Hyoscine Butylbromide ADMINISTRATION ROUTES: IV, PO, IM, SC

ALTERNATIVE NAMES: Buscopan, Gastro-Soothe

ICU INDICATIONS: 1. Gastrointestinal tract spasm

PRESENTATION AND ADMINISTRATION: IV: 20mg in 1ml (solution) Dilute required dose to 10ml with normal saline. Inject slowly over 3-5 minutes. Compatible with the following IV fluids: Normal saline, 5% glucose glucose and sodium chloride May be given into the side arm when the above IV fluids are being infused. Store at room temperature. Protect from light. IM or SC: Inject undiluted into a large muscle mass or subcutaneously PO: Buscopan 10mg (white) Gastro-Soothe 10mg (white)

DOSAGE: IV, IM, SC, PO: 20-40mg 6-8 hourly

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY: Dose as in normal renal function

DOSAGE IN PAEDIATRICS: IV 0.5mg/kg 6-8 hourly IV

CLINICAL PHARMACOLOGY: Buscopan exerts a spasmolytic action on the smooth muscle of the gastrointestinal, biliary and urinary tracts. As a quaternary ammonium derivative, hyoscine-N- butylbromide does not enter the central nervous system. Therefore, anticholinergic side effects at the central nervous system do not occur. Peripheral anticholinergic effects result from a ganglion-blocking action within the visceral wall as well as from anti- muscarinic activity.

CONTRAINDICATIONS: 1. 2. myasthenia gravis mechanical gastrointestinal tract obstruction

WARNINGS Tachycardia: Hyoscine butylbromide may cause marked tachycardia Urinary retention: Hyoscine butylbromide may precipitate urinary retention

PRECAUTIONS

General: Hyoscine butylbromide should not be given by intramuscular injection to patients being treated with anticoagulant drugs since intramuscular haematoma may occur. In these patients, the subcutaneous or intravenous routes may be used Laboratory Tests: No tests in addition to routine ICU tests are required Drug/Laboratory Test Interactions: None known

IMPORTANT DRUG INTERACTIONS FOR THE ICU The anticholinergic effect of drugs such as tricyclic antidepressants, antihistamines, quinidine, amantadine, disopyramide and other anticholinergics (e.g. tiotropium, ipratropium) may be intensified by Hyoscine-N-butylbromide. Concomitant treatment with dopamine antagonists such as metoclopramide may result in diminution of the effects of both drugs on the gastrointestinal tract. The tachycardic effects of beta-adrenergic agents may be enhanced by Hyoscine-Nbutylbromide

ADVERSE REACTIONS Body as a Whole: Anaphylactic shock, anaphylactoidic reactions and other hypersensitivity, skin reactions Cardiovascular: Tachycardia, hypotension, dizziness, flushing Respiratory: Dyspnoea Gastrointestinal: Dry mouth Renal and urinary disorders: Urinary retention