Hyoscine butylbromide

Buscopan contains hyoscine butylbromide, which is a quaternary ammonium compound with antimuscarinic properties. It is used as an antispasmodic and therefore may be useful in irritable bowel syndrome. Hyoscine butylbromide, as with all antimuscarinics, must be used with caution in patients with prostatic hypertrophy, as they may lead to urinary retention. 

Buscopan is a branded preparation containing hyoscine butylbromide, an antimuscarinic agent that reduces gastrointestinal motility. Antimuscarinic agents are contraindicated in cases of angle-closure glaucoma as they may aggrevate the condition. Hyoscine butylbromide is a quaternary ammonium compound, unlike atropine, which is a tertiary ammonium compound. 

Natural alkaloids, tertiary amines atropine sulfate hyoscine butylbromide hyoscine hydrobromide hyoscyamine sulfate... 

Individuals on very small amounts of heroin are prescribed diazepam for anxiety, agitation or craving, zopiclone or zolpidem for insomnia, hyoscine butylbromide (Buscopan) for stomach cramps, and diphenoxylate/atropine (Lomotil) for diarrhoea, over a seven-day period. The medication schedule provided to the user explains which drug is for which symptoms, and the maximum doses of each that can be taken in a day, which for diazepam varies during the course. The basic medication regime is included in the Appendix. 

Tytgat GN (2007) Hyoscine butylbromide, a review of its use in the treatment of abdominal cramping and pain. Drugs 67 1343-1357... 

The GP also prescribed hyoscine butylbromide 10 mg tablets, two of which were to be taken up to four times daily. 

Opioid analgesics Tricyclic antidepressants Sedating antihistamines 5HT3 antagonists Calcium channel blockers Antispasmodics, e.g. hyoscine butylbromide Antimuscarinic drugs used in parkinsonism Aluminium-containing antacids Loperamide... 

YELLOW Amprolium, atropine methobromide, hyoscine butylbromide, hyoscine methobromide, ketoprofen, pipazethate, tetrahy-drozoline, tetramisole, trimetaphan... 

Hyoscine Butylbromide 457.6 Cyclomethycaine Sulphate 480.9 Tetracycline Hydrochloride... 

Hyoscine butylbromide (strictly N-butylhyosdne bromide, Buscopan) also blocks autonomic ganglia. If injected, it is an effective relaxant of smooth muscle, including the cardia in achalasia, the pyloric antral region and the colon, which properties are utilised by radiologists and endoscopists. It may sometimes be useful for colic. 

Hyoscine is an anticholinergic drug, a stereoisomer of atropine. It is available in different salts, hyoscine hydro-bromide and hyoscine butylbromide. 

When given parenterally hyoscine butylbromide is effective but very short-acting when given by mouth it... 

An isolated case of angioedema has been described during the use of hyoscine butylbromide (SEDA-8,148). 

Two Japanese primigravidae, aged 25 and 28 years, developed the HELLP syndrome, a severe variant of preeclampsia in which there is Hemolysis, Elevated Liver enzymes, and a Low Platelet count (4). They were given parenteral hyoscine butylbromide for abdominal pain and had seizures 60-90 minutes later. One died from intracerebral hemorrhage some days later and the other survived after a cesarean section soon afterward. The authors speculated that anticholinergic drugs may enhance sympathetic nervous system activity, and in particular vasoconstriction, and should be avoided in pre-eclampsia. It is not clear how widespread their use is... 

Grainger S L, Smith S E 1983 Dose-response relationships of intravenous hyoscine butylbromide and atropine sulphate on heart rate in healthy volunteers. British Journal of Clinical Pharmacology 16 ... 

These are medicines that are listed in the Prescription Only Medicines (ffuman Use) Order 1997. If the pack size of a POM is reduced it may be considered for licensing as a P or GSL medicine (see paracetamol example in Section 1.3.1). If a POM is intended for sale below a certain strength or dose then the medicine may be also considered to be a P medicine. An example of this is hyoscine butylbromide tablets 10 mg, which are normally classified as a POM but if packaged and labelled appropriately, a P classification is given. For P classification in this example, the packaging must state that a single dose must not exceed 20 mg and the daily dose must not exceed 80 mg and the pack must contain no more than 240 mg. 

Hyoscine butylbromide, an antimuscarinic antispasmodic, is a hydrophilic quaternary ammonium compound that is poorly absorbed from the gut and claimed to act directly on it, and any drug absorbed does not readily cross the blood-brain barrier. Nevertheless, antimuscarinic side-effects have been very occasionally reported. Hyoscine butylbromide is contraindicated in patients with glaucoma, and caution is advised for men with prostate problems, the elderly and pregnant women. 

Asthmatic attacks due to non-narcotic analgesics, mostly occur in patients with so-called intrinsic or idiosyncratic asthma (often associated with nasal polyposis, sinusitis and eosinophilia of the blood) (McFadden and Austen 1977). About 10% of patients with this kind of asthma show severe reactions to aspirin, methyl-salicylate, pyrazolone derivatives, indomethacin, ibuprofen, diclofenac and sometimes even phenacetin and paracetamol. (Sodium salicylate is often tolerated.) The special reactivity may appear only in later life and concerns a number of chemically unrelated drugs. In some of these patients analgesic therapy with a morphine derivative such as pentazocine (Fortalgesic) or hyoscine butylbromide (Buscopan) may be necessary. However, in other patients, those with aspirin urticaria rather than asthma, the reaction may also rely on a drug-specific allergic mechanism (de Weck 1971). 

Taylor SA, Halligan S, Goh V et al (2003) Optimizing colonic distention for multi-detector row CT colonography effect of hyoscine butylbromide and rectal balloon catheter. Radiology 229 99-108... 

There are two intravenous spasmolytics available for CT colonography hyoscine butylbromide and glucagon hydrochloride. Both produce hypotonia in smooth muscle within the colonic wall and are used widely to improve distension during double contrast barium enema. However, while both agents have been shown to improve patient perception during barium enema, only hyoscine butylbromide reliably improves distension (Goei et al. 1995 Bova et al. 1993). As a result, it is widely utilized for barium enema across Eimope (hyoscine butylbromide is not licensed for use in the USA). 

While the authors would recommend routine use of hyoscine butylbromide prior to CT colonography, some caution needs to be exercised prior to administration. Glaucoma, cardiac ischaemia and urinary retention may all be precipitated and minor self limiting effects of dry mouth and blurred vision are also associated. Consequently, patients should be questioned about any relevant past medical history and advised not to drive for a short time following administration. 

---