Donnatal® (phenobarbital, Hyoscyamine Sulfate, Atropine Sulfate, Scopolamine Hydrobromide) Elixir

The dosage of Donnatal® Elixir should be adjusted to the needs of the individual patient to assure symptomatic control with a minimum of adverse effects.

Donnatal® Elixir. Adults: One or two teaspoonfuls of elixir three or four times a day according to conditions and severity of symptoms.

Pediatric patients: may be dosed every 4 to 6 hours. Use a pediatric dosing device or oral syringe to measure the dose.

• glaucoma;
• obstructive uropathy (for example, bladder neck obstruction due to prostatic hypertrophy);
• obstructive disease of the gastrointestinal tract (as in achalasia, pyloroduodenal stenosis, etc.);
• paralytic ileus, intestinal atony of the elderly or debilitated patient;
• unstable cardiovascular status in acute hemorrhage;
• severe ulcerative colitis especially if complicated by toxic megacolon;
• myasthenia gravis;
• hiatal hernia associated with reflux esophagitis;
• in patients with known hypersensitivity to any of the ingredients.

Phenobarbital is contraindicated in acute intermittent porphyria and in those patients in whom phenobarbital produces restlessness and/or excitement.

Adverse reactions may include xerostomia; urinary hesitancy and retention; blurred vision; tachycardia; palpitation; mydriasis; cycloplegia; increased ocular tension; loss of taste sense; headache; nervousness; drowsiness; weakness; dizziness; insomnia; nausea; vomiting; impotence; suppression of lactation; constipation; bloated feeling; musculoskeletal pain; severe allergic reaction or drug idiosyncrasies, including anaphylaxis, urticaria, and other dermal manifestations; and decreased sweating.

Acquired hypersensitivity to barbiturates consists chiefly in allergic reactions that occur especially in persons who tend to have asthma, urticaria, angioedema, and similar conditions. Hypersensitivity reactions in this category include localized swelling, particularly of the eyelids, cheeks, or lips, and erythematous dermatitis. Rarely, exfoliative dermatitis (e.g. Stevens-Johnson syndrome and toxic epidermal necrolysis) may be caused by phenobarbital and can prove fatal. The skin eruption may be associated with fever, delirium, and marked degenerative changes in the liver and other parenchymatous organs. In a few cases, megaloblastic anemia has been associated with the chronic use of phenobarbital.

Phenobarbital may produce excitement in some patients, rather than a sedative effect.

To report SUSPECTED ADVERSE REACTIONS, contact VistaPharm, Inc. at 1-888-655-1505 or the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

Phenobarbital may decrease the effect of anticoagulants, and necessitate larger doses of the anticoagulant for optimal effect. When the phenobarbital is discontinued, the dose of the anticoagulant may have to be decreased.

Donnatal® Elixir - Grape is a purple colored, grape flavored liquid.

• NDC 66689-063-01: 5 mL unit dose cup.
• NDC 66689-063-10: Case contains 10 unit-dose cups of 5 mL (NDC 66689-063-01), packed in 1 tray of 10 unit-dose cups;
• NDC 66689-063-40: Case contains 40 unit-dose cups of 5 mL (NDC 66689-063-01), packed in 4 trays of 10 unit-dose cups;
• NDC 66689-063-50: Case contains 50 unit-dose cups of 5 mL (NDC 66689-063-01), packed in 5 trays of 10 unit-dose cups;
• NDC 66689-063-99: Case contains 100 unit-dose cups of 5 mL (NDC 66689-063-01), packed in 10 trays of 10 unit-dose cups;

Avoid Freezing

Store Donnatal® Elixir at 20º- 25ºC (68º - 77ºF) [see USP Controlled Room Temperature]. Protect from light and moisture.

Dispense in a tight, light-resistant container as defined in the USP using a child-resistant closure.

DEA EXEMPT PRODUCT

Distributed By:

VistaPharm, Inc.

Largo, FL 33771

VP2189R2

Rev.10/20

Made in USA.

Donnatal ® Elixir - Grape

Each 5 mL (teaspoonful) of elixir (alcohol not more than 23.8%) contains:

Phenobarbital, USP.............................................16.2 mg

Hyoscyamine Sulfate, USP...............................0.1037 mg

Atropine Sulfate, USP.......................................0.0194 mg

Scopolamine Hydrobromide, USP....................0.0065 mg

Phenobarbital may be habit forming and should not be administered to individuals known to be addiction prone or to those with a history of physical and/or psychological dependence upon drugs (see WARNINGS ).

Use with caution in patients with:

• autonomic neuropathy
• hepatic or renal disease
• hyperthyroidism
• coronary heart disease
• congestive heart failure
• cardiac arrhythmias
• tachycardia
• hypertension

Belladonna alkaloids may produce a delay in gastric emptying (antral stasis) which would complicate the management of gastric ulcer.

Do not rely on the use of the drug in the presence of complication of biliary tract disease.

Theoretically, with overdosage, a curare-like action may occur.

Donnatal® Elixir can cause fetal harm when administered to a pregnant woman. Animal reproduction studies have not been conducted with Donnatal® Elixir. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the fetus.

In the presence of a high environmental temperature, heat prostration can occur with belladonna alkaloids (fever and heatstroke due to decreased sweating).

Diarrhea may be an early symptom of incomplete intestinal obstruction, especially in patients with ileostomy or colostomy. In this instance, treatment with this drug would be inappropriate and possibly harmful.

Donnatal® Elixir may produce drowsiness or blurred vision. The patient should be warned, should these occur, not to engage in activities requiring mental alertness, such as operating a motor vehicle or other machinery, and not to perform hazardous work.

Phenobarbital may decrease the effect of anticoagulants, and necessitate larger doses of the anticoagulant for optimal effect. When the phenobarbital is discontinued, the dose of the anticoagulant may have to be decreased.

Phenobarbital may be habit forming and should not be administered to individuals known to be addiction prone or to those with a history of physical and/or psychological dependence upon drugs.

Since barbiturates are metabolized in the liver, they should be used with caution and initial doses should be small in patients with hepatic dysfunction.

Animal reproduction studies have not been conducted with Donnatal® Elixir. There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks (see WARNINGS ).

In patients habituated to barbiturates, abrupt withdrawal may produce delirium or convulsions.

The signs and symptoms of overdose are headache, nausea, vomiting, blurred vision, dilated pupils, hot and dry skin, dizziness, dryness of the mouth, difficulty in swallowing, and CNS stimulation. Treatment should consist of gastric lavage, emetics, and activated charcoal. If indicated, parenteral cholinergic agents such as physostigmine or bethanechol chloride should be used.

Elderly patients may react with symptoms of excitement, agitation, drowsiness, and other untoward manifestations to even small doses of the drug.

It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Donnatal® Elixir is administered to a nursing woman.

Purified Water, Glycerin, Sorbitol, Ethyl Alcohol, Sucrose, Saccharin Sodium, Artificial and Natural Grape Flavor, FD&C Red #3, and FD&C Blue #1.

This drug combination provides natural belladonna alkaloids in a specific, fixed ratio combined with phenobarbital to provide peripheral anticholinergic/antispasmodic action and mild sedation.

Donnatal® Elixir may produce drowsiness or blurred vision. The patient should be warned, should these occur, not to engage in activities requiring mental alertness, such as operating a motor vehicle or other machinery, and not to perform hazardous work.

Long-term studies in animals have not been performed to evaluate carcinogenic potential.

Donnatal^®

Elixir grape flavored

Each 5 mL contains:

Phenobarbital, USP.............................. 16.2 mg

Hyoscyamine Sulfate, USP............... 0.1037 mg

Atropine Sulfate, USP...................... 0.0194 mg

Scopolamine Hydrobromide, USP.... 0.0065 mg

Alcohol not more than 23.8%

Delivers 5 mL

For Institutional Use Only

Store at 20°-25°C (68°-77°F) (see USP)

Avoid freezing. DEA EXEMPT PRODUCT

NDC 66689-063-01

Dist. by: VistaPharm, Inc.

Largo, FL, USA

Rx Only

VP2196R5

Rev.05/22

Phenobarbital may be habit forming and should not be administered to individuals known to be addiction prone or to those with a history of physical and/or psychological dependence upon drugs (see WARNINGS ).

Use with caution in patients with:

• autonomic neuropathy
• hepatic or renal disease
• hyperthyroidism
• coronary heart disease
• congestive heart failure
• cardiac arrhythmias
• tachycardia
• hypertension

Belladonna alkaloids may produce a delay in gastric emptying (antral stasis) which would complicate the management of gastric ulcer.

Do not rely on the use of the drug in the presence of complication of biliary tract disease.

Theoretically, with overdosage, a curare-like action may occur.

Donnatal® Elixir can cause fetal harm when administered to a pregnant woman. Animal reproduction studies have not been conducted with Donnatal® Elixir. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the fetus.

In the presence of a high environmental temperature, heat prostration can occur with belladonna alkaloids (fever and heatstroke due to decreased sweating).

Diarrhea may be an early symptom of incomplete intestinal obstruction, especially in patients with ileostomy or colostomy. In this instance, treatment with this drug would be inappropriate and possibly harmful.

Donnatal® Elixir may produce drowsiness or blurred vision. The patient should be warned, should these occur, not to engage in activities requiring mental alertness, such as operating a motor vehicle or other machinery, and not to perform hazardous work.

Phenobarbital may decrease the effect of anticoagulants, and necessitate larger doses of the anticoagulant for optimal effect. When the phenobarbital is discontinued, the dose of the anticoagulant may have to be decreased.

Phenobarbital may be habit forming and should not be administered to individuals known to be addiction prone or to those with a history of physical and/or psychological dependence upon drugs.

Since barbiturates are metabolized in the liver, they should be used with caution and initial doses should be small in patients with hepatic dysfunction.

Animal reproduction studies have not been conducted with Donnatal® Elixir. There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks (see WARNINGS ).

In patients habituated to barbiturates, abrupt withdrawal may produce delirium or convulsions.

The signs and symptoms of overdose are headache, nausea, vomiting, blurred vision, dilated pupils, hot and dry skin, dizziness, dryness of the mouth, difficulty in swallowing, and CNS stimulation. Treatment should consist of gastric lavage, emetics, and activated charcoal. If indicated, parenteral cholinergic agents such as physostigmine or bethanechol chloride should be used.

Donnatal ® Elixir - Grape

Each 5 mL (teaspoonful) of elixir (alcohol not more than 23.8%) contains:

Phenobarbital, USP.............................................16.2 mg

Hyoscyamine Sulfate, USP...............................0.1037 mg

Atropine Sulfate, USP.......................................0.0194 mg

Scopolamine Hydrobromide, USP....................0.0065 mg

Donnatal® Elixir - Grape is a purple colored, grape flavored liquid.

• NDC 66689-063-01: 5 mL unit dose cup.
• NDC 66689-063-10: Case contains 10 unit-dose cups of 5 mL (NDC 66689-063-01), packed in 1 tray of 10 unit-dose cups;
• NDC 66689-063-40: Case contains 40 unit-dose cups of 5 mL (NDC 66689-063-01), packed in 4 trays of 10 unit-dose cups;
• NDC 66689-063-50: Case contains 50 unit-dose cups of 5 mL (NDC 66689-063-01), packed in 5 trays of 10 unit-dose cups;
• NDC 66689-063-99: Case contains 100 unit-dose cups of 5 mL (NDC 66689-063-01), packed in 10 trays of 10 unit-dose cups;

Avoid Freezing

Store Donnatal® Elixir at 20º- 25ºC (68º - 77ºF) [see USP Controlled Room Temperature]. Protect from light and moisture.

Dispense in a tight, light-resistant container as defined in the USP using a child-resistant closure.

DEA EXEMPT PRODUCT

Distributed By:

VistaPharm, Inc.

Largo, FL 33771

VP2189R2

Rev.10/20

Made in USA.

Elderly patients may react with symptoms of excitement, agitation, drowsiness, and other untoward manifestations to even small doses of the drug.

It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Donnatal® Elixir is administered to a nursing woman.

Adverse reactions may include xerostomia; urinary hesitancy and retention; blurred vision; tachycardia; palpitation; mydriasis; cycloplegia; increased ocular tension; loss of taste sense; headache; nervousness; drowsiness; weakness; dizziness; insomnia; nausea; vomiting; impotence; suppression of lactation; constipation; bloated feeling; musculoskeletal pain; severe allergic reaction or drug idiosyncrasies, including anaphylaxis, urticaria, and other dermal manifestations; and decreased sweating.

Acquired hypersensitivity to barbiturates consists chiefly in allergic reactions that occur especially in persons who tend to have asthma, urticaria, angioedema, and similar conditions. Hypersensitivity reactions in this category include localized swelling, particularly of the eyelids, cheeks, or lips, and erythematous dermatitis. Rarely, exfoliative dermatitis (e.g. Stevens-Johnson syndrome and toxic epidermal necrolysis) may be caused by phenobarbital and can prove fatal. The skin eruption may be associated with fever, delirium, and marked degenerative changes in the liver and other parenchymatous organs. In a few cases, megaloblastic anemia has been associated with the chronic use of phenobarbital.

Phenobarbital may produce excitement in some patients, rather than a sedative effect.

To report SUSPECTED ADVERSE REACTIONS, contact VistaPharm, Inc. at 1-888-655-1505 or the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

• glaucoma;
• obstructive uropathy (for example, bladder neck obstruction due to prostatic hypertrophy);
• obstructive disease of the gastrointestinal tract (as in achalasia, pyloroduodenal stenosis, etc.);
• paralytic ileus, intestinal atony of the elderly or debilitated patient;
• unstable cardiovascular status in acute hemorrhage;
• severe ulcerative colitis especially if complicated by toxic megacolon;
• myasthenia gravis;
• hiatal hernia associated with reflux esophagitis;
• in patients with known hypersensitivity to any of the ingredients.

Phenobarbital is contraindicated in acute intermittent porphyria and in those patients in whom phenobarbital produces restlessness and/or excitement.

Phenobarbital may decrease the effect of anticoagulants, and necessitate larger doses of the anticoagulant for optimal effect. When the phenobarbital is discontinued, the dose of the anticoagulant may have to be decreased.

Purified Water, Glycerin, Sorbitol, Ethyl Alcohol, Sucrose, Saccharin Sodium, Artificial and Natural Grape Flavor, FD&C Red #3, and FD&C Blue #1.

This drug combination provides natural belladonna alkaloids in a specific, fixed ratio combined with phenobarbital to provide peripheral anticholinergic/antispasmodic action and mild sedation.

Donnatal® Elixir may produce drowsiness or blurred vision. The patient should be warned, should these occur, not to engage in activities requiring mental alertness, such as operating a motor vehicle or other machinery, and not to perform hazardous work.

The dosage of Donnatal® Elixir should be adjusted to the needs of the individual patient to assure symptomatic control with a minimum of adverse effects.

Donnatal® Elixir. Adults: One or two teaspoonfuls of elixir three or four times a day according to conditions and severity of symptoms.

Pediatric patients: may be dosed every 4 to 6 hours. Use a pediatric dosing device or oral syringe to measure the dose.

Long-term studies in animals have not been performed to evaluate carcinogenic potential.

Donnatal^®

Elixir grape flavored

Each 5 mL contains:

Phenobarbital, USP.............................. 16.2 mg

Hyoscyamine Sulfate, USP............... 0.1037 mg

Atropine Sulfate, USP...................... 0.0194 mg

Scopolamine Hydrobromide, USP.... 0.0065 mg

Alcohol not more than 23.8%

Delivers 5 mL

For Institutional Use Only

Store at 20°-25°C (68°-77°F) (see USP)

Avoid freezing. DEA EXEMPT PRODUCT

NDC 66689-063-01

Dist. by: VistaPharm, Inc.

Largo, FL, USA

Rx Only

VP2196R5

Rev.05/22