Being a
quaternary ammonium compound derived from
scopolamine, the
alkaloid hyoscine butylbromide (HBB) exerts
anticholinergic effects without side effects related to the central nervous system because it does not pass the blood-brain barrier. Clinical experience with this
antispasmodic dates back to the 1950s and led to its registration for treating
abdominal cramps/
spasm and for diagnostic imaging purposes. OBJECTIVES AND SCOPE: This review focuses on the therapeutic efficacy and safety of the parenteral administration of HBB for treating biliary and
renal colic and acute
spasm in the genito-urinary tract. In addition, its value for diagnostic or therapeutic procedures in the abdomen, as well as for labour and
palliative care, is reviewed. With the generic and trade name of the
drug combined with various search terms related to the relevant clinical applications, a thorough literature search was performed in the Medline and EMBASE databases in April 2008.
FINDINGS: In most clinical studies, recommended doses of 20-40 mg HBB were injected, mainly intravenously. Fast
pain reduction was achieved by HBB in
renal colic; about 90% of the patients showed good to moderate
analgesic responses after 30 min and the onset of action was noticeable within 10 min. Similarly, a
pain reduction of 42-78% was observed in patients with biliary
colic within 30 min after a single
intravenous injection of 20 mg. In contrast, no
analgesic efficacy of a single injection of 20 mg was found after surgical or
shock-wave procedures in the urogenital area. Administration of HBB prior to, or during, radiological imaging distended the gastrointestinal (GI) tract in double-contrast
barium and computed tomographic colonography studies and reduced motion artefacts in magnetic resonance imaging. This improved diagnostic image quality and organ visualisation. Pre-medication led to shorter and easier endoscopy in some, but not all, studies. Because of cervical relaxation, HBB shortened total labour duration with 17-67%. It also relieved
pain and reduced GI secretions in terminal
cancer patients with inoperable bowel obstruction. With regard to its safety profile, parenteral administration of HBB is associated with mild and self-limiting adverse events, typical for
anticholinergic drugs.
CONCLUSIONS: These clinical results of rapid action and beneficial efficacy combined with good tolerability support the use of HBB in a range of indications related to acute abdominal
spasm, in labour and
palliative care and for supporting diagnostic and therapeutic abdominal procedures, where
spasm may be a problem.