Antispasmodic — Ureteric Spasm
Pregnancy: Use with caution in pregnancy — limited data; generally considered low risk for short-term use
Hyoscine Butylbromide
Brand names: Buscopan
Adult dose
Dose: 20 mg IV/IM; or 20 mg oral four times daily
Route: Intravenous / Intramuscular / Oral
Frequency: Repeat IV dose after 30 minutes if needed; oral up to four times daily
Max: 100 mg/day IV; 80 mg/day oral
IV: 20 mg over at least 1 minute. Used as adjunct to NSAID/opioid in renal colic to relieve ureteric smooth muscle spasm
Paediatric dose
Dose: 0.3-0.6 mg/kg IV mg/kg
Route: IV / Oral
Frequency: As required
Max: 0.6 mg/kg per dose
Child 1 month to 1 year: 300-500 micrograms/kg IV/IM (max 5 mg). Child 1-5 years: 5 mg. Child 6-11 years: 5-10 mg. Child 12 years and over: 10-20 mg
Dose adjustments
Renal
No dose adjustment required
Hepatic
Use with caution
Paediatric weight-based calculator
Child 1 month to 1 year: 300-500 micrograms/kg IV/IM (max 5 mg). Child 1-5 years: 5 mg. Child 6-11 years: 5-10 mg. Child 12 years and over: 10-20 mg
Clinical pearls
- Quaternary ammonium compound — does not cross blood-brain barrier; no CNS effects; distinguished from hyoscine hydrobromide (scopolamine) which crosses BBB and causes sedation
- Evidence for benefit in renal colic is modest — Cochrane review (2014) found insufficient evidence that antispasmodics add benefit over NSAIDs alone; RCEM guidelines do not mandate its use
- Common practice in UK EDs: diclofenac + buscopan combination for renal colic — buscopan provides additional smooth muscle relaxation even if evidence is limited
- IV administration causes rapid tachycardia — monitor heart rate; use with caution in patients with arrhythmias
- Oral buscopan (OTC): widely used for irritable bowel syndrome — same drug, different indication
Contraindications
- Myasthenia gravis
- Paralytic ileus
- Megacolon
- Narrow-angle glaucoma
- Tachycardia
Side effects
- Tachycardia (common with IV)
- Dry mouth
- Urinary retention
- Constipation
- Blurred vision
- Skin flushing
Interactions
- Other antimuscarinics (additive effects)
- Metoclopramide (antagonism — reduced gastric motility effect of metoclopramide)
Monitoring
- Heart rate (IV use)
- Pain score response
- Urinary symptoms (retention)
Reference: BNFc; BNF 90; RCEM Clinical Standards; Cochrane Review (antispasmodics for renal colic, 2014); EAU Urolithiasis Guidelines 2024. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.