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# Hyoscine butylbromide
## Overview
Hyoscine butylbromide (Scopolamine butylbromide) is a quaternary ammonium antispasmodic agent. Unlike hyoscine hydrobromide, it does not cross the blood-brain barrier significantly and thus has minimal CNS effects. It acts specifically on the muscarinic receptors in the smooth muscle of the gastrointestinal, biliary, and urinary tracts.
## Primary Indications
* Symptomatic relief of gastrointestinal (GI) or genitourinary (GU) spasms (e.g., irritable bowel syndrome, biliary colic).
* Diagnostic/radiological procedures (to induce hypotonia).
## Adult Dosing
* **Oral:** 10–20 mg three to four times daily. Maximum daily dose: 80–100 mg.
* **Parenteral (IM/IV/SC):** 20 mg as a single dose; may repeat after 30 minutes if necessary. Maximum daily dose: 100 mg.
## Pediatric Dosing
* **Children 6–12 years:** 10 mg orally three times daily.
* **Children <6 years:** Generally not recommended; dosage is not well-established for this population.
* *Note: Always verify doses against local pediatric hospital protocols or weight-based formulary guidelines.*
## Dose Adjustments
* **Renal/Hepatic Impairment:** No specific guidelines exist; use with caution. Reduced frequency or dose may be required in severe impairment due to decreased clearance.
## Contraindications
* Hypersensitivity to hyoscine butylbromide.
* Myasthenia gravis.
* Megacolon or paralytic ileus.
* Narrow-angle glaucoma.
* Prostatic hypertrophy with urinary retention.
* Pyloric stenosis or mechanical GI obstruction.
* Tachycardia and cardiac tachyarrhythmias.
## Adverse Effects
* **Common:** Dry mouth, xerophthalmia (dry eyes), blurred vision, tachycardia, constipation, and urinary retention.
* **Serious:** Anaphylaxis (rare), cardiac arrhythmias, and acute angle-closure glaucoma (in predisposed individuals).
## Key Drug Interactions
* **Anticholinergics/Tricyclic Antidepressants:** May enhance anticholinergic effects (dry mouth, urinary retention).
* **Metoclopramide:** Antagonistic effects on GI motility; monitor efficacy.
* **Tachycardia-inducing agents:** May exacerbate tachycardia risks.
## Monitoring
* Monitor GI symptoms, heart rate, and ability to void (especially in patients with BPH).
* Observe for signs of vision changes or confusion (though rare due to poor BBB penetration).
## Clinical Pearls
* **Onset/Duration:** Parenteral onset is rapid (minutes); oral onset is slower.
* **Systemic Absorption:** Poor systemic absorption following oral administration, which limits potential for systemic toxicity but maintains local efficacy in the gut.
* **Administration:** When given IV, inject slowly to avoid transient tachycardia or hypotension.
* **Not for CNS use:** Unlike the hydrobromide salt, it is not effective for motion sickness and lacks sedative properties.
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**Educational Disclaimer:** This information is for educational purposes only. Drug dosing, indications, and contraindications can vary by jurisdiction and clinical context. Always verify current prescribing information, institutional protocols, and patient-specific factors before administering any medication.
