Nulev

Nulev Uses, Dosage, Side Effects, Food Interaction and all others data.

Nulev is a tropane alkaloid and the levo-isomer of atropine. It is commonly extracted from plants in the Solanaceae or nightshade family. Research into the action of hyoscyamine in published literature dates back to 1826. Nulev is used for a wide variety of treatments and therapeutics due to its antimuscarinic properties.

Although hyoscyamine is marketed in the United States, it is not FDA approved.

Nulev is not FDA approved, and so it has not official indications. However, it is used as an antimuscarinic agent in a number of treatments and therapies. Nulev has a short duration of action as it may need to be given multiple times per day. Patients should be counselled regarding the risks and signs of anticholinergic toxicity.

Nulev
Uses
Dosage
Side Effect
Precautions
Interactions
Uses during Pregnancy
Uses during Breastfeeding
Accute Overdose
Food Interaction
Half Life
Volume of Distribution
Clearance
Interaction With other Medicine
Contradiction
Storage

Trade Name	Nulev
Availability	Prescription only
Generic	Hyoscyamine
Hyoscyamine Other Names	(S)-atropine, Daturin, Daturine, Duboisine, Hyoscyamin, Hyoscyamine, Hyoscyaminum, L-Hyoscyamine, L-Tropine tropate, Tropine-L-tropate
Related Drugs	diazepam, fentanyl, dicyclomine, oxybutynin, lidocaine, Valium, Bentyl, simethicone, ketamine, propofol
Weight	0.125mg/5ml, 0.125mg/ml, 0.125mg, 0.375mg, 0.375mgdual + release,
Type	Oral Liquid, Oral Solution, Oral Tablet, Disintegrating, Extended Release, Sublingual Tablet
Formula	C₁₇H₂₃NO₃
Weight	Average: 289.3694 Monoisotopic: 289.167793607
Groups	Approved
Therapeutic Class
Manufacturer
Available Country	United States,
Last Updated:	September 19, 2023 at 7:00 am

Uses

Nulev is an anticholinergic indicated to treat functional gastrointestinal disorders, biliary and renal colic, and acute rhinitis.

As a drug that is not FDA approved, hyscyamine has no official indications. Intravenous hysocyamine has been used to reduce gastric motility, reduce pancreatic pain and secretions, to facilitate imaging of the gastrointestinal tract, treat anticholinesterase toxicity, treat certain cases of partial heart block, improve visualization of the kidneys, and for symptomatic relief of biliary and renal colic. Intravenous hyoscyamine is also used pre-operatively to reduce secretions of the mouth and respiratory tract to facilitate intubation. Oral hyoscyamine is used to treat functional intestinal disorders, for symptomatic relief of biliary and renal colic, and symptomatic relief of acute rhinitis.

Nulev is also used to associated treatment for these conditions: Biliary Colic, Colic, Cystitis, Diverticulitis, Heart Block, Irritable Bowel Syndrome (IBS), Neurogenic Bladder Dysfunction, Neurogenic Bowel Dysfunction, Pancreatitis, Parkinsonism, Peptic Ulcer, Poisoning caused by anticholinesterases, Pylorospasm, Renal Colic, Spastic bladder, Tracheo-bronchial secretion excess, Acute Enterocolitis, Acute Rhinitis, Gastric secretions, Mild Dysentery, Pharyngeal secretions, Salivary secretions, Spastic colitis

How Nulev works

Nulev competitively and non-selectively antagonises muscarinic receptors in the smooth muscle, cardiac muscle, sino-atrial node, atrioventricular node, exocrine nodes, gastrointestinal tract, and respiratory tract. Antagonism of muscarinic M1, M4, and M5 receptors in the central nervous system lead to cognitive impairment; antagonism of M2 in the sinoatrial and atrioventricular nodes leads to bradycardia and lowers contractility; and antagonism of M3 in smooth muscle results in reduced peristalsis, bladder contraction, salivary secretions, gastric secretions, bronchial secretions, sweating, increased bronchodilation, mydriasis, and cycloplegia.

Toxicity

Patients experiencing an overdose may present with headache, nausea, vomiting, dizziness, dry mouth, difficulty in swallowing, dilated pupils, blurred vision, urinary retention, hot dry and flushed skin, tachycardia, hypertension, hypotension, respiratory depression, CNS stimulation, fever, ataxia, excitation, lethargy, stupor, coma, and paralysis. Patients should be treated with symptomatic and supportive therapy which may include emesis, gastric lavage, activated charcoal, artificial respiration, or intravenous physostigmine. Dialysis is expected to remove hyoscyamine sulfate from circulation.

Food Interaction

Take before a meal. Take 30-60 minutes before a meal.
Take separate from antacids. Take oral hyoscyamine before meals and antacids after meals.

Nulev Alcohol interaction

[Moderate] GENERALLY AVOID:

Use of anticholinergic agents with alcohol may result in sufficient impairment of attention so as to render driving and operating machinery more hazardous.

In addition, the potential for abuse may be increased with the combination.

The mechanism of interaction is not established but may involve additive depressant effects on the central nervous system.

No effect of oral propantheline or atropine on blood alcohol levels was observed in healthy volunteers when administered before ingestion of a standard ethanol load.

However, one study found impairment of attention in subjects given atropine 0.5 mg or glycopyrrolate 1 mg in combination with alcohol.

Alcohol should generally be avoided during therapy with anticholinergic agents.

Patients should be counseled to avoid activities requiring mental alertness until they know how these agents affect them.