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Home , Hyoscine butylbromide, Simeticone

1845

2 mg may be given up to 1 hour before chemotherapy, or, probably not porphyrinogenic; it may be used as a drug of i P....repa...... rat...... ons ...... alternatively, I mg can be taken up to 1 hour before first choice and no precautions are needed.1 ...... (details are given in Volume B) chemotherapy with another dose of 1 mg 12 hours later. 1. The Drug Database for Acute Porphyria. Available at: http:l/www. ProprietaryPreparations Granisetron is given only on the days that chemotherapy is drugs-porphyria.org (accessed 07/IO/ll) Single-ingredient Preparations, Austria: Talcid; Talidat; China: administered. An Da (:tit;);Hai Di Te (illJ'Ji!l'i'f); Tai Er Sai Ke i*'!J;�3'1;);Tal­ Granisetron can also be delivered transdermally to Interactions cid (i5'l'l'): Wei Di Mei (i!

The symbol t denotes a preparation no longer actively marketed 1846 Gastrointestinal

NOTE. HYO is a code approved by the BP 2014 for use on Anoxic seizures. For mention of the use of transdermal patch is licensed in the UK for adults and children aged 10 single unit doses of eye drops containing hyoscine hyoscine as an alternative to in the management years and over and should be applied 5 to 6 hours before hydrobromide where the individual container may be too of reflex anoxic seizures in children, see p. 1311.3. travelling or on the preceding evening and removed at the small to bear all the appropriate labelling information. end of the journey. Pharmacopoeias. In Chin., Bur. (see p. vii), Jpn, and US. Biliary and . Hyoscine has been used as an An intranasal formulation of hyoscine hydrobromide has adjunct to opioid analgesics for symptomatic relief of been investigated for the treatment and prevention of Ph. Eur. 8: (Hyoscine Hydrobromide). A white or almost biliary or renal colic (see p. 6.3) although the evidence for motion sickness. white, efflorescent, crystalline powder or colourless crystals. such use is weak. Hyoscine butylbromide 20 mg is given Transdermal hyoscine has been used in adults and Freely soluble in water; soluble in alcohol. A 5% solution in by intramuscular or slow intravenous injection; this may children for the prevention of postoperative nausea and water has a pH of 4.0 to 5.5. Store in well-filled airtight be repeated after 30 minutes if necessary to a maximum vomiting. containers of small capacity. Protect from light. daily dose of 100 mg. See also Palliative Care, below. Hyoscine hydrobromide has also been given by USP 36: (Scopolamine Hydrobromide). Colourless or white intravenous, subcutaneous, or for References. crystals, or white granular powder. Is odourless and slightly its effect in doses ranging from 200 micrograms L Holdgate A, Oh CM. Is there a role for antimuscarinics in renal colic? A efflorescent in dry air. Soluble 1 in I.5 of water and I in 20 174: randomized controlled trial. 1 Urol (Baltimore) 2005; 572-5. to 1 mg in adults. of alcohol; slightly soluble in chloroform; insoluble in ether. The other drugs used in the management of motion pH of a 5% solution in water is between 4.0 and 5.5. Store in Cardiac disorders. Although hyoscine is not one of the sickness and postoperative nausea and vomiting are airtight containers. Protect from light. conventional therapies for heart failure (p. 1262.3) or discussed on p. 1811.3. myocardial infarction (p. 1257.1), low-dose transdermal References. hyoscine can increase cardiac vagal activity and thereby l. Kranke P. et al. The efficacy and safety of transdermal scopolamine for Hyoscine Methobromide {BANI reduce the autonomic imbalance seen in patients with the prevention of postoperative nausea and vomiting: a quantitative systematic review. Anesth Analg 2002; 95: 133--43. Epoxymetharnine Bromide; Escopofamina, metilbromuro these conditions.1-3 Improved exercise tolerance has been de; 2. Nachum Z, et al. Transdermal scopolamine for prevention of motion . reported after 1 week of treatment with transdermal hyo­ Hyoscine ivlethyibrom�ro de motion sickness. Available in The Cochrane Database of Systematic l. Casadei B, et a!. Low doses of scopolamine increase cardiac vagal tone in ScopoliJmine. Methyiprornlde;fVl. Cl(V1Hil Reviews; Issue 3. Chichester: John Wiley; 2007 (accessed 03/04/08). � Mero!JpOMV!/1. the acute phase of myocardial infarction. Circulation 1993; 88: 353-7. (·).(J5,3s,5R,6R,75),q17-Epoxy-8-methyi-3-[(S)"tropoyloxy]tro­ . 2. La Rovere MT, et al. Scopolamine autonomic balance in pa niumbror(\ide. advanced congestive heart failure. 1994; 90: 838-43. Palliative core. The BNF includes doses for hyoscine in et a!. ,sH24BrN04c;3983 3. Venkatesh G, Double blind placebo controlled trial of short term palliative care. Hyoscine hydrobromide is used in palliative C transdermal scopolamine on heart rate variability in patients with · 76: care for the treatment of bowel colic and to reduce exces­ CAS � I 55·41"9. chronic heart failure. Heart 1996; 137-43. ATC _,__A03BBOs: SO iFA0.3 4. De Vccchis R, et al. Different impact of carvedi!ol and transdermal sive respiratory secretions, although care should be taken scopolamine on cardiovascular performance of mild-moderate chronic to avoid the discomfort of a dry mouth. The following par­ ATC • .Ve t .� OA Q38[)03; QSO /FAQ3. . heart failure patients: evidence of useful effects of scopolamine on enteral doses have been suggested for adults: Minerva Cardioangiol UN/I .:.�RT NS I LK?\'IfL. tolerance to work load. 2000; 48: 393-401. 400 micrograms by subcutaneous injection, usually • Pharmacopoeias. In US. given every 4 hours when required, although hourly Depression. Rapid reductions in severity of depression USP 36: (Methscopolamine Bromide). use is sometimes necessary were seen after intravenous hyoscine hydrobromide or containers. Protect from light. 4micrograms/kg was given to patients with major depres­ 1.2 to 2 mg by continuous subcutaneous infusion over 24 sive disorders or bipolar disorders (see Depression, • hours p. 398.1). Repeat doses showed more benefit than single Hyoscine Methonitrate {BANM! i To reduce excessive respiratory secretions in children, the doses. Clinical effects persisted beyond the treatment peri­ BNFC suggests parenteral doses of: Escopolatl'liha; metHnitrato d�; Hyosdpe od, which led the authors to conclude the effects were not •• Methylnltrate: 10 micrograms/kg (maximum 600 micrograms) by sub­ due to euphoria. While noting that the • MetnscopolamineNi1Jate; Methylhyoscini Nitras;.Methytsco: cutaneous or intravenous injection every 4 to 8 hours pola,mlne · Nitrate; Methvlscopolamini Nitras: Metilnitrato de optimal schedule and potential long-term use of hyoscine or as an antidepressant needed further study, they also con­ hioscina; Metonitrato de esc,opolamina; Metonltrato de 40 to 60 micrograms/kg by continuous subcutaneous or cluded that hyoscine could be a relatively safe and well­ • hiosci�a; MetylskopPiamit;nitrat: Metyyliskopolamiininitraat' intravenous infusion over 24 hours tolerated intervention for achieving a rapid initial ti; Scopolamine Methonitrate; S�:opolamine Methy/nitraw; 1 Oral and sublingual doses have also been suggested for . · antidepressant response.1 ft10C4)1Ha MerofJwrpar, . . · . · . · .. · . children, according to age: .· · ·· ...... • . . l. (.)•(1 thyi·3-.((SJ'tr()pPylo�ylJra· Furey ML, Drevets WC. Antidepressant efficacy of the antimuscarinic 2 to 12 years: 10 micrograms/kg (maximum 300 micr- S,.3s,51?,1511.75)-6,7 Epoxy·B·me . drug scopolamine: a randomized, placebo-controlled clinical tria!. Arch • pa nium nitrete Gen Psychiatry 2006; 63: 1121-9. ograms) four times daily 12 to 18 years: 300 micrograms four times daily CeH24NPr"'380,4 • CAS 6106·46-3. Dysmenorrhoea. Hyoscine as the butylbrontlde or hydro­ Alternatively, hyoscine hydrobromide may be given as a bromide has been used for its antispasmodic action in the transdermal patch in the following doses: ATC-7- A038BO ;SIJIFA03 . } BNF 1 month to 3 years: 250micrograms (quarter of a patch) J\T( V?i- QA03 BB03; QSOIFI\03. treatment of dysmenorrhoea. (p. 8.2), but the consid­ • . ers that antispasmodics do not generally provide signifi­ every 72 hours UN/1 ,.--- K08 13KQM3rt. 3 to 10 years: 500micrograms (half a patch) every 72 cant relief. • hours 10 to 18 years: 1 mg (one patch) every 72 hours Eye disorders. Hyoscine hydrobromide is used in the eye • Uses and Administration for its mydriatic and cycloplegic actions (p. 2000.2) usually Hyoscine has also been used transdermally in adults for Hyoscine is a tertiary amine antimuscarinic with central and in a concentration of 0.25%. It has a faster onset and reducing respiratory secretions; one regimen uses 2 to 4 mg peripheral actions (see Action of Antimuscarinics, shorter duration of action than atropine although the (two to four patches) every 72 hours with additional p. 1310.3). It is a more powerful suppressant of salivation effects may still persist for up to 3 to 7 days. It may be use­ parenteral doses of (see than atropine, and usually slows rather than increases heart ful for patients who are hypersensitive to atropine. p. 2520.1) 1 rate, especially in low doses. Its central action differs from Hy oscine butylbromide is also used in palliative care; the that of atropine in that it depresses the cerebral cortex and Hyperhidrosis. Adverse effects of antimuscarinics given BNF suggests the following doses for adults: bowel colic: 60 to 300 mg by continuous subcutaneous produces drowsiness and . Hyoscine hydrobromide orally generally preclude their use by this route for the • is also a tertiary amine, whereas hyosdne butylbromide, management of hyperhidrosis (p. 1685.1), but some, such infusion over 24 hours excessive respiratory secretions: 20 to 120 mg by hyoscine methobromide, and hyoscine methonitrate are as hyoscine, have been applied topically as alternatives to • quaternary ammonium derivatives. aluminium salts. Hyoscine hydrobromide applied as a 3% continuous subcutaneous infusion over 24 hours Hyoscine and hyoscine hydrobromide are used in the cream was successful in reducing gustatory sweating, con­ or bowel colic and excessive respiratory secretions: 20 mg management of motion sickness and other forms of nausea sisting of flushing and sweating over the right mandible • and vomiting (below); hyoscine hydrobromide is also given during eating, in a patient who had previously undergone by subcutaneous injection, usually given every 4 hours as a premedicant in anaesthesia (below), and to produce surgical excision of the right submandibular salivary when required, although hourly use is sometimes mydriasis and cycloplegia (below). Hyoscine butylbromide gland.1 The use of transdermal or injectable hyoscine was necessary and other quaternary ammonium derivatives are used in reported2 to be effective for the control of opioid-asso­ The use of hyoscine in palliative care has been reviewed.2'3 conditions associated with visceral spasms. Hyoscine ciated sweating in 2 patients receiving palliative care (see Hyoscine hydrobromide may be more effective than methobromide has also been employed as an adjunct in also below for other uses of hyoscine in palliative care). glycopyrronium bromide in drying secretions, and has a the treatment of peptic ulcer disease (below). 1. Bailey BMW, Pearce DE. Gustatory sweating following submandibular rapid onset of action, but it can produce both sedation and Other hyoscine salts or derivatives that have been used salivary gland removal. Br Dent 1 1985; 158: 17-18. agitation;4 there is no clear evidence favouring one include hyoscine borate, hyoscine hydrochloride, and 2. Mercadante S. Hyoscine in opioid-induced sweating. 1 Pain Symptom antimuscarinic over another.4·5 Manage 1998; 15: 2 14-15. hyoscine oxide hydrobromide. 1. Kintzel PE, et a!. Anticholinergic medications for managing noisy respirations in adult hospice patients. Am J Health-Syst Pharm 2009; 66: Nausea and vomiting. Hyoscine is effective in the preven­ 458--64. Anaesthesia. The role of antimuscarinics, including hyo­ tion of motion sickness and is one of the principal drugs 2. Muir JC, von Gunten CF. Antisecretory agents in gastrointestinal 16: scine, in anaesthesia is discussed under Atropine on used. It may be given orally for short-term protection or obstruction. Clin Geriatr Med 2000; 327-34. 3. Spiller JA. Fallon M. The use of Scopoderrn in palliative care. Hasp Med p. 1311.1. For the use of hyoscine in the prevention of by transdermal patch for a prolonged duration of action. 2000; 61: 782--4. postoperative nausea and vomiting, see below. In the UK, a dose of hyoscine hydrobromide is taken 20 4. Bennett M, et al. Association for Palliative Medicine. Using For premedication hyoscine hydrobromide is injected to 30 minutes before a journey, followed by the same dose anti-muscarinic drugs in the management of : evidence­ 16: subcutaneously or intramuscularly in doses of 200 to every 6 hours if required up to a maximum of 3 doses in 24 based guidelines for palliative care. Palliat Med 2002; 369-74. 5. Wee B, Hillier R. Interventions for noisy breathing in patients near to 600 micrograms, usually with papaveretum about half to hours. The usual dose in adults is 300 micrograms. Children death. Available in The Cochrane Database of Systematic Reviews; Issue one hour before induction of general anaesthesia. In the aged 4 to 10 years may be given 75 to 150 micrograms and l. Chichester: John Wiley; 2008 (accessed 04/06/09). UK, a dose of 15 micrograms/kg is licensed in children (the those over 10 years, 150 to 300 micrograms. Children aged 3 BNFC suggests that this dose is appropriate from 1 to 12 to 4 years may be given 75 micrograms, repeated once if Smooth muscle spasm. Hyoscine has been used as an years of age; older children may be given the adult dose). If necessary to a maximum total dose of 150 micrograms in 24 antispasmodic (p. 1803.3) to relieve the pain of smooth necessary for acute use, the same doses may be given by hours. Hyoscine is also given via a transdermal patch which muscle spasm associated with the and intravenous injection. is placed behind the ear and supplies 1 mg over 3 days. The genito-urinary tract. In adults, hyoscine butylbromide 20mg

All cross-references refer to entries in Volume A