Please check your internet connection and try again.
# Hyoscine butylbromide (Buscopan)
## Overview
Hyoscine butylbromide is a quaternary ammonium derivative of hyoscine. Unlike hyoscine hydrobromide, it is a peripherally acting antimuscarinic that does not cross the blood-brain barrier, resulting in minimal central nervous system (CNS) side effects.
## Primary Indications
* Symptomatic relief of gastrointestinal (GI) and genitourinary (GU) spasms.
* Irritable Bowel Syndrome (IBS).
* Diagnostic or therapeutic procedures (e.g., endoscopy, radiology) to inhibit GI motility.
## Adult Dosing
* **Oral:** 10–20 mg three to four times daily. Maximum: 100 mg/day.
* **IM/IV/SC:** 20 mg as a single dose. May be repeated after 30 minutes if required. Maximum: 100 mg/day.
* *Note: Local protocols may vary regarding IV administration rates and total daily limits.*
## Pediatric Dosing
* **Children 6–12 years:** 10 mg orally three times daily.
* **Children <6 years:** Generally not recommended for routine use.
* *Note: Pediatric dosing is highly protocol-dependent. Seek institutional guidelines before administration.*
## Dose Adjustments
* **Renal/Hepatic Impairment:** No formal standardized adjustment guidelines; however, use with caution due to the potential for systemic accumulation.
* **Elderly:** Use lower starting doses and monitor for urinary retention and tachycardia.
## Contraindications
* Hypersensitivity to hyoscine butylbromide.
* Myasthenia gravis.
* Megacolon or intestinal obstruction (paralytic ileus).
* Narrow-angle glaucoma.
* Prostatic hypertrophy with urinary retention.
* Tachyarrhythmias.
## Adverse Effects
* **Common:** Dry mouth, blurred vision (mydriasis), tachycardia, constipation, and reduced sweating.
* **Serious:** Anaphylaxis, urinary retention, and rarely, angle-closure glaucoma.
## Key Drug Interactions
* **Anticholinergics:** Enhanced anticholinergic effects (e.g., tricyclic antidepressants, antihistamines, amantadine).
* **Dopamine antagonists:** May have antagonistic effects on GI motility (e.g., metoclopramide).
* **Tachycardia-inducing agents:** May enhance the heart rate-increasing effects of beta-adrenergic agents.
## Monitoring
* Monitor heart rate and blood pressure (especially post-IV administration).
* Assess for relief of spasm vs. progression of symptoms.
* Monitor urine output in elderly patients or those with prostatic hyperplasia.
## Clinical Pearls
* **Non-CNS effects:** Because it is a quaternary ammonium compound, it does not cause the sedation or confusion typical of scopolamine hydrobromide.
* **IV Administration:** When administered IV, inject slowly to avoid transient tachycardia or hypotension.
* **Acute Abdomen:** Exercise extreme caution; masking symptoms of an acute surgical abdomen (such as appendicitis or bowel obstruction) can delay necessary intervention.
***
**Educational Disclaimer:** This information is for educational purposes only. Always consult current institutional prescribing guidelines, local formularies, and the manufacturer’s product monograph before prescribing or administering any medication.
