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Introduction: Drotaverine, paracetamol, and peppermint oil are often prescribed for the treatment of gastrointestinal spasm and pain. This study aimed to evaluate the effect of these drugs alone and combined with the well-known antispasmodic hyoscine butylbromide on the human colon. Methods: Colon samples were obtained from macroscopically normal regions of 68 patients undergoing surgery and studied in muscle bath. Drotaverine, paracetamol, and peppermint oil were tested alone and in combination with hyoscine butylbromide on (1) spontaneous contractility induced by isometric stretch (in the presence of 1 µM tetrodotoxin) and (2) contractility induced by 10-5 M carbachol and after (3) electrical field stimulation-induced selective stimulation of excitatory (in the presence of 1 mM Nε-nitro-L-arginine and 10 µM MRS2179) and (4) inhibitory (under non-adrenergic, non-cholinergic conditions) pathways. (5) Drotaverine alone was also tested on cAMPdependent pathway activated by forskolin. Results: Compared with the vehicle, drotaverine and paracetamol (10-9-10-5 M) did not modify spontaneous contractions, carbachol-induced contractions, and responses attributed to selective activation of excitatory pathways. The addition of hyoscine butylbromide (10-7-10-5 M), concentration-dependently reduced myogenic contractions and carbachol- and electrical field stimulation-induced contractile responses. The association of paracetamol (10-4 M) and hyoscine butylbromide (10-7-10-5 M) was not different from hyoscine butylbromide alone (10-7-10-5 M). At higher concentrations (10-3M-3*10-3 M), paracetamol decreased myogenic and carbachol-induced contractions. The adenylate cyclase activator, forskolin, concentration-dependently reduced contractility, leading to smooth muscle relaxation. The effect of forskolin 10-7 M was concentration-dependently enhanced by drotaverine (10-6M-10-5M). Discussion: Peppermint oil reduced myogenic activity and carbachol- and electrical field stimulation-induced contractions. The association of hyoscine butylbromide and peppermint oil was synergistic since the interaction index measured with the isobologram was lower than 1. No effect was seen on the neural-mediated inhibitory responses with any of the drugs studied although peppermint oil reduced the subsequent off-contraction. Drotaverine and hyoscine butylbromide have a complementary effect on human colon motility as one stimulates the cAMP inhibitory pathway and the other inhibits the excitatory pathway. Peppermint oil is synergic with hyoscine butylbromide suggesting that a combination therapy may be more effective in treating patients. In contrast, at therapeutic concentrations, paracetamol does not modify colonic contractility, suggesting that the association of paracetamol and hyoscine butylbromide has independent analgesic and antispasmodic properties. [ABSTRACT FROM AUTHOR]

IntroductionDrotaverine, paracetamol, and peppermint oil are often prescribed for the treatment of gastrointestinal spasm and pain. This study aimed to evaluate the effect of these drugs alone and combined with the well-known antispasmodic hyoscine butylbromide on the human colon.MethodsColon samples were obtained from macroscopically normal regions of 68 patients undergoing surgery and studied in muscle bath. Drotaverine, paracetamol, and peppermint oil were tested alone and in combination with hyoscine butylbromide on (1) spontaneous contractility induced by isometric stretch (in the presence of 1 µM tetrodotoxin) and (2) contractility induced by 10–5 M carbachol and after (3) electrical field stimulation-induced selective stimulation of excitatory (in the presence of 1 mM Nω-nitro-L-arginine and 10 µM MRS2179) and (4) inhibitory (under non-adrenergic, non-cholinergic conditions) pathways. (5) Drotaverine alone was also tested on cAMP-dependent pathway activated by forskolin.ResultsCompared with the vehicle, drotaverine and paracetamol (10−9–10−5 M) did not modify spontaneous contractions, carbachol-induced contractions, and responses attributed to selective activation of excitatory pathways. The addition of hyoscine butylbromide (10−7–10−5 M), concentration-dependently reduced myogenic contractions and carbachol- and electrical field stimulation-induced contractile responses. The association of paracetamol (10−4 M) and hyoscine butylbromide (10−7–10−5 M) was not different from hyoscine butylbromide alone (10−7–10−5 M). At higher concentrations (10−3M–3*10−3 M), paracetamol decreased myogenic and carbachol-induced contractions. The adenylate cyclase activator, forskolin, concentration-dependently reduced contractility, leading to smooth muscle relaxation. The effect of forskolin 10–7 M was concentration-dependently enhanced by drotaverine (10−6M–10−5M).DiscussionPeppermint oil reduced myogenic activity and carbachol- and electrical field stimulation-induced contractions. The association of hyoscine butylbromide and peppermint oil was synergistic since the interaction index measured with the isobologram was lower than 1. No effect was seen on the neural-mediated inhibitory responses with any of the drugs studied although peppermint oil reduced the subsequent off-contraction. Drotaverine and hyoscine butylbromide have a complementary effect on human colon motility as one stimulates the cAMP inhibitory pathway and the other inhibits the excitatory pathway. Peppermint oil is synergic with hyoscine butylbromide suggesting that a combination therapy may be more effective in treating patients. In contrast, at therapeutic concentrations, paracetamol does not modify colonic contractility, suggesting that the association of paracetamol and hyoscine butylbromide has independent analgesic and antispasmodic properties.

Abstract Background Butylscopolamine (or hyoscine butylbromide, trade name Buscopan®) is occasionally administered as a premedication to reduce non-specific FDG uptake in the gastrointestinal tract based on its antiperistaltic effect. To date, there are no consistent recommendations for its use. The aim of this study was to quantify the reduction in intestinal and non-intestinal uptake by butylscopolamine administration and to derive relevance for clinical evaluation. Results 458 patients (PET/CT for lung cancer) were retrospectively reviewed. 218 patients with butylscopolamine and 240 patients without butylscopolamine had comparable characteristics. While the SUVmean in the gullet/stomach and small intestine was significantly reduced with butylscopolamine, the colon and rectum/anus showed no difference. The liver and salivary glands showed a reduced SUVmean, while skeletal muscle and blood pool were unaffected. An effect of butylscopolamine was particularly evident in men and patients under 65 years of age. There was no difference in the perceived confidence in the assessment of intestinal findings in the subjective evaluation, although in the butylscopolamine group further diagnostics appeared advisable more frequently. Conclusions Butylscopolamine reduces gastrointestinal FDG accumulation only in selected segments and, despite a significant effect, only to a small extent. A general recommendation for the use of butylscopolamine cannot be derived from these results, its use for specific issues could be considered individually.

Background: A treatment called hysteroscopy is used to examine and treat a number of gynecological issues. Objective: To compare misoprostol versus hyoscine butylbromide as a cervical priming agent in patients underlying hysteroscopy. Patients and methods: This randomized controlled clinical trial was carried out on 82 participants who were scheduled for operative hysteroscopy at Obstetrics and Gynecology Department, Zagazig University Hospitals. All participants in our study were divided randomly for cervical ripening prior to hysteroscopy into two groups; Group (A): Misoprostol was administrated (n=41), Group (B): Hyoscine butylbromide was administrated (n= 41). All patients were subjected to full history taking, routine clinical examination and laboratory investigations. The cervical priming agent was administrated 2 hours before the scheduled hysteroscopy. Results: There was no statistically significant difference between the two studied groups regarding age, height, weight, BMI, the mean parity, previous history of CS, history of abortion, the diagnosis, the procedure time, and anesthesia. Cervical dilatation width was significantly higher among group A while cervical dilatation time was significantly lower among group A than group B. The self-reported pain was significantly higher among group A than group B. Nearly 44% of the participants of group A needed postoperative analgesia administration, while only 12.2% of group B needed postoperative analgesia administration. Conclusion: Hyoscine butylbromide is as effective as misoprostol as a cervical priming agent in patients undergoing operative hysteroscopy with less need for postoperative pain medication and postoperative complications. [ABSTRACT FROM AUTHOR]

Background: Butylscopolamine (or hyoscine butylbromide, trade name Buscopan®) is occasionally administered as a premedication to reduce non-specific FDG uptake in the gastrointestinal tract based on its antiperistaltic effect. To date, there are no consistent recommendations for its use. The aim of this study was to quantify the reduction in intestinal and non-intestinal uptake by butylscopolamine administration and to derive relevance for clinical evaluation. Results: 458 patients (PET/CT for lung cancer) were retrospectively reviewed. 218 patients with butylscopolamine and 240 patients without butylscopolamine had comparable characteristics. While the SUVmean in the gullet/stomach and small intestine was significantly reduced with butylscopolamine, the colon and rectum/anus showed no difference. The liver and salivary glands showed a reduced SUVmean, while skeletal muscle and blood pool were unaffected. An effect of butylscopolamine was particularly evident in men and patients under 65 years of age. There was no difference in the perceived confidence in the assessment of intestinal findings in the subjective evaluation, although in the butylscopolamine group further diagnostics appeared advisable more frequently. Conclusions: Butylscopolamine reduces gastrointestinal FDG accumulation only in selected segments and, despite a significant effect, only to a small extent. A general recommendation for the use of butylscopolamine cannot be derived from these results, its use for specific issues could be considered individually. [ABSTRACT FROM AUTHOR]

Background: Hyoscine butylbromide (HBB) has been available for use as an antispasmodic since 1951 and is indicated for the treatment of abdominal pain associated with cramps. A previous review in 2007 summarized the evidence on the mode of action of HBB in vitro and in vivo in both animal and human studies. However, since then, novel publications have appeared within the literature and also our knowledge of what represents normal motility in humans has evolved. Purpose: This review is the result of the collaboration between a basic scientist and clinicians with the aim of providing an updated overview of the mechanisms of action of HBB and its clinical efficacy to guide not only use in clinical practice, but also future research. [ABSTRACT FROM AUTHOR]

Two spectrometric methods and a TLC-densitometric method are described for the determination of hyoscine/ketoprofen combination. A new spectrophotometric method called the co-absorptive point has been explained based on the idea of the isosbestic point. This method has been introduced to resolve the overlapped spectra and the challenging drug ratios found in the mentioned dosage form. Also, a dual wavelength technique measuring at 208.4 and 218.2 nm was explained. In the two spectrometric techniques, ketoprofen was determined by zero-order spectra, while hyoscine was determined by co-absorptive point and dual wavelength techniques with linearity ranges of 8–100 and 8–70 µg/mL. In the TLC-densitometric method, the developing phase was methanol-ethyl acetate-ammonia (35 : 65 : 5, v/v) with linearity ranges of 1–20 and 5–25 µg/mL for hyoscine and ketoprofen, respectively. The greenness of the described techniques was assessed according to the eco-scale and compared to previously reported methods. [ABSTRACT FROM AUTHOR]

This paper reports a systematic review and meta-analysis of the effectiveness of hyoscine-N-butylbromide (HBB) administration in hysterosalpingography (HSG). Four electronic databases were searched for randomised controlled trials (RCTs) that compared HBB versus placebo or no intervention in infertile women undergoing HSG. Pain during and after HSG and different adverse events including nausea, vomiting, and dizziness were evaluated. Three RCTs with 335 patients were included. The analysis showed HBB was significantly effective in reducing pain during and after HSG (MD = −0.76 mm, 95% CI [−1.35, −0.17], p = 0.01) and (MD = −0.81 mm, 95% CI [−1.07, −0.56], p < 0.001), respectively. There were no significant differences in adverse events between HBB and control groups. The methodological evidence quality was high as evaluated by GRADEpro. In conclusion, this review provides good evidence that prior administration of HBB is effective in reducing induced pain during and after HSG with tolerable side effects. [ABSTRACT FROM AUTHOR]

Abstract Hyoscine butylbromide–induced pyschosis, though rare, should be considered in a child presenting with deteriorating cognitive functions and psychotic features acutely as evident in our case of a 9‐year‐old child taking hyoscine for her non‐specific abdominal pain.

• Ultrasound-guided manual vacuum aspiration causes painful uterine contraction. • Abdominal pain during USG-MVA is insignificantly reduced by hyoscine butylbromide. • Alternative anti-spasmodics or higher dosage should be investigated. What is the effect of adding an anti-spasmodic drug to an existing ultrasound-guided manual vacuum aspiration (USG-MVA) protocol to alleviate immediate post-procedure abdominal cramping pain in women treated for early pregnancy loss? Double-blind, placebo-controlled, randomized controlled trial conducted between February 2018 and January 2020. Participants were assigned to receive a 1-ml intravenous injection containing 20-mg hyoscine butylbromide (HBB) (n=55) or saline (n =56) as a control immediately before USG-MVA. Primary outcome was reduced abdominal pain after adding a 20-mg dose of HBB to the current pain control regimen. Secondary outcomes were vaginal pain, complications and side-effects, women's pre- and post-procedure psychological state, physiological stress (saliva alpha-amylase) and procedure pain control satisfaction. Two-way mixed ANOVA was used to evaluate the main effects and interactions. VAS abdominal pain scores in the HBB group were 16% lower immediately after and 21% lower 2 h after surgery (not statistically significant). Two-way ANOVA indicated that time (F[ 1108 ] = 83.41, P < 0.001) was the only significant main effect for reduced abdominal pain after the procedure and vaginal pain score (F [1108] = 180.1, P < 0.0001) but not drug received. No adverse events were reported. No significant difference was found for psychological state, physiological stress and procedure pain control satisfaction between the two groups. Anti-spasmodic drugs can help to reduce abdominal cramping pain associated with USG-MVA; HBB produced an insignificant decrease in abdominal pain score. Further studies with longer acting or larger doses of anti-spasmodic drugs are warranted. [ABSTRACT FROM AUTHOR]

Objective: To assess the safety and efficacy of hyoscine butyl bromide (HBB) in primipara with prolonged 1st stage of labor. Materials and methods: A double-blinded randomized controlled trial included 100 primiparas diagnosed with prolonged labor. They were randomly divided two equal groups. Group I received 40 mg HBB intravenously. Group II received 2 ml of normal saline. The primary outcome was the duration of the 1st stage of labor. Secondary outcomes included success of vaginal delivery, rate of cervical dilation, duration of 2nd and 3rd stages of labor, causes of CS, neonatal outcome and drug side effects. Results: The duration of the 1st stage was 322.3 ± 89.8 min in women who received HBB compared with 451.3 ± 198.3 min in the control women (P < 0.001). The rate of cervical dilation was increased from 0.4 ± 0.2 to 1.5 ± 0.6 in women who received HBB compared with its increase from 0.4 ± 0.1 to 0.9 ± 0.2 in other women (P < 0.001). The rate of CS were significantly higher in control women when compared to those received HBB (34 vs. 20%, P < 0.001). The commonest indication for the operation was arrest of cervical dilatation (28 and 16%, respectively). Conclusion: HBB is associated with shortening of the 1st stage, lowered rate of CS without any side effects. Clinical trial.gov ID: NCT03430362 date of registration 6 February 2018. Synopsis Hyoscine butyl bromide is associated with shortening of the 1st stage, lowered rate of CS in primiparas with prolonged labor. [ABSTRACT FROM AUTHOR]

Purpose: Bowel motion is a significant source of artifacts in mouse abdominal MRI. Fasting and administration of hyoscine butylbromide (BUSC) have been proposed for bowel motion reduction but with inconsistent results and limited efficacy assessments. Here, we evaluate these regimes for mouse abdominal MRI at high field. Methods: Thirty‐two adult C57BL/6J mice were imaged on a 9.4T scanner with a FLASH sequence, acquired over 90 min with ~19 s temporal resolution. During MRI acquisition, 8 mice were injected with a low‐dose and 8 mice with a high‐dose bolus of BUSC (0.5 and 5 mg/kg, respectively). Eight mice were food deprived for 4.5‐6.5 hours before MRI and another group of eight mice was injected with saline during MRI acquisition. Two expert readers reviewed the images and classified bowel motion, and quantitative voxel‐wise analyses were performed for identification of moving regions. After defining the most effective protocol, high‐resolution T2‐weighted and diffusion‐weighted images were acquired from 4 mice. Results: High‐dose BUSC was the most effective protocol for bowel motion reduction, for up to 45 min. Fasting and saline protocols were not effective in suppressing bowel motion. High‐resolution abdominal MRI clearly demonstrated improved image quality and ADC quantification with the high‐dose BUSC protocol. Conclusion: Our data show that BUSC administration is advantageous for abdominal MRI in the mouse. Specifically, it endows significant bowel motion reduction, with relatively short onset timings after injection (~8.5 min) and relatively long duration of the effect (~45 min). These features improve the quality of high‐resolution images of the mouse abdomen. [ABSTRACT FROM AUTHOR]

Hyoscine butylbromide (HBB) is one of the most used antispasmodics in clinical practice. Recent translational consensus has demonstrated a similarity between human colonic motor patterns studied ex vivo and in vivo, suggesting ex vi vo can predict in vivo results. It is unclear whether the mechanism of action of antispasmodics can predict different use in clinical practice. The aim of the present study is to bridge this gap dissecting HBB's role in excitatory and inhibitory neural pathways. Methods: 309 colon samples from 48 patients were studied in muscle bath experiments. HBB was tested on: 1-spontaneous phasic contractions (SPCs); 2-carbachol-induced contractility; electrical field stimulation (EFS)-induced selective stimulation of 3-excitatory and 4-inhibitory pathways and 5- SPCs and EFS-induced contractions enhanced by neostigmine. Atropine, AF-DX116 (M2 blocker) and DAU-5884 (M3 blocker) were used as comparators. In the presence of tetrodotoxin (TTX), HBB and atropine 1 μM reduced SPCs. HBB and atropine concentration-dependently reduced carbachol- and EFS-induced contractions. Inhibitory effects of DAU-5884 on EFS-induced contractions were more potent than of AF-DX116. HBB did not affect the off-response associated to neural inhibitory responses. Neostigmine enhanced both SPCs and EFS-induced contractions. In the presence of TTX and ω-conotoxin (GVIA), neostigmine still enhanced SPCs. Addition of HBB and atropine reduced these responses. This study demonstrates that HBB inhibits neural cholinergic contractions associated to muscarinic (mainly M3) receptors. HBB has a potential role in reducing colonic spasm induced by the release of acetylcholine from enteric motor neurons and from an atypical source including a potential non-neuronal origin. • Hyoscine Butylbromide (HBB) reduced colonic contractions. • The receptor involved in the response is mainly the M3 muscarinic receptor. • Neural-mediated relaxation and its off-contraction were unaffected by HBB. • After neural blockade, HBB reduced contractions enhanced with neostigmine. • HBB reduces spasms of neural and potentially non-neural origin. [ABSTRACT FROM AUTHOR]

Background Cervical dilation is indicated prior to performing various gynecological procedures. However, gynecologists are at times confronted with a stenotic or tight cervix, resistant to dilation. This can be problematic particularly when cervical ripening has not been attempted hours before the start of the procedure. Objective The objective of this study is to investigate the efficacy of administration of hyoscine butylbromide for cervical dilation for immediate dilation of the tight or stenotic cervix. Materials and Methods In this clinical trial study, a population of 40 women, aged 20-70 yr with stenotic cervix, evidenced by resistance to pass dilator #2 through their cervical canal were compared. Cervical patency was assessed 10 min following intra-cervical canal instillation of hyoscine butylbromide. Results Cervical width of 57.5% of patients became wider, as evidenced by passage of the number 4 Hegar dilator through the cervical canal without resistance. Independent T-tests did not reveal any statistically significant difference between the two groups based on their age. Fisher Exact test revealed a statistically significant difference between the two groups based on the prior route of delivery, with a more statistically significant response in patients who had vaginal deliveries. Conclusion Intra-cervical canal instillation of hyoscine butylbromide is effective in immediate dilation of the tight or stenotic cervix during intra-uterine procedures.

A stability indicating method was developed and validated for the quantitative simultaneous estimation of hyoscine butylbromide (HBB) and paracetamol (PAR) in a combined dosage form by means of isocratic reverse-phase high-performance liquid chromatography (RP-HPLC). Separation was performed on a YMC C18 (250 × 4.6 mm, 5 μm) column using phosphate buffer–Methanol (60:40, v/v) in the isocratic elution regime at a flow rate of 1 mL/min. Quantification was achieved with UV detection at 210 nm. The retention time obtained for HBB was 9.509 min and that for PAR was 4.198 min in a continuous run up to 20 min. The detector response was found to be linear in a concentration range of 2.5 – 7.5 μg/mL for HBB and 125 – 375 μg/mL for PAR. The proposed method was validated as per ICH guidelines and shown to be specific, precise, linear, accurate, and robust. The samples were subjected to various accelerated stress conditions. The degradation products were well resolved at significantly different retention times. Thus, the proposed method can be applied successfully for the simultaneous estimation of PAR and HBB in combined pharmaceutical formulations and for their stability studies. [ABSTRACT FROM AUTHOR]

Trimethyl chitosan (TMC) has demonstrated effectiveness as an absorption enhancer for hydrophilic and high molecular weight (MW) drugs across the intestinal epithelium. However, the effects of degrees of quaternization (DQ) of TMC on the absorption of negatively and positively charged drugs have not been investigated. This investigation aimed to determine the properties of the tablets formulated using TMC with different DQ. In this study, TMC with DQ of 20 % (TMC-20), 40 % (TMC-40) and 60 % (TMC-60) were synthesized and subsequently characterized. Cetirizine dihydrochloride (CHC) and hyoscine butylbromide (HBB) were used as negatively and positively charged model drugs. Eight tablet formulations were prepared using the wet granulation method. The formulated tablets were evaluated regarding their properties in terms of thickness and hardness, weight variation, disintegration time, and dissolution profile. These tablets were evaluated according to the standards set by the United States Pharmacopeia (USP41) guidelines. The results showed that TMC with all DQ have the MW and an intrinsic viscosity less than starting chitosan. The MW and an intrinsic viscosity of the synthesized TMC decreased with increasing DQ. In order to evaluate the effect of TMC with various DQ on the properties of the formulated tablets, all tablet formulations prepared had good characteristics and were found to be within the acceptable range based on the requirements of USP. In conclusion, TMC had a minor retarding effect on the dissolution profiles of CHC from the formulated tablets. Still, TMC was able to significantly delay the release of HBB from the formulated tablets (p > 0.05). When TMC with various DQ were compared, TMC-60 showed higher drug release than TMC-20 and TMC-40. In our study, we observed a possible interaction between the model drugs and TMC. This warrants the need for further studies. [ABSTRACT FROM AUTHOR]

Hyoscine butylbromide–induced pyschosis, though rare, should be considered in a child presenting with deteriorating cognitive functions and psychotic features acutely as evident in our case of a 9‐year‐old child taking hyoscine for her non‐specific abdominal pain. Through this case, we hope to communicate the notion that every practitioner should be aware of common medicines with anticholinergic effects, and drug‐induced psychosis should be investigated in young patients with acute behavioral abnormalities. [ABSTRACT FROM AUTHOR]

Multiple eccrine hidrocystomas are uncommon benign cystic lesions with a non-remitting clinical course marked by episodic erythema, a burning sensation, and exacerbations during warm weather, which is often distressing. Females are affected more often than males aged between 30 and 70 years. Surgical excision is curative for solitary lesions but most treatments for multiple lesions remain frustrating for both the patient and the clinician. This 47-year-old female with classic multiple eccrine hidrocystomas became completely asymptomatic after treatment with topical 0.5% hyoscine butylbromide without the adverse effects of anticholinergic drugs. It appears to be a safe, effective, and cosmetically elegant treatment option for multiple eccrine hidrocystomas, but needs further evaluation. [ABSTRACT FROM AUTHOR]

The aim of review. To present the diagnostic and treatment algorithm for abdominal pain at out-patient/ polyclinic healthcare institutions and to demonstrate potential of hyoscine butylbromide application during diagnostic process and for relief of abdominal pain at irritable bowel syndrome.Summary. From 20% to 50% of all admissions to medical institutions are related to abdominal spasms and pain caused by irritable bowel syndrome (IBS). According to the Clinical guidelines of the Russian gastroenterological association and abdominal pain management algorithm at outpatient reception, the doctor on the basis of interviewing, inspection and physical data first of all should exclude acute abdominal diseases (acute pain, parietal pain) requiring urgent examination by the surgeon or gynecologist and subsequent hospitalization. In the case of visceral pain the minimal range of laboratory and instrumental tests is indicated. If the history of visceral pain is more than 6 months and there are no alarm symptoms, doctor should define specific features of clinical presentation already during outpatient visit, taking into account pain location, that provides formulation of preliminary diagnosis. Epigastric pain (dyspepsia), biliary pain, abdominal pain which can be accompanied by impaired frequency and consistency of stool determine the further investigation plan. Implementation of diagnostic algorithm allows to distinguish the organic disease or to establishthe diagnosis of functional disease. Hyoscine butylbromide at short-term treatment will relieve abdominal spasm as a symptomatic agent. Course treatment effectively reduces intensity and frequency of abdominal pain at IBS. The rate of adverse events and tolerability of hyoscine butylbromide are comparable to that of placebo.Conclusion. Symptomatic treatment by antispasmodic drugs is justified from the moment of referral for medical aid to outpatient department. Hyoscine butylbromide can be prescribed for relief of acute and chronic pain at any stage of diagnostic process. Course intake of antispasmodics has proved its efficacy for pain relief at IBS.

Context: Death rattle (DR) is a dramatic sign in the dying patient. Existing studies with anticholinergic agents are controversial, as this class of drugs has been commonly administered without considering the rationale of the mechanism of action. A meaningful use of these drugs may provide a better outcome.Objectives: The aim of this study was to assess the efficacy of hyoscine butylbromide (HB), given prophylactically in comparison with HB administered once DR occurs.Methods: Dying patients having a score of ≥3 in the Richmond Agitation-Sedation Scale-palliative version were included in the study. HB (60 mg/day) was given when DR occurred (Group 1) or as pre-emptive treatment (Group 2). The onset of DR (death rattle free time) and intensity of DR were recorded at intervals until death.Results: Eighty-one and 51 patients were randomized to Group 1 and 2, respectively. Patients in Group 2 survived longer than those in Group 1 (P < 0.05). DR occurred in 49 (60.5%) and three patients (5.9%) in Group 1 and 2, respectively (P = 0.001). A significant difference in the number of patients reporting DR was found at intervals examined (30 minutes, one hour, and then every six hours until death [P = 0.001]). In Group 1 and 2, DR free time was 20.4 (20.5) and 27.3 hours (25.2), respectively (P = 0.001). In Group 1, the treatment was considered effective in 10 patients (20.4%) only, after a mean of 14.4 hours (SD 8.57).Conclusion: The prophylactic use of HB is an efficient method to prevent DR, whereas the late administration produces a limited response, confirming data from traditional studies performed with anticholinergics. This could be considered a new paradigm to manage a difficult and dramatic sign, such as DR. [ABSTRACT FROM AUTHOR]

Objective: To assess the effect of hyoscine butylbromide (HBB) on duration of the first stage of labor in primigravdae.Methods: A case-control study conducted on 120 primigravida at term admitted in active labor were divided into three equal groups. A single dose of the drug (placebo or HBB 20 mg or HBB 40 mg) was injected intravenously slowly to groups A, B, and C. The duration of the first stage was calculated from the time of cervical dilatation of three to four centimeters in active labor until a fully dilated cervix was observed.Results: The duration of first stage was significantly shorter in women receiving 20 and 40 mg of HBB when controlled to control women (187.73 ± 20.92, 186.41 ± 19.40 versus 231.39 ± 33.14 min). There was no significant difference between the three study groups regarding duration of the second stage (36.76 ± 9.98, 35.72 ± 9.97 and 37.55 ± 10.57, respectively, p > .05), number of cases delivered by cesarean section (12.5%, 12.5%, and 15%, respectively, p > .05) and Apgar score of the neonates (p > .05). There was no significant difference between the three study groups regarding occurrence of side effects named dry mouth (7.5%, 12.5%, and 5%, p > .05), flushing (2.5%, 5% and 0%, p > .05), tachycardia (2.5%, 2.5%, and 2.5%, p > .05), or urinary retention (2.5%, 0%, and 0%, p > .05).Conclusion: Intravenous injection of HBB decreases the duration of active phase of labor in primigravidae with no side effects. [ABSTRACT FROM AUTHOR]

Abstract: A flow injection method with chemiluminescence (CL) detection has been developed for hyoscine butylbromide (HBB) determination based on an enhancement of cerium(IV)-sulphite CL reaction in an acidic medium. The method enables HBB determination in the range of 0.005-15 ppm (R2 = 0.9990, n = 10), with relative standard deviation of 2.5% (n = 12) for 0.25 ppm of HBB. The limit of detection (3s × blank) was 0.001 ppm with an injection throughput of 180 h-1. The concentration of reagents involved in the CL reaction and the key physical variables were carefully studied and optimized. The proposed procedure offered high sensitivity, simplicity and rapidity, and was successfully applied to HBB determination in pharmaceutical preparations. The results obtained were in good agreement with the conventional spectrophotometric method. The mechanism of Ce(IV)‒Na2SO3‒HBB CL reaction is also discussed. [ABSTRACT FROM AUTHOR]

• Hyoscine butylbromide (Buscopan®) is often administered to horses with colic, which could potentially affect the appearance of the small intestines onultrasound. • Small intestinal motility did not decrease following hyoscine butylbromide insix horses with medically treated colic. • No horse developed dilated turgid loops of small intestines. Horses commonly receive hyoscine butylbromide (HB) prior to hospital admission for colic. This could alter the appearance of the small intestine (SI) on ultrasound scan and affect clinical decision making. The aim of this study was to assess the impact of HB on ultrasonographically assessed SI motility and heart rate. Six horses hospitalised for medical colic with no significant abnormalities on baseline abdominal ultrasound examination were included. Ultrasound was performed in three locations (right inguinal, left inguinal and hepatoduodenal window) before and at 1, 5, 15, 30, 45, 60, 90, and 120 minutes after intravenous injection of 0.3 mg/kg HB. Three blinded reviewers assessed SI motility using a subjective grading scale from 1 to 4, one being normal motility and four being no motility. Moderate interindividual and interobserver variability was observed, but none of the included horses developed dilated turgid loops of SI. Hyoscine butylbromide did not significantly reduce SI motility grade in any location (P =.60 left inguinal, P =.16 right inguinal, P =.09 duodenum). Heart rate (mean ± SD) was 33 ± 3 prior to HB injection and peaked at 71.3 ± 9 one-minute postinjection. Heart rate was significantly increased until 45 minutes (48 ± 9) after HB administration (P =.04). The appearance of dilated turgid SI loops common with strangulating intestinal lesions did not appear to develop following HB administration. Hyoscine butylbromide administered shortly before abdominal ultrasound examination would not be expected to affect clinical decision making in horses without small intestinal disease. [ABSTRACT FROM AUTHOR]

Objectives: To prospectively evaluate the effect of hyoscine butylbromide (HBB) on visualisation of anatomical details and motion-related artefacts in mp-MRI of the prostate at 3.0 Tesla.Methods: One hundred and three consecutive patients (65 ± 10 years) were included in this trial, powered to demonstrate an improvement of image quality after HBB administration, assessed on a 5-point scale by two blinded readers. All patients received high-spatial resolution axial T2-weighted TSE sequences at 3.0 T without spasmolytic agent, repeated after application of 40 mg HBB and followed by routine mp-MRI. Secondary endpoints were (1) susceptibility to side effects, (2) dependence of spasmolytic effect on patients´ weight, and (3) prostate volume.Results: In 68% of patients, HBB significantly improved the anatomic score (mean 3.4 ± 0.9 before and 4.4 ± 0.7 after HBB for both readers, p = <0.001). In 67%, HBB significantly enhanced the artefact score (mean 3.2 ± 1 before and 4.2 ± 0.8 after HBB for reader 1, p = <0.001; 3.2 ± 1 and 4.1 ± 0.8 for reader 2, p = <0.001). Subgroup analysis revealed no statistically significant difference between patients with different bodyweight or prostate volume. Inter-reader agreement was excellent (k = 0.95-0.98).Conclusions: Hyoscine butylbromide significantly improves image quality and reduces motion-related artefacts in mp-MRI of the prostate independent of bodyweight or prostate volume. No side effects were reported.Key Points: • Hyoscine butylbromide (HBB) improved image quality in over 2/3 of patients. • Severe artefacts were reduced after HBB in more than 20%. • The number of non-diagnostic MRI was reduced to <1% after HBB. • HBB effect was independent of bodyweight and prostate volume. • No side effects of HBB were reported in this study population. [ABSTRACT FROM AUTHOR]

Background: Labour is a physiologic process that results in expulsion of the products of conception outside the uterus throughout 3 stages. It is achieved with changes in the biochemical connective tissue and with gradual effacement and dilatation of the uterine cervix as a result of rhythmic uterine contractions of sufficient frequency, intensity, and duration. Hyoscine butylbromide (HBB) belongs to the parasympatholytic group of drugs and is a semisynthetic derivative of scopolamine. It is a quaternary ammonium derivative, which exerts a spasmolytic action on the smooth muscle of the gastrointestinal, biliary, and genitourinary tracts. Methods: A case control study conducted on 150 women coming to Al Azhar University Maternity Hospital.Patients who meet the inclusion criteria were asked to participate in the study and a verbal consent was obtained from each patient. Patients were divided into three equal groups (A, B, C). A single dose of the drug (placebo or HBB 20mg or HBB 40 mg) was injected intravenously slowly to groups A, B, C respectively. Labouring mothers were monitored in bed. Vaginal examination was conducted every two hours. The duration of the first stage was calculated from the time of cervical dilatation of three to four centimeters in active labour until a fully dilated cervix was observed Results: showed significant difference between the three groups regarding the progress of labour. There was a significant decrease in the duration of the active phase of first stage of labour in study groups who received hyoscine butylbromide compared to placebo group. The decrease in the duration of active phase of first stage of labour was not related to the drug dose. There was no significant difference between the three groups regarding the second stage duration. There were no significant adverse effects of hyoscine butylbromide on either mothers or neonates. Conclusion: Hyoscine butylbromide helps to decrease the duration of active phase of labour in primigravdae with no side effects on either the mother or the neonate. This decrease is not related to the dose of the drug. Hyoscine butylbromide (HBB) belongs to the parasympatholytic group of drugs and is a semisynthetic derivative of scopolamine. It is a quaternary ammoniu m derivative, which exerts a spasmolytic action on the smooth muscle of the gastrointestinal, biliary, and genitourinary tracts. Role of intravenous hyoscine butylbromide injection on the duration and progress of first stage of labour in primigavidae. [ABSTRACT FROM AUTHOR]

OBJECTIVE Acute gastric or intestinal spasm-like pain is common in clinical setting. Hyoscine butylbromide (HBB), an anti-cholinergic agent, relieves pain in stomach and bowel cramps by inhibiting smooth muscle contractility. In this study, we aimed to compare the efficacy and safety of parenteral HBB and anisodamine for treating acute gastric or intestinal pain. METHODS In this randomized, controlled, double-blind, parallel-group, multicenter non-inferiority trial, 299 Chinese patients were randomly assigned to HBB or anisodamine in a ratio of 1:1. They were administrated a single dose of either HBB 20 mg or anisodamine 10 mg, and a second dose was given when needed. The primary end-point was the difference in pain intensity (PID) from the pre-dose baseline at 20 min after the first injection. RESULTS Altogether 295 patients completed the protocol (153 in the HBB and 142 in the anisodamine group). For the primary end-point, the PID was −4.09 (95% confidence interval [CI]: −4.41, −3.76) for the HBB group and −3.66 (95% CI: −4.02, −3.31) for the anisodamine group ( P < 0.0001 for non-inferiority). The percentage of patients with at least one adverse event was lower in the HBB group than in the anisodamine group (13.1% vs 17.6%), but there was no statistical significance ( P = 0.279). The most frequent adverse events were thirst (7.8%) and dry mouth (2.6%) in the HBB group, and thirst (7.0%), dry mouth (3.5%) and nodal arrhythmia (2.1%) in the anisodamine group. CONCLUSIONS HBB 20 mg was not inferior to anisodamine 10 mg in pain relief of patients with acute gastric or intestinal spasm-like pain. Both drugs were safe and well tolerated. [ABSTRACT FROM AUTHOR]

The aim of review. To demonstrate value of disorders of cholinergic innervation in pathogenesis of irritable bowel syndrome (IBS).Original positions. The important place in regulation of gastro-intestinal tract functions belongs not only to M-, but also to N-receptors localized in enteral plexus ganglions and on presynaptic endings of cholinergic motor neurones. Acetylcholine is the universal mediator which is intimately interacts with other mediators regulating intestinal functions. The role of disorders of cholinergic innervation in pathogenesis of IBS is actively investigated by now. Experimental data allow to assume, that «subclinical inflammation» within intestinal wall at IBS, disturbances of peristaltic activity and hyperalgesia, are related to altered response of immune and smooth-muscle cells to acetylcholine stimulation.Conclusion. Acetylcholine represents the major mediator regulating motor and secretory function of intestine. Change of acetylcholine metabolism of has immediate value in pathogenesis of IBS. The agents, influencing cholinergic receptors, are one of basic resources of modern pharmaceutical therapy of irritable bowel syndrome.

Background: Cardiovascular effects for drugs such as hyoscine butylbromide are poorly documented in the literature, unlike atropine, which is considered the antimuscarinic of choice in the presence of intraoperative bradycardia., Aim: The aim of the study was to describe the dose-related cardiovascular effect of hyoscine butylbromide in patients between 18 and 65 years of age, with low perioperative risk undergoing elective surgery under general anaesthesia on an outpatient basis or hospitalised at our institution between 1 January and 31 May 2019., Methods: Descriptive, cross-sectional, retrospective study; 28 patients with low perioperative risk who underwent general anaesthesia were selected. Changes in heart rate and blood pressure were analysed during the first 6 minutes after the administration of hyoscine butylbromide. The data obtained was recorded in a Microsoft Excel database and analysed using the Excel analysis tool and IBM SPSS., Results: The average dose of 0.15mg/kg of hyoscine butylbromide achieved an increase in heart rate and mean arterial pressure in 96% and 92.8%, respectively, in the first 6 minutes after the administration. Significant changes in heart rate and blood pressure were obtained during the first 6 minutes at doses between 0.05mg/kg and 0.15mg/kg., Conclusion: Hyoscine butylbromide generates positive effects on the heart rate and blood pressure of patients under general anaesthesia, representing a possible alternative in the management of intraoperative bradycardia.

Purpose: Inoperable malignant bowel obstruction (MBO), a severe complication of peritoneal carcinomatosis, has a low desobstruction rate (30-40 %) and end-of-life decision-making is hampered by the lack of known prognostic factors. This study aimed to explore prognostic factors for desobstruction in MBO.Methods: All patients with inoperable MBO admitted in our large oncology hospital between 2010 and 2013 were treated following a clinical protocol based on antiemetics, steroids and two antisecretories, octreotide, and hyoscine butylbromide. Two prognostic factor analyses using logistic regressions were performed, one based on data from day 1 of admission and the other on data from day 8.Results: Forty-five patients were included. Frequency of desobstruction was 48.9 %. In the analysis of prognostic factors on day 1, MBO episodes derived from functional physiopathologic mechanisms (vs. mechanic or mixed) were more prone to resolve (p < 0.001 corrected for multiple comparisons). Considering patients alive with persistent obstruction on day 8, a better clinical condition was the variable more associated with desobstruction, but without statistical significance after correction for multiple comparisons.Conclusions: A functional physiopathologic mechanism of MBO development may be an early prognostic factor for desobstruction. A high proportion of desobstruction was observed, suggesting that the combination of antisecretories with different mechanism of action warrants further investigation. [ABSTRACT FROM AUTHOR]

Hyoscine butylbromide (Buscopan ®) is clinically used as an anticholinergic antispasmodic for the treatment of abdominal cramping or visceral pain associated with cramps. However, the spasmolytic efficacy on contractile activity of human gastrointestinal smooth muscle from various sections remains unclear. We aimed to investigate the potentially selective actions of Buscopan on different bowel segments, as well as muscular layers and contractile states. Human smooth muscle tissues of the esophagus, gastric corpus and antrum, jejunum, ileum and colon were obtained. Isometric measurements of circular and longitudinal muscle strips were performed to determine effects of Buscopan on spontaneous activity and induced-contractions by 30 mM KCl, 10 μM bethanechol and electrical field stimulation (EFS). Buscopan concentration-dependently (10 −9 –10 −5 M) inhibited smooth muscle activity, particularly in spasticity evoked by bethanechol and EFS but not high K + . The inhibiting effects were mainly responsible for the antagonism on muscarinic M 2 and M 3 receptors (IC 50 values: 3.1×10 −5 M vs. 0.9×10 −5 M). The sensitivity toward Buscopan revealed a tendency of increasing from the esophagus, gastric corpus and antrum to the colon, jejunum and ileum. There was a reversed gradient of mRNA and protein expression of muscarinic M 2 and M 3 receptors from the blocking effects of Buscopan, which could be ascribed to the fact that a higher concentration of Buscopan was needed to antagonize the spastic contraction to reach the equipotent inhibitory rate in the region with higher muscarinic receptor activity. The findings of different inhibitory effectiveness on various parts of the gastrointestinal tract provide a potential guideline for the clinical application. [ABSTRACT FROM AUTHOR]