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# Hyoscine butylbromide (Buscopan)
## Overview
Hyoscine butylbromide is a quaternary ammonium antispasmodic agent. Unlike hyoscine hydrobromide, it does not cross the blood-brain barrier, resulting in minimal central nervous system effects.
## Primary Indications
Symptomatic relief of gastrointestinal (GI) and genitourinary spasms, including biliary colic, renal colic, and irritable bowel syndrome (IBS).
## Adult Dosing
* **Oral:** 10–20 mg three to four times daily. Maximum: 100 mg/day.
* **Parenteral (IM/IV/SC):** 20 mg as a single dose, repeated every 30 minutes if necessary. Maximum: 100 mg/day.
## Pediatric Dosing
* **Children 6–12 years:** 10 mg (one tablet) three times daily.
* **Children <6 years:** Not routinely recommended; consult local pediatric formulary for weight-based protocols or off-label consensus.
## Dose Adjustments
* **Renal/Hepatic Impairment:** No specific guidelines exist, but caution is advised in severe impairment due to delayed clearance.
* **Elderly:** Use with caution due to an increased risk of urinary retention and anticholinergic side effects (e.g., visual disturbances, dizziness).
## Contraindications
* Hypersensitivity to hyoscine butylbromide.
* Myasthenia gravis.
* Megacolon.
* Mechanical intestinal obstruction or paralytic ileus.
* Narrow-angle glaucoma.
* Prostatic hypertrophy (with urinary retention).
* Tachyarrhythmias.
## Adverse Effects
* **Common:** Dry mouth, tachycardia, blurred vision (mydriasis), and constipation.
* **Serious:** Anaphylaxis, urinary retention, and angle-closure glaucoma (rare).
## Key Drug Interactions
* **Anticholinergics:** Concomitant use (e.g., antihistamines, tricyclic antidepressants) may increase anticholinergic adverse effects.
* **Dopamine Antagonists:** May result in reduced GI motility effects of metoclopramide or domperidone.
* **Tachycardia medications:** May enhance the heart rate-increasing effects of beta-agonists or sympathomimetics.
## Monitoring
* Monitor heart rate (risk of tachycardia).
* Monitor for signs of urinary retention, especially in elderly males.
* Assess for resolution of spasm symptoms.
## Clinical Pearls
* The quaternary ammonium structure ensures the drug is poorly absorbed and does not enter the central nervous system, avoiding sedation.
* It is significantly less effective than nitrates or NSAIDs for severe renal colic, but often used as an adjunct.
* If parenteral administration is required, monitor for transient hypotension or tachycardia immediately following IV push.
* Always verify institutional protocols, as oral and parenteral dosing local guidelines may vary regarding maximum daily limits.
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*Disclaimer: This information is for educational purposes only. Always verify dosages, contraindications, and drug interactions against current local prescribing information, institutional protocols, or the official Summary of Product Characteristics (SmPC) before clinical use.*
