Makindo Medical Notes

⚠️ Do not confuse doses of Hyoscine butylbromide (Buscopan) with the much lower doses of Hyoscine hydrobromide.

📖 About

Always check the BNF links for up-to-date prescribing advice.

• 👓 Can cause blurred vision → may affect driving.
• Both are antimuscarinics (anticholinergics) but differ in sedation and clinical use.

⚙️ Mode of Action

• Blocks muscarinic receptors → ↓ parasympathetic activity.
• Effects: relaxation of smooth muscle, ↓ secretions, mydriasis, ↑ heart rate.

💊 Indications & Doses – Hyoscine Butylbromide (Buscopan)

• 🧘 Less sedative than hydrobromide.
• 💢 Bowel spasm, colic, excess secretions: 20 mg PO QDS.
• 💧 IBS: 10–20 mg PO TDS–QDS.
• ⚡ Acute spasm: 20 mg IM or slow IV, may repeat after 30 min.
• 🤲 Palliative excess secretions: 20–120 mg/24 h via SC infusion.
• 🤲 Palliative bowel colic: 60–300 mg/24 h via SC infusion.

💊 Indications & Doses – Hyoscine Hydrobromide

• 💤 More sedative than butylbromide (sometimes paradoxical agitation).
• 🤲 Palliative excess secretions: 1.2–2 mg/24 h SC infusion.
• 🤲 Palliative bowel colic: 1.2–2 mg/24 h SC infusion.

🔄 Interactions

• See antimuscarinic drug class.

⚠️ Cautions

• 🚗 Driving – may impair vision.
• 👴 Elderly more sensitive to confusion/drowsiness.
• 🤰 Use in pregnancy → seek specialist advice.

⛔ Contraindications

• ❤️ Tachycardia, thyrotoxicosis.
• 👨 Prostatism → risk of retention.
• 💪 Myasthenia gravis.
• 👁️ Closed-angle glaucoma.

🤒 Side Effects

• 👄 Dry mouth, ↓ secretions.
• 😴 Sedation, dizziness (more with hydrobromide).
• 👓 Blurred vision, dilated pupils.
• ❤️ Tachycardia, palpitations.
• 🚽 Urinary retention, ↓ sweating.
• 🩹 Allergic skin reactions (rare).

🧠 Teaching Pearls

💡 Buscopan (butylbromide) is widely used for bowel colic and IBS – it works peripherally and is not sedating.
💡 Hydrobromide is mainly palliative (secretions/colic), crosses the blood–brain barrier → more sedative.
👉 Exam trick: doses differ by a factor of ~100 (Buscopan mg vs Hydrobromide mcg–mg). Always double-check before prescribing.

📚 References

• BNF: Hyoscine butylbromide
• BNF: Hyoscine hydrobromide
• Katzung BG. Basic & Clinical Pharmacology, 15th Ed.