregnancy have not been
done in either humans or animals.
* Scopolamine—Studies on effects in pregnancy have not been
done in either humans or animals.
Breast-feeding—Although these medicines may pass into the
breast milk, they have not been reported to cause problems in
nursing babies. However, the flow of breast milk may be
reduced in some patients. The use of dicyclomine in nursing
mothers has been reported to cause breathing problems in
infants.
Children—Unusual excitement, nervousness, restlessness, or
irritability and unusual warmth, dryness, and flushing of skin
are more likely to occur in children, who are usually more
sensitive to the effects of anticholinergics. Also, when
anticholinergics are given to children during hot weather, a
rapid increase in body temperature may occur. In infants and
children, especially those with spastic paralysis or brain
damage, this medicine may be more likely to cause severe side
effects. Shortness of breath or difficulty in breathing has
occurred in children taking dicyclomine.
Older adults—Confusion or memory loss; constipation;
difficult urination; drowsiness; dryness of mouth, nose,
throat, or skin; and unusual excitement, nervousness,
restlessness, or irritability may be more likely to occur in
the elderly, who are usually more sensitive than younger
adults to the effects of anticholinergics. Also, eye pain may
occur, which may be a sign of glaucoma.
Other medicines—Although certain medicines should not be
used together at all, in other cases two different medicines
may be used together even if an interaction might occur. In
these cases, your doctor may want to change the dose, or other
precautions may be necessary. When you are taking
anticholinergics/antispasmodics, it is especially important
that your health care professional know if you are taking any
of the following:
* Antacids or
* Diarrhea medicine containing kaolin or attapulgite or
* Ketoconazole (e.g., Nizoral)—Using these medicines with an
anticholinergic may lessen the effects of the anticholinergic
* Central nervous system (CNS) depressants (medicines that
cause drowsiness)—Taking scopolamine with CNS depressants may
increase the effects of either medicine
* Other anticholinergics (medicine for abdominal or stomach
spasms or cramps) or
* Tricyclic antidepressants (amitriptyline [e.g., Elavil],
amoxapine [e.g., Asendin], clomipramine [e.g., Anafranil],
desipramine [e.g., Pertofrane], doxepin [e.g., Sinequan],
imipramine [e.g., Tofranil], nortriptyline [e.g., Aventyl],
protriptyline [e.g., Vivactil], trimipramine [e.g., Surmontil])—Taking
anticholinergics with tricyclic antidepressants or other
anticholinergics may cause an increase in the effects of the
anticholinergic
* Potassium chloride (e.g., Kay Ciel)—Using this medicine
with an anticholinergic may make gastrointestinal problems
caused by potassium worse
Other medical problems—The presence of other medical
problems may affect the use of anticholinergics/antispasmodics.
Make sure you tell your doctor if you have any other medical
problems, especially:
* Bleeding problems (severe)—These medicines may increase
heart rate, which would make bleeding problems worse
* Brain damage (in children)—May increase the CNS effects
of this medicine
* Colitis (severe) or
* Dryness of mouth (severe and continuing) or
* Enlarged prostate or
* Fever or
* Glaucoma or
* Heart disease or
* Hernia (hiatal) or
* High blood pressure (hypertension) or
* Intestinal blockage or other intestinal problems or
* Lung disease (chronic) or
* Myasthenia gravis or
* Toxemia of pregnancy or
* Urinary tract blockage or difficult urination—These
medicines may make these conditions worse
* Down's syndrome—These medicines may cause an increase in
pupil dilation and heart rate
* Kidney disease or
* Liver disease—Higher blood levels may occur and cause an
increase in side effects
* Overactive thyroid—These medicines may further increase
heart rate
* Spastic paralysis (in children)—This condition may
increase the effects of the anticholinergic
Proper Use of This Medicine
Take this medicine only as directed. Do not take more of
it, do not take it more often, and do not take it for a longer
time than your doctor ordered. To do so may increase the
chance of side effects.
Dosing—
The dose of the anticholinergic/antispasmodic will be
different for different patients. Follow your doctor's orders
or the directions on the label. The following information
includes only the average doses of your medicine. If your dose
is different, do not change it unless your doctor tells you to
do so.
The number of capsules or tablets or teaspoonfuls of
solution or syrup that you take depends on the strength of the
medicine. Also, the number of doses you take each day, the
time allowed between doses, and the length of time you take
the medicine depends on the medical problem for which you are
taking this medicine.
* For anisotropine For oral dosage forms (tablets):
o To treat duodenal or stomach ulcers:
+ Older adults, adults, and teenagers—50 milligrams (mg) three
times a day. Your doctor may change the dose if needed.
+ Children—Dose must be determined by your doctor.
* For atropine For oral dosage form (tablets):
o To treat duodenal or stomach ulcers, intestine problems, or
urinary problems:
+ Older adults, adults, and teenagers—300 to 1200 micrograms
(mcg) every four to six hours.
+ Children—Dose is based on body weight. The usual dose is 10
mcg per kilogram (kg) (4.5 mcg per pound) of body weight every
four to six hours. However, the dose will not be more than 400
mcg every four to six hours.
* For injectable dosage form:
o To treat duodenal or stomach ulcers or intestine problems:
+ Older adults, adults, and teenagers—400 to 600 mcg injected
into a muscle, vein, or under the skin every four to six
hours.
+ Children—The dose is based on body weight. The usual dose is
10 mcg per kilogram (kg) (4.5 mcg per pound) of body weight
injected under the skin every four to six hours. However, the
dose will not be more than 400 mcg every four to six hours.
o To treat heart problems:
+ Older adults, adults, and teenagers—400 to 1000 mcg injected
into a vein every one to two hours as needed. The total dose
will not be more than 2 mg.
+ Children—The dose is based on body weight. The usual dose is
10 to 30 mcg per kilogram (kg) (4.5 to 13.6 mcg per pound) of
body weight injected under the skin.
* For belladonna For oral dosage form (oral solution):
o To treat duodenal or stomach ulcers or intestine problems:
+ Older adults, adults, and teenagers—180 to 300 micrograms
(mcg) three or four times a day. The dose should be taken 30
to 60 minutes before meals and at bedtime. Your doctor may
change the dose if needed.
+ Children—The dose is based on body weight. The usual dose is
9 mcg per kilogram (kg) (4 mcg per pound) of body weight three
or four times a day.
* For clidinium For oral dosage form (capsules):
o To treat duodenal or stomach ulcers:
+ Older adults, adults, and teenagers—2.5 to 5 milligrams (mg)
three or four times a day. The dose should be taken before
meals and at bedtime. Your doctor may change the dose if
needed.
+ Children—Dose must be determined by your doctor.
* For dicyclomine For oral dosage forms (capsules,
extended-release tablets, syrup, tablets):
o To treat intestine problems:
+ Older adults, adults, and teenagers—10 to 20 milligrams (mg)
three or four times a day. Some people may take 30 mg two
times a day. Your doctor may change the dose if needed. Your
dose will not be more than 160 mg a day.
+ Children 2 years of age and older—5 to 10 mg three or four
times a day. Your doctor may change the dose if needed.
+ Children 6 months to 2 years of age—5 to 10 mg of the syrup
three or four times a day. Your doctor may change the dose if
needed.
+ Children up to 6 months of age—Use is not recommended.
* For injectable dosage form:
o To treat intestine problems:
+ Older adults, adults, and teenagers—20 mg injected into a
muscle every four to six hours. Your doctor may change the
dose if needed.
+ Children—Dose must be determined by your doctor.
* For glycopyrrolate For oral dosage form (tablets):
o To treat duodenal or stomach ulcers:
+ Older adults, adults, and teenagers—To start, 1 to 2
milligrams (mg) two or three times a day. Some people may also
take 2 mg at bedtime. Your doctor may change the dose if
needed. However, your dose will not be more than 8 mg a day.
+ Children—Dose must be determined by your doctor.
* For injectable dosage form:
o To treat duodenal or stomach ulcers:
+ Older adults, adults, and teenagers—100 to 200 micrograms
(mcg) injected into a muscle or vein. The dose may be repeated
every four hours up to four times a day.
+ Children—Dose must be determined by your doctor.
* For homatropine For oral dosage form:
o To treat duodenal or stomach ulcers:
+ Older adults, adults, and teenagers—5 to 10 milligrams (mg)
three or four times a day. Your doctor may change the dose if
needed.
+ Children—Dose must be determined by your doctor.
* For hyoscyamine For oral dosage forms (capsules, elixir,
oral solution, tablets):
o To treat duodenal or stomach ulcers, intestine problems, or
urinary problems:
+ Older adults, adults, and teenagers—125 to 500 micrograms
(mcg) four to six times a day. Some people may take 375 mcg
two times a day. The tablets should be taken 30 to 60 minutes
before meals. Your doctor may change the dose if needed.
+ Children—Dose is based on body weight. The usual dose is
12.5 to 187 mcg every four hours if needed.
* For injectable dosage form:
o To treat duodenal or stomach ulcers or intestine problems:
+ Older adults, adults, and teenagers—250 to 500 mcg injected
into a muscle, vein, or under the skin every four to six
hours.
+ Children—Dose must be determined by your doctor.
* For mepenzolate For oral dosage form (tablets):
o To treat duodenal or stomach ulcers or intestine problems:
+ Older adults, adults, and teenagers—25 to 50 milligrams (mg)
four times a day, with meals and at bedtime. Your doctor may
change the dose if needed.
+ Children—Dose must be determined by your doctor.
* For methantheline For oral dosage form (tablets):
o To treat intestine or stomach ulcers, intestine problems, or
urinary problems:
+ Older adults, adults, and teenagers—50 to 100 milligrams
(mg) every six hours. Your doctor may change the dose if
needed.
+ Children 1 year of age and older—12.5 to 50 mg four times a
day. Your doctor may change the dose if needed.
+ Children 1 month to 1 year of age—12.5 mg four times a day.
Your doctor may change the dose if needed.
+ Children up to 1 month of age—12.5 mg two times a day. Your
doctor may change the dose if needed.
* For methscopolamine For oral dosage form (tablets):
o To treat duodenal or stomach ulcers or intestine problems:
+ Older adults, adults, and teenagers—2.5 to 5 milligrams (mg)
four times a day, one-half hour before meals and at bedtime.
Your doctor may change the dose if needed.
+ Children—Dose is based on body weight. The usual dose is 200
micrograms (mcg) per kilogram (kg) (90.9 mcg per pound) of
body weight four times a day. The dose should be taken before
meals and at bedtime.
* For pirenzepine For oral dosage form (tablets):
o To treat duodenal or stomach ulcers or intestine problems:
+ Older adults, adults, and teenagers—50 milligrams (mg) two
times a day, in the morning and at bedtime. Your doctor may
change the dose if needed.
+ Children—Dose must be determined by your doctor.
* For propantheline For oral dosage form (tablets):
o To treat duodenal or stomach ulcers:
+ Older adults, adults, and teenagers—7.5 to 15 milligrams
(mg) three times a day, one-half hour before meals, and 30 mg
at bedtime. Your doctor may change the dose if needed.
+ Children—Dose is based on body weight. The usual dose is 375
micrograms (mcg) per kilogram (kg) (170 mcg per pound) of body
weight four times a day. Your doctor may change the dose if
needed.
* For scopolamine For oral dosage form (tablets):
o To treat urinary problems or intestine problems or painful
menstruation:
+ Older adults, adults, and teenagers—10 to 20 milligrams (mg)
three or four times a day. Your doctor may change the dose if
needed.
+ Children—Dose must be determined by your doctor.
* For injectable dosage form:
o To treat urinary problems or intestine problems:
+ Older adults, adults, and teenagers—10 to 20 mg three or
four times a day. Your doctor may change the dose if needed.
+ Children—Dose must be determined by your doctor.
* For rectal dosage form (suppository):
o To treat urinary problems or intestine problems or painful
menstruation:
+ Older adults, adults, and teenagers—Insert one 10 mg
suppository rectally three or four times a day. Your doctor
may change the dose if needed.
+ Children—Dose must be determined by your doctor.
* For transdermal dosage form (patch):
o To treat motion sickness:
+ Older adults, adults, and teenagers—Apply one 1.0 milligram
(mg) patch behind ear at least four hours before antinausea
effect is needed.
+ Children—Use is not recommended.
o To treat nausea and vomiting after surgery
+ Older adults, adults and teenagers—Apply one 1.0 mg patch
behind the ear the evening before surgery to prevent nausea
and vomiting after surgery
+ Children—Use is not recommended.
Missed dose—
If you miss a dose of this medicine, take it as soon as
possible. However, if it is almost time for your next dose,
skip the missed dose and go back to your regular dosing
schedule. Do not double doses.
For patients taking any of these medicines by mouth :
* Take this medicine 30 minutes to 1 hour before meals
unless otherwise directed by your doctor.
To use the rectal suppository form of scopolamine:
* If the suppository is too soft to insert, chill it in the
refrigerator for 30 minutes or run cold water over it before
removing the foil wrapper.
* To insert the suppository: First remove the foil wrapper and
moisten the suppository with cold water. Lie down on your side
and use your finger to push the suppository well up into the
rectum.
To use the transdermal disk form of scopolamine:
* This medicine usually comes with patient directions. Read
them carefully before using this medicine.
* Wash and dry your hands thoroughly before and after
handling.
* Apply the disk to the hairless area of skin behind the ear.
Do not place over any cuts or irritations.
Storage—
To store this medicine:
* Keep out of the reach of children. Overdose is especially
dangerous in young children.
* Store away from heat and direct light.
* Do not store the capsule or tablet form of this medicine in
the bathroom, near the kitchen sink, or in other damp places.
Heat or moisture may cause the medicine to break down.
* Keep the liquid form of this medicine tightly closed and
keep it from freezing. Do not refrigerate the syrup form of
this medicine.
* Do not keep outdated medicine or medicine no longer needed.
Be sure that any discarded medicine is out of the reach of
children.
Precautions While Using This Medicine
If you think you or someone else may have taken an
overdose, get emergency help at once. Taking an overdose of
any of the belladonna alkaloids or taking scopolamine with
alcohol or other CNS depressants may lead to unconsciousness
and possibly death. Some signs of overdose are clumsiness or
unsteadiness; dizziness; severe drowsiness; fever;
hallucinations (seeing, hearing, or feeling things that are
not there); confusion; shortness of breath or troubled
breathing; slurred speech; unusual excitement, nervousness,
restlessness, or irritability; fast heartbeat; and unusual
warmth, dryness, and flushing of skin.
These medicines may make you sweat less, causing your body
temperature to increase. Use extra care not to become
overheated during exercise or hot weather while you are taking
this medicine, since overheating may result in heat stroke.
Also, hot baths or saunas may make you dizzy or faint while
you are taking this medicine.
Check with your doctor before you stop using this medicine
. Your doctor may want you to reduce gradually the amount you
are using before stopping completely. Stopping this medicine
may cause withdrawal side effects such as vomiting, sweating,
and dizziness.
Anticholinergics may cause some people to have blurred
vision. Make sure your vision is clear before you drive or do
anything else that could be dangerous if you are not able to
see well. These medicines may also cause your eyes to become
more sensitive to light than they are normally. Wearing
sunglasses may help lessen the discomfort from bright light.
These medicines, especially in high doses, may cause some
people to become dizzy or drowsy. Make sure you know how you
react to this medicine before you drive, use machines, or do
anything else that could be dangerous if you are dizzy or are
not alert.
Dizziness, lightheadedness, or fainting may occur,
especially when you get up from a lying or sitting position.
Getting up slowly may help lessen this problem.
These medicines may cause dryness of the mouth, nose, and
throat. For temporary relief of mouth dryness, use sugarless
candy or gum, melt bits of ice in your mouth, or use a saliva
substitute. However, if your mouth continues to feel dry for
more than 2 weeks, check with your medical doctor or dentist.
Continuing dryness of the mouth may increase the chance of
dental disease, including tooth decay, gum disease, and fungus
infections.
For patients taking scopolamine:
* This medicine will add to the effects of alcohol and
other CNS depressants (medicines that slow down the nervous
system, possibly causing drowsiness). Some examples of CNS
depressants are antihistamines or medicine for hay fever,
other allergies, or colds; sedatives, tranquilizers, or
sleeping medicine; prescription pain medicine or narcotics;
barbiturates; medicine for seizures; muscle relaxants; or
anesthetics, including some dental anesthetics. Check with
your doctor before taking any of the above while you are using
this medicine.
For patients taking any of these medicines by mouth :
* Do not take this medicine within 2 or 3 hours of taking
antacids or medicine for diarrhea. Taking antacids or
antidiarrhea medicines and this medicine too close together
may prevent this medicine from working properly.
Side Effects of This Medicine
Along with its needed effects, a medicine may cause some
unwanted effects. Although not all of these side effects may
occur, if they do occur they may need medical attention.
Check with your doctor as soon as possible if any of the
following side effects occur:
* Rare
o Confusion (especially in the elderly); dizziness,
lightheadedness (continuing), or fainting; eye pain; skin rash
or hives
* Symptoms of overdose
o Blurred vision (continuing) or changes in near vision;
clumsiness or unsteadiness; confusion ; convulsions
(seizures); difficulty in breathing, muscle weakness (severe),
or tiredness (severe); dizziness; drowsiness (severe); dryness
of mouth, nose, or throat (severe); fast heartbeat; fever;
hallucinations (seeing, hearing, or feeling things that are
not there); slurred speech; unusual excitement, nervousness,
restlessness, or irritability; unusual warmth, dryness, and
flushing of skin
Other side effects may occur that usually do not need
medical attention. These side effects may go away during
treatment as your body adjusts to the medicine. However, check
with your doctor if any of the following side effects continue
or are bothersome:
* More common
o Constipation (less common with hyoscyamine); decreased
sweating; dryness of mouth, nose, throat, or skin
* Less common or rare
o Bloated feeling; blurred vision; decreased flow of breast
milk; difficult urination; difficulty in swallowing;
drowsiness (more common with high doses of any of these
medicines and with usual doses of scopolamine when given by
mouth or by injection); false sense of well-being (for
scopolamine only); headache; increased sensitivity of eyes to
light; lightheadedness (with injection); loss of memory;
nausea or vomiting; redness or other signs of irritation at
place of injection; trouble in sleeping (for scopolamine
only); unusual tiredness or weakness
For patients using scopolamine :
* After you stop using scopolamine, your body may need time
to adjust. The length of time this takes depends on the amount
of scopolamine you were using and how long you used it. During
this period of time check with your doctor if you notice any
of the following side effects:
* Anxiety; irritability; nightmares; trouble in sleeping
For patients using the transdermal disk of scopolamine :
* While using the disk or even after removing it, your eyes
may become more sensitive to light than usual. You may also
notice the pupil in one eye is larger than the other. Check
with your doctor if this side effect continues or is
bothersome
Other side effects not listed above may also occur in some
patients. If you notice any other effects, check with your
doctor.
