Hyoscine butylbromide

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Hyoscine butylbromide
Butylscopolamine skeletal.svg
Clinical data
Trade names Buscopan, others
Pregnancy
category
Routes of
administration
By mouth, rectal, intravenous
ATC code
Legal status
Legal status
Pharmacokinetic data
Bioavailability <1%
Protein binding Low
Elimination half-life 5 hours
Excretion Renal (50%)[citation needed] and fecal
Identifiers
CAS Number
PubChem CID
DrugBank
ChemSpider
UNII
ChEMBL
ECHA InfoCard 100.005.223 Edit this at Wikidata
Chemical and physical data
Formula C21H30NO4+
Molar mass 360.467 g/mol
3D model (JSmol)
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Hyoscine butylbromide, also known as scopolamine butylbromide[1] and sold under the brandname Buscopan,[2] is a medication used to treat crampy abdominal pain, esophageal spasms, renal colic, and bladder spasms.[3][4] It is also used to improve respiratory secretions at the end of life.[5] Hyoscine butylbromide can be taken by mouth, injection into a muscle, or into a vein.[2]

Side effects may include sleepiness, vision changes, dry mouth, rapid heart rate, triggering of glaucoma, and severe allergies.[3] Sleepiness however, is uncommon.[6] It is unclear if it is safe in pregnancy.[2] Greater care is recommended in those with heart problems.[7] It is an anticholinergic agent,[2] which does not have much effect on the brain.[8]

It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[9] It is not available in the United States,[10] and a similar compound methscopolamine may be used instead.[11] The wholesale cost in the developing world is 0.004 to 0.11 USD per pill as of 2014.[12] It is manufactured from hyoscine which occurs naturally in the plant deadly nightshade.[13]

Medical uses[edit]

A package of injectable buscopan

Hyoscine butylbromide is effective in treating crampy abdominal pain.[14]

Hyoscine butylbromide is effective in reducing the duration of the first stage of labour, and it is not associated with any obvious adverse outcomes in mother or neonate.[15]

It is also used during abdominal or pelvic MRI or CT scans to improve the quality of pictures.[16]

Side effects[edit]

As little of the medication crosses the blood brain barrier it has less effect on the brain and therefore has reduced occurrence of the centrally-mediated effects (such as delusions, somnolence, and inhibition of motor-functions) which hinder the usefulness of some other anticholinergic drugs.[8] Hyoscine butylbromide is still capable of impacting the chemoreceptor trigger zone due to the lack of a well-developed blood-brain-barrier in the medulla oblongata, which potentiates the antiemetic effects that it produces via local action on the smooth muscle of the gastrointestinal tract.[17]

Pharmacology[edit]

It is a quaternary ammonium compound and a semisynthetic derivative of hyoscine hydrobromide (scopolamine). The attachment of the butyl-bromide moiety effectively prevents the movement of this drug across the blood–brain barrier, effectively minimising undesirable central nervous system side effects associated with scopolamine/hyoscine.

Abuse[edit]

Hyoscine butylbromide is not centrally active and has a low incidence of abuse.[citation needed] In 2015, it was reported that prisoners at Wandsworth Prison and other UK prisons were smoking prescribed hyoscine butylbromide, releasing the potent hallucinogen scopolamine.[18][19] There have also been reports of abuse in Mashhad Central Prison in Iran.[20]

References[edit]

  1. ^ Juo, Pei-Show (2001). Concise Dictionary of Biomedicine and Molecular Biology (2nd ed.). Hoboken: CRC Press. p. 570. ISBN 9781420041309. Archived from the original on 2015-12-08. 
  2. ^ a b c d "Buscopan Tablets and Ampoules". Therapeutic Goods Administration, Australia. 8 November 2010. Archived from the original on 30 March 2017. Retrieved 22 October 2013. 
  3. ^ a b "Hyoscine butylbromide SXP". www.ebs.tga.gov.au. 3 July 2017. Retrieved 15 March 2018. 
  4. ^ Hamilton, Richart (2015). Tarascon Pocket Pharmacopoeia 2015 Deluxe Lab-Coat Edition. Jones & Bartlett Learning. p. 270. ISBN 9781284057560. 
  5. ^ Paice, Judith (2015). Care of the Imminently Dying. Oxford University Press. p. 43. ISBN 9780190244309. Archived from the original on 2015-12-08. 
  6. ^ Handbook of Palliative Care (3rd ed.). New York: Wiley. 2012. p. 570. ISBN 9781118426814. Archived from the original on 2015-12-08. 
  7. ^ "Hyoscine butylbromide (Buscopan) injection: risk of serious adverse effects in patients with underlying cardiac disease". www.gov.uk. 20 February 2017. Retrieved 15 March 2018. hyoscine butylbromide injection should be used with caution in patients with cardiac disease 
  8. ^ a b Hanks, Geoffrey (2011). Oxford textbook of palliative medicine (4th ed.). Oxford [etc.]: Oxford University Press. p. 805. ISBN 9780199693146. Archived from the original on 2015-12-08. 
  9. ^ "WHO Model List of Essential Medicines (19th List)" (PDF). World Health Organization. April 2015. Archived (PDF) from the original on 13 December 2016. Retrieved 8 December 2016. 
  10. ^ Territo, editor, Dennis A. Casciato ; associate editor, Mary C. (2012). Manual of clinical oncology (7th ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health. p. 146. ISBN 9781451115604. Archived from the original on 2015-12-08. 
  11. ^ Satoskar, R. S.; Rege, S. D. Bhandarkar &nirmala N. (1973). Pharmacology and Pharmacotherapeutics. Popular Prakashan. p. 296. ISBN 9788179915271. 
  12. ^ "Hyoscine Butylbromide". International Drug Price Indicator Guide. Archived from the original on 10 May 2017. Retrieved 4 December 2015. 
  13. ^ Twycross, Robert (2003). Introducing palliative care (4th ed.). Oxford: Radcliffe Medical Press. p. 172. ISBN 9781857759150. Archived from the original on 2015-12-08. 
  14. ^ Tytgat, G. N. (2007). "Hyoscine Butylbromide: A Review of its Use in the Treatment of Abdominal Cramping and Pain". Drugs. 67 (9): 1343–1357. doi:10.2165/00003495-200767090-00007. PMID 17547475. 
  15. ^ Samuels, L. A.; Christie, L.; Roberts-Gittens, B.; Fletcher, H.; Frederick, J. (2007). "The effect of hyoscine butylbromide on the first stage of labour in term pregnancies". BJOG. 114 (12): 1542–1546. doi:10.1111/j.1471-0528.2007.01497.x. PMID 17903230. 
  16. ^ "Hyoscine butylbromide (Buscopan®)" (PDF). UK: Guy's and St Thomas' NHS Foundation Trust. July 2014. Archived (PDF) from the original on 8 August 2016. Retrieved 16 June 2016. 
  17. ^ Paul Glare, Jeanna Miller, Tanya Nikolova, and Roma Tickoo (12 September 2011). "Treating nausea and vomiting in palliative care: a review". Clinical Interventions in Aging. 6: 243–59. doi:10.2147/CIA.S13109. PMC 3180521Freely accessible. PMID 21966219. 
  18. ^ "Medics warned to review Buscopan prescriptions after prisoners found smoking it". Pulse Today. Retrieved 2018-02-07. 
  19. ^ Optimisation, NECS Medicines. "Misuse of hyoscine butylbromide (Buscopan)". medicines.necsu.nhs.uk. Retrieved 2018-02-07. 
  20. ^ Jalali, Farzad; Afshari, Reza; Babaei, Ali (June 2014). "Smoking crushed hyoscine/scopolamine tablets as drug abuse". Substance Use & Misuse. 49 (7): 793–797. doi:10.3109/10826084.2014.880178. ISSN 1532-2491. PMID 24494624.