Anaspaz, Cystospaz, Levsin, Levsinex, NuLev
Classifications: anticholinergic; antimuscarinic; antispasmodic;
Therapeutic: antispasmodic
; anticholinergic
Prototype: Atropine
Pregnancy Category: C


0.125 mg, 0.150 mg tablets; 0.125 mg sublingual tablets; 0.375 sustained release capsules; 0.125 mg orally disintegrating tablet 0.125 mg/mL oral solution; 0.125 mg/5 mL elixir; 0.5 mg/mL injection


Competitive inhibitor of acethycholine at autonomic postganglionic cholinergic receptors. It decreases motility (smooth muscle tone) in GI, biliary, and urinary tracts. Specific anticholingenric responses are dose-related.

Therapeutic Effect

Has both anticholinergic and antispasmodic activity.


GI tract disorders caused by spasm and hypermotility, as conjunct therapy with diet and antacids for peptic ulcer management, and as an aid in the control of gastric hypersecretion and intestinal hypermotility. Also symptomatic relief of biliary and renal colic, as a "drying agent" to relieve symptoms of acute rhinitis, to control preanesthesia salivation and respiratory tract secretions, to treat symptoms of parkinsonism, and to reduce pain and hypersecretion in pancreatitis.


Hypersensitivity to belladonna alkaloids, prostatic hypertrophy, obstructive diseases of GI or GU tract, ulcerative colitis, paralytic ileus or intestinal atony; myasthenia gravis; children <2 y; pregnancy (category C), lactation.

Cautious Use

Diabetes mellitus, cardiac disease, cardiac arrhythmias; autonomic neuropathy; closed-angle glaucoma; GERD, hiatal hernia; pulmonary disease; renal or hepatic disease.

Route & Dosage

GI Spasms
Adult: IV/IM/SC 0.25–0.5 mg q4h PO/SL 0.125–0.25 mg t.i.d. or q.i.d. prn
Child (2–12 y): PO 0.0625–0.125 mg q4h prn (max: 0.75 mg/d)


  • Note: Dose for older adults may need to be less than the standard adult dose. Observe patient carefully for signs of paradoxic reactions.
  • Give preparations about 1 h before meals and at bedtime (at least 2 h after last meal).
  • Ensure that sustained release form of drug is not chewed or crushed. It must be swallowed whole.

PREPARE: Direct: Give undiluted.  

ADMINISTER: Direct: Give a single dose over 60 sec.  

  • Store 15°–30° C (59°–86° F).

Adverse Effects (≥1%)

CNS: Headache, unusual tiredness or weakness, confusion, drowsiness, excitement in older adult patients. CV: Palpitations, tachycardia. Special Senses: Blurred vision, increased intraocular tension, cycloplegia, mydriasis. GI: Dry mouth, constipation, paralytic ileus. Other: Urinary retention, anhidrosis, suppression of lactation.


Drug: Amantadine, antihistamines, tricyclic anti-depressants, quinidine, disopyramide, procainamide add anticholinergic effects; decreases levodopa effects; methotrimeprazine may precipitate extrapyramidal effects; decreases antipsychotic effects of phenothiazines (decreased absorption).


Absorption: Well absorbed from all administration sites. Onset: 2–3 min IV; 20–30 min PO. Peak: 15–30 min IV; 30–60 min PO. Duration: 4–6 h (up to 12 h with sustained release form). Distribution: Distributed in most body tissues; crosses blood–brain barrier and placenta; distributed in breast milk. Metabolism: In liver. Elimination: In urine. Half-Life: 3.5–13 h.

Nursing Implications

Assessment & Drug Effects

  • Monitor bowel elimination; may cause constipation.
  • Monitor urinary output.
  • Lessen risk of urinary retention by having patient void prior to each dose.
  • Assess for dry mouth and recommend good practices of oral hygiene.

Patient & Family Education

  • Avoid excessive exposure to high temperatures; drug-induced heatstroke can develop.
  • Do not drive or engage in other potentially hazardous activities until response to drug is known.
  • Use dark glasses if experiencing blurred vision, but if this adverse effect persists, notify physician for dose adjustment or possible drug change.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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