Hyoscine Butyl Bromide, Uses, Side effects, Dosage and Brands

Introduction

Hyoscine Butyl Bromide (scopolamine butylbromide) also known as Buscopan is an antispasmodic medication used to relieve abdominal pain and cramps associated with gastrointestinal conditions such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and other gastrointestinal disorders. It works by relaxing the smooth muscles in the gastrointestinal tract and reducing spasms and pain.

Hyoscine butyl bromide, initially registered in Germany in 1951 and subsequently introduced to the market in 1952, has evolved into a globally available medication. Its widespread availability extends to numerous countries, where it is accessible as a prescription pharmaceutical and an over-the-counter (OTC) remedy. This accessibility underscores its established role in the management of abdominal pain and discomfort associated with gastrointestinal conditions.

Mechanism of action

The mechanism of action of hyoscine butyl bromide involves its role as an antimuscarinic agent, specifically targeting muscarinic receptors in the smooth muscle tissue of the gastrointestinal tract. By competitively antagonizing these receptors, hyoscine butyl bromide interferes with the binding of acetylcholine, a neurotransmitter responsible for stimulating smooth muscle contraction.

As a result, the medication inhibits the downstream signalling pathways that would normally trigger muscular contractions, leading to the relaxation of the affected gastrointestinal muscles. This relaxation effect alleviates spasms and reduces the associated abdominal pain and discomfort. Additionally, hyoscine butyl bromide exhibits limited central nervous system penetration due to its quaternary ammonium structure.

Hyoscine butylbromide works by blocking muscarinic receptors on smooth muscle cells in the gastrointestinal tract and bladder. This action inhibits the effects of acetylcholine, a neurotransmitter that promotes smooth muscle contraction. As a result, hyoscine butylbromide causes relaxation of these muscles, relieving abdominal pain and cramping associated with conditions like irritable bowel syndrome (IBS) and urinary urgency.

Medical uses

Hyoscine butylbromide has several medical uses, primarily related to its ability to relax smooth muscles. Some of the medical uses of hyoscine butylbromide include:

• Relief of abdominal cramps and spasms: Hyoscine butylbromide is commonly used to relieve abdominal cramps and spasms associated with conditions such as irritable bowel syndrome (IBS), gastrointestinal disorders, and menstrual cramps.
• Diagnostic procedures: It is sometimes administered before diagnostic procedures such as colonoscopies, barium enemas, or certain imaging studies to reduce bowel motility and improve visualization of the gastrointestinal tract.
• Treatment of biliary colic: IT is used to alleviate the pain associated with biliary colic by relaxing the smooth muscles of the bile ducts.
• Relief of urinary tract spasms: It also be used to relieve spasms of the urinary tract, such as those caused by urinary tract infections or kidney stones.
• Management of motion sickness: In some cases, hyoscine butylbromide is used to alleviate symptoms of motion sickness.

Administration and Dosage

The administration and dosage of hyoscine butylbromide (also known as scopolamine butylbromide) can vary depending on the condition being treated and the individual patient’s needs. Here are some general guidelines:

Tablet Form

• Administration: Tablets are swallowed whole with a glass of water, preferably before meals.
• Dosage for Adults: 10 to 20 milligrams (mg) taken three to five times daily, as needed. The dosage may vary depending on the severity of symptoms and individual response to the medication.
• Dosage for Children: The dosage for children is based on their age and weight and should be determined by a healthcare professional. Pediatric dosages are typically lower than adult dosages.

Syrup Form

• Administration: Typically administered orally using a measuring spoon or syringe to ensure accurate dosage. Shake the bottle well before use to ensure proper mixing of the medication.
• Dosage: The dosage varies depending on the age, weight, and condition being treated. Pediatric dosages are typically lower than adult dosages and should be determined by a healthcare professional.

Injectable Form

• Intramuscular or Intravenous Injection: Administered as an injectable solution for intramuscular (IM) or intravenous (IV) use.
• Dosage: The dosage and frequency of administration will be determined by a healthcare professional based on the severity of symptoms and individual patient factors. Injectable formulations are often used when rapid relief is needed.

Dosage Adjustment

The dosage of hyoscine butyl bromide may need to be adjusted based on individual factors such as the patient’s age, renal function, and presence of other medical conditions.
Elderly patients or those with impaired renal function may require lower doses to reduce the risk of adverse effects.

Duration of Treatment

The duration of treatment with hyoscine butyl bromide varies depending on the underlying condition being treated and the patient’s response to therapy.
It is typically used for short-term relief of symptoms associated with gastrointestinal or genitourinary spasms and is not intended for long-term use.

Missed Dose

If a dose of hyoscine butyl bromide is missed, it should be taken as soon as possible. However, if it is almost time for the next scheduled dose, the missed dose should be skipped, and the regular dosing schedule resumed.
Patients should not double the dose to make up for a missed dose, as this can increase the risk of side effects.

Hyoscine Butyl Bromide Side Effects

Hyoscine butyl bromide, like any medication, can potentially cause side effects, although not everyone experiences them. Common side effects associated with hyoscine butyl bromide use :

• Dry Mouth: Hyoscine butyl bromide can reduce saliva production, leading to a dry mouth sensation. This can increase the risk of dental problems such as tooth decay and oral infections.
• Blurred Vision: Some individuals may experience blurred vision or difficulty focusing while taking it, This side effect can impair activities such as driving or operating machinery.
• Urinary Retention: It can interfere with normal bladder function, leading to difficulty urinating or urinary retention. This side effect is more common in men with prostate enlargement.
• Constipation: It slows down bowel movements and causes constipation. Increasing fluid intake and dietary fiber may help alleviate this side effect.
• Dizziness or Drowsiness: Some individuals experience dizziness or drowsiness while taking it, particularly when starting treatment or with higher doses. Avoiding activities that require mental alertness, such as driving or operating heavy machinery, is necessary.
• Increased Heart Rate (Tachycardia): This causes an increase in heart rate, or tachycardia, in some individuals. This side effect is usually mild and transient.
• Nausea or Vomiting: While hyoscine butyl bromide is often used to relieve gastrointestinal symptoms, such as nausea and vomiting, it can rarely cause these symptoms as side effects, especially when starting treatment.
• Allergic Reactions: In rare cases, individuals may experience allergic reactions to hyoscine butyl bromide, characterized by symptoms such as rash, itching, swelling, or difficulty breathing. Seek immediate medical attention if any signs of an allergic reaction occur.
• Confusion or Hallucinations: Although uncommon, hyoscine butyl bromide causes central nervous system effects such as confusion, hallucinations, or agitation, particularly in elderly individuals or those with pre-existing cognitive impairment.

when not to use

Hyoscine butylbromide is avoided or used with caution in individuals with allergies to the medication, narrow-angle glaucoma, urinary retention, severe gastrointestinal conditions like bowel obstruction, myasthenia gravis, pregnancy, breastfeeding, elderly patients, and those with renal or hepatic impairment. It also impairs driving and operating machinery due to its potential to cause drowsiness and blurred vision.

Pregnancy and breastfeeding

Hyoscine Butyl Bromide (Buscopan) is used cautiously during pregnancy and breastfeeding, and it is important to consult a healthcare provider before use.

• Pregnancy: Limited data are available on the use of hyoscine butylbromide in pregnancy. It is recommended only if there are no alternative treatments, as there is very little information about how it might affect the unborn baby. Studies have been conducted to assess the effectiveness of hyoscine butyl bromide in labor progress, showing its potential role in shortening the first stage of labour in primiparous women. Due to the limited data, caution is advised, and it is important to consult a healthcare professional before using hyoscine butyl bromide during pregnancy.
• Breastfeeding: It is unclear how much hyoscine butyl bromide gets into breast milk, but it’s likely to be a very small amount. If taken occasionally for a short time, for example for travel sickness, it’s generally considered safe to use while breastfeeding, and the baby does not need to be monitored for side effects. A safety score of 3 out of 8 has been assigned to hyoscine butylbromide for breastfeeding, indicating low risk. However, it may cause some minor side effects in breastfed babies, and monitoring for possible reactions is recommended.

Medication Interactions

Hyoscine hydrobromide is not to be taken with certain medicines such as domperidone or metoclopramide, which are used to increase the movement of food through the gut, as it can stop hyoscine hydrobromide from working properly.

Brands in Pakistan

Hyoscine Butylbromide is available under various brand names, each offering relief from abdominal cramps and spasms. Some of the prominent brand names for Hyoscine Butylbromide in Pakistan include:

1. Buscopan is Available in tablets, injectable solutions, and suppositories used for abdominal cramps and spasms.
2. Spasmocalm: Used for relieving abdominal cramps and spasms.
3. Hyocimax: Available in tablets and injections is used for abdominal cramps and spasms.
4. Scopinal: Available in tablet form is used for abdominal cramps and spasms.

Alternative medications

If Hyoscine Butyl Bromide (Buscopan) is not suitable or available, there are alternative medications that are used to relieve cramps and spasms in the stomach, intestines, and bladder. Some alternatives include:

• Dicyclomine (Bentyl): Dicyclomine is another antispasmodic medication used to treat irritable bowel syndrome (IBS) and other gastrointestinal conditions by reducing muscle spasms in the digestive tract.
• Mebeverine (Colofac): Mebeverine is an antispasmodic medication used to relieve symptoms of irritable bowel syndrome (IBS), including abdominal cramps, pain, and bloating.
• Peppermint oil: Peppermint oil is a natural remedy that may help alleviate symptoms of digestive discomfort, including cramps and spasms. It is available in enteric-coated capsules or as an essential oil.
• Antispasmodic herbs: Certain herbs, such as chamomile, fennel, and ginger, have been traditionally used to relieve digestive discomfort and may help reduce cramps and spasms in the gastrointestinal tract.
• Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin): These over-the-counter pain relievers may provide some relief from abdominal cramps and discomfort, although they do not directly target muscle spasms.
• Hyoscyamine (Levsin): Hyoscyamine is another antispasmodic medication that works similarly to Hyoscine Butyl Bromide and may be used to relieve symptoms of gastrointestinal spasms and cramps.