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Nutritional and Dietary Supplementation during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Hyoscyamine is used to treat spasmodic bowel diseases and asthma. Over 300 women were exposed to hyoscyamine in early pregnancy, and their infants did not have an increased frequency of birth defects (Heinonen et al., 1977). No animal teratology studies have been published on hyoscyamine.
Diagnosing and treating pain
Published in Mervyn Dean, Juan-Diego Harris, Claud Regnard, Jo Hockley, Symptom Relief in Palliative Care, 2018
Mervyn Dean, Juan-Diego Harris, Claud Regnard, Jo Hockley
Smooth muscle spasm causes regular episodes of pain lasting a few minutes. This periodic feature is characteristic of colic, although occasionally colic is continuous. Bowel is the commonest source, followed by bladder and ureter. Bile duct is an unusual source. Opioids are inefective and may worsen the pain. A smooth muscle relaxant (anti-spasmodic) is the treatment of choice. Hyoscine butylbromide (Buscopan) (Canada only) is preferred since it has fewer central effects than hyoscine hydrobromide (known as scopolamine in the US) or glycopyrrolate. In the US use hyoscyamine (Levsin) 0.125–0.25 mg PO/SL tid-qid prn.
Diphenhydramine overdose with neuromuscular excitation
Published in Clinical Toxicology, 2022
Ruby Hoang, Matthew S. Correia, Rachel Castelli
In this report of diphenhydramine overdoses, we observed overt antimuscarinic toxicity and characteristically serotonergic features without a well-established serotonergic medication. Antimuscarinic toxicity with overlapping serotoninergic features has been previously documented in a few case reports of diphenhydramine overdoses [1,2]. However, they are cofounded by concomitant ingestions of tramadol [1] and linezolid [2]. There is another instance of diphenhydramine ingestion mimicking serotonin toxicity with quantitative confirmation of diphenhydramine but could not exclude co-ingestions [3]. Lastly, there was an ambiguous case of mixed anticholinergic and serotonin toxicity in a child taking sertraline and administered hyoscyamine and diphenhydramine [4]. She was hospitalized with agitation, confusion, disorientation, visual hallucinations, dry and flushed skin, and nonsensical speech. She was diagnosed with serotonin toxicity and treated with a midazolam infusion and cyproheptadine. Despite the discontinuation of sertraline, her agitation remained with persistent skin and vision findings. She developed clonus on hospital day 3 that continued until the cessation of hyoscyamine and diphenhydramine.
A randomized trial comparing physostigmine vs lorazepam for treatment of antimuscarinic (anticholinergic) toxidrome
Published in Clinical Toxicology, 2021
George Sam Wang, Keith Baker, Patrick Ng, Gregory C. Janis, Jan Leonard, Rakesh D. Mistry, Kennon Heard
From March 20, 2017 to June 30, 2020, 175 patients presented to our hospital with a xenobiotic ingestion that can potentially result in antimuscarinic toxidrome. We excluded 156 patients and enrolled 19 patients, 9 (47%) to the physostigmine arm and 10 (53%) to the lorazepam arm (Figure 1). There was no significant difference in the demographics or clinical characteristics (vital signs) between the two treatment arms (Table 1). The most common antimuscarinic xenobiotic ingested was diphenhydramine (16, 84%), followed by doxylamine (1, 5%), hyoscyamine (1, 5%), and dicyclomine (1, 5%). All ingestions were confirmed via HPLC-MS/MS, with the exception of hyoscyamine and dicyclomine which were not targets on the expanded urine drug assay. Additional co-ingestants included ibuprofen (4), naproxen (1), sertraline (1), and one ingestion of a combination product containing pseudoephedrine, ephedrine, and phenylpropalanine. Although not significant, the median RASS score was slightly higher in the physostigmine arm (Table 1).
Takotsubo cardiomyopathy and its variants: a case series and literature review
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Syed Mustajab Hasan, Jay D. Patel, Mohammed Faluk, Jigar Patel, Premranjan Singh
A 36-year-old Caucasian gentleman with no past medical history presented to the ED for management of nephrolithiasis. Upon arrival, the patient was given ketorolac and Hyoscyamine immediately after which he developed chest pressure, severe shortness of breath with desaturation to 83% on RA, hypertensive emergency with BP of 188/122, sinus tachycardia with HR as high as 130 bpm. At this time, CT chest with contrast was performed which showed left ventricular dilatation and bilateral airspace disease representing pulmonary edema. EKG revealed diffuse ST-T wave elevations, which prompted troponins that were peaked at 2.16. A follow-up echocardiogram as seen in Figures 3 and 4 revealed diffuse hypokinesis, RVSP of 45 mmHg and LVEF of 35%. The patient was taken for cardiac catheterization and was found to have no coronary artery disease, however, did have ballooning of the basal myocardium with a hyperdynamic apex; findings consistent with reverse Takotsubo cardiomyopathy. This case illustrates one of the rare cases of reverse Takotsubo cardiomyopathy in the setting of anticholinergic toxicity. Hyoscyamine, which is used as an antispasmodic commonly, results in anticholinergic side effects on the cardiovascular system causing tachycardia which in this case resulted in reverse Takotsubo cardiomyopathy. Clinicians should remain cognizant of the effect of anticholinergic medications, particularly the cardiovascular system as it may result in the aforementioned findings.