phenobarbital / hyoscyamine / atropine / scopolamine
Donnatal is a prescription medication that's added alongside other treatments to help manage stomach problems, such as irritable bowel syndrome (IBS), enterocolitis (inflammation in the intestines), and duodenal ulcers. It contains a combination of four active ingredients: a barbiturate (phenobarbital) and three anticholinergic medications (hyoscyamine, atropine, and scopolamine). This combination of medications is also available as a lower-cost generic and under the brand name Phenohytro. Typically, the tablets and elixir (liquid) are taken by mouth 3 to 4 times per day. Side effects include sleepiness, dizziness, blurry vision, and dry mouth.
What is Donnatal?
What is Donnatal used for?
Add-on therapy to treat:
Short term enterocolitis (inflammation in the intestines)
How Donnatal works
Donnatal is a combination of four medications that work together to treat stomach problems:
Phenobarbital is a barbiturate. It causes changes in the brain to produce a mild calming effect.
Hyoscyamine, atropine, and scopolamine are all anticholinergic medications. They work by blocking a chemical called acetylcholine from attaching to receptors in your body. This helps relax stomach muscles, slow down gut movement, and reduce stomach secretions to help treat a variety of stomach problems.
Drug Facts
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What are the side effects of Donnatal?
Common Side Effects
- Dry mouth
- Dizziness
- Blurred vision
- Constipation
- Sweating less
- Difficulty passing urine
- Fast heartbeat
Other Side Effects
- Headache
- Nervousness
- Bloating
- Nausea
- Vomiting
- Muscle pain
- Weakness
- Loss of taste
- Trouble sleeping
- Eye problems
Serious Side Effects
- Serious allergic reaction: swelling of eyelids, cheeks, or lips
- Serious skin reaction: rash, severe skin redness, peeling of the skin, painful blisters, fever, confusion
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Bowel blockage—stomach cramping, unable to have a bowel movement or pass gas, loss of appetite, vomiting
- Fever that does not go away, decreased sweating
- Trouble passing urine
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
- Blurry vision
- Confusion
- Constipation
- Dizziness
- Drowsiness
- Dry mouth
- Headache
Pros and cons of Donnatal
Pros
Available in both tablet and elixir (liquid) form
Can be used in both children and adults
Can treat many stomach conditions
Cons
Rated by the FDA to be "possibly" effective
Needs to be taken multiple times a day
Could be habit-forming because it contains phenobarbital
Pharmacist tips for Donnatal
You can take Donnatal with or without food, but if it upsets your stomach, try taking it with food to help.
Donnatal can make you sleepy and dizzy, which can raise your risk for falls. Avoid alcohol, driving, or activities that need focus until you know how this medication affects you. Tell your prescriber if you're taking benzodiazepines, anxiety medications, or muscle relaxants, as these can worsen these effects.
Donnatal might affect how well certain blood thinners work. If you're also taking anticoagulants, your prescriber might have to raise your anticoagulant dose. When Donnatal is stopped, your prescriber might have to lower your anticoagulant dose.
Donnatal can cause your mouth to feel dry because it causes your body to make less saliva. Be sure to drink enough water when you're taking this medication.
Donnatal can cause you to sweat less. Be careful in hot weather or during exercise, as this can lead to a fever and overheating.
Don't change your dose or stop taking Donnatal without talking to your prescriber first. Stopping suddenly can cause withdrawal symptoms, like seizures and confusion. If you need to stop, follow your prescriber's instructions to gradually reduce your dose.
Let your prescriber know if you experience diarrhea with Donnatal, especially if you have surgical openings in the stomach like an ileostomy or colostomy. Diarrhea could be a sign of a partial stomach blockage, which could be harmful, so you'll need to be seen right away.
More tips for the liquid:
Store the bottle at room temperature and keep it in the original bottle to protect from light.
Make sure to only use a medication dose cup, syringe, or dropper from the pharmacy to measure out your dose. Don't use household spoons because they aren't accurate and might cause you to take the wrong dose.
Frequently asked questions about Donnatal
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What are the risks and warnings for Donnatal?
Donnatal can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Harm to your unborn baby
It's strongly recommended to avoid using Donnatal while pregnant unless a healthcare professional determines the benefits outweigh the risks. Donnatal hasn’t been studied in pregnancy, and the phenobarbital in it can cause withdrawal symptoms in babies, like weakness and trouble sleeping. If you're pregnant or are planning on becoming pregnant, let your care team know right away.
Fever and heatstroke
Donnatal can reduce your ability to sweat. This can make your body overheat more easily, leading to a higher risk of fever or heatstroke in hot temperatures. Make sure to drink enough water and stay hydrated while taking this medication.
Dependence and withdrawal
Risk factors: History of substance use disorder | History of mental health problems | Using higher doses of Donnatal for a long time | Stopping Donnatal suddenly
Phenobarbital in Donnatal can lead to dependence, where your body needs the medication to function normally. Take the medication exactly as prescribed and don't change the dose without talking to your prescriber first.
If you need to stop taking Donnatal, talk to your prescriber about a way to safely do so. Stopping the medication too suddenly can lead to life-threatening withdrawal symptoms, such as seizures and confusion.
Donnatal dosage forms
Typical dosing for Donnatal
Donnatal tablets and generics: Each tablet contains 16.2 mg of phenobarbital, 0.1037 mg of hyoscyamine, 0.0194 mg of atropine, and 0.0065 mg of scopolamine.
Adults: The typical dose is 1 to 2 tablets by mouth 3 or 4 times a day.
Donnatal elixir, Phenohytro elixir, and generics : Each teaspoonful (5 mL) contains 16.2 mg of phenobarbital, 0.1037 mg of hyoscyamine, 0.0194 mg of atropine, and 0.0065 mg of scopolamine.
Adults: The typical dose is 1 to 2 teaspoonfuls (5 mL to 10 mL) by mouth 3 to 4 times a day.
Children: The dose is calculated based on your child’s weight. In general, the dose ranges from 0.5 mL to 5 mL by mouth every 4 hours, or 0.75 mL to 7.5 mL every 6 hours.
How much does Donnatal cost?
Donnatal contraindications
Urinary tract blockage
Stomach or intestinal blockage
Long-term constipation
Unstable heart or bleeding problems
Severe ulcerative colitis with toxic megacolon
Hiatal hernia with acid reflux
People who get restless and/or excited from phenobarbital
What are alternatives to Donnatal?
Add-on therapy to treat:
Short term enterocolitis (inflammation in the intestines)
To control emotional and somatic (physical) factors related to stomach conditions
Add-on therapy for peptic (stomach) ulcer
Add-on therapy for irritable bowel syndrome (IBS)
Add-on therapy for acute enterocolitis
Donnatal images
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References
Best studies we foundCalifornia State Board of Pharmacy. (2017). State Board of Pharmacy Department of Consumer Affairs Enforcement and Compounding Committee meeting minutes.
Concordia Pharmaceuticals Inc. (2023). Donnatal- phenobarbital, hyoscyamine sulfate, atropine sulfate, scopolamine hydrobromide elixir [package insert]. DailyMed.
Concordia Pharmaceuticals Inc. (2023). Donnatal - phenobarbital, hyoscyamine sulfate, atropine sulfate, scopolamine hydrobromide tablet [package insert]. DailyMed.
Department of Justice/Drug Enforcement Administration. (2020). Narcotics.
Drug Enforcement Administration. (2024). Table of exempted prescription products.
Meadows, M. (2006). Promoting safe and effective drugs for 100 years. FDA Consumer Magazine.
Mubaslat, O., et al. (2021). Pharmacokinetics and effects on saliva flow of sublingual and oral atropine in clozapine-treated and healthy adults: An interventional cross-over study. Psychiatry and Clinical Psychopharmacology.
National Center for Emerging and Zoonotic Infectious Diseases (U.S.). Division of Healthcare Quality Promotion. (2018). Spoons are for soup / Milliliters (mL) are for medicine.
National Institute of Diabetes and Digestive and Kidney Diseases. (2020). Porphyria.
Nelson, E., et al. (1982). Phenobarbital pharmacokinetics and bioavailability in adults. The Journal of Clinical Pharmacology.
Putcha, L., et al. (1989). Pharmacokinetics and oral bioavailability of scopolamine in normal subjects. Pharmaceutical Research.
Sam, C., et al. (2023). Physiology, acetylcholine. StatPearls.
Winder Laboratories LLC. (2019). Phenohytro- phenobarbital, hyoscyamine sulfate, atropine sulfate, and scopolamine hydrobromide elixir [package insert]. DailyMed.
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