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Antispasmodic — Ureteric Spasm Pregnancy: There are limited data from the use of hyoscine butylbromide in pregnant women, and animal studies are insufficient with respect to reproductive toxicity. As a precautionary measure Buscopan is not recommended during pregnancy. Lactation: there is insufficient information on the excretion of hyoscine butylbromide and its metabolites in human milk; a risk to the breastfeeding child cannot be excluded, and use during breastfeeding is not recommended. Fertility: no studies on the effects on human fertility have been conducted.

Hyoscine Butylbromide

Brand names: Buscopan

Hyoscine butylbromide (an antimuscarinic and smooth-muscle relaxant) is used for relief of abdominal and genitourinary smooth-muscle spasm, including ureteric/renal colic and bladder spasm, available as oral tablets and as an injection.

Adult dose

Dose: Acute spasm, as in renal colic: one ampoule (20 mg) intramuscularly or intravenously
Route: Intramuscular or intravenous (intravenous injection to be performed slowly)
Frequency: Repeated after half an hour if necessary
Max: 100 mg daily (SPC: 'Maximum daily dose of 100mg')
The pinned product, Buscopan Ampoules (eMC product 890), is licensed in section 4.1 'in acute spasm, as in renal or biliary colic', so the indication matches. ROUTE THIS CARD DOES NOT COVER: oral - this is an ampoule SPC, so no oral dose is given. Administration: 'Intravenous injection should be performed slowly (in rare cases a marked drop in blood pressure and even shock may be produced by Buscopan).' Section 4.2 adds: 'When used in endoscopy this dose may need to be repeated more frequently.' The injection solution may be diluted with dextrose or sodium chloride 0.9% injection solutions. Duration: 'Buscopan Ampoules should not be taken on a continuous daily basis or for extended periods without investigating the cause of abdominal pain.' Section 4.4: if severe, unexplained abdominal pain persists or worsens, or occurs with fever, nausea, vomiting, changes in bowel movements, abdominal tenderness, decreased blood pressure, fainting or blood in stool, appropriate diagnostic measures are needed. Buscopan injection can cause tachycardia, hypotension and anaphylaxis: use with caution in cardiac failure, coronary heart disease, cardiac arrhythmia, hypertension and cardiac surgery; emergency equipment and trained personnel must be readily available. Intramuscular injection must not be given to patients being treated with anticoagulant drugs (intramuscular haematoma may occur). Elderly: no specific information; clinical trials included patients over 65 years with no age-specific adverse reactions reported. Paediatric: 'Not recommended for children.'

Dose adjustments

Renal

The retrieved SPC sections (4.2-4.8) contain no renal-impairment dosing guidance; no adjustment is stated and none is asserted here.

Hepatic

The retrieved SPC sections (4.2-4.8) contain no hepatic-impairment dosing guidance; no adjustment is stated and none is asserted here.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Hypersensitivity to the active substance or to any of the excipients
  • Narrow angle glaucoma
  • Hypertrophy of the prostate with urinary retention
  • Mechanical stenosis in the gastrointestinal tract
  • Paralytic or obstructive ileus
  • Megacolon
  • Tachycardia
  • Myasthenia gravis
  • Intramuscular injection must not be given to patients being treated with anticoagulant drugs (intramuscular haematoma may occur)

Side effects

  • Common: accommodation disorders; tachycardia; dizziness; dry mouth. Constipation is also listed (frequency not shown in the retrieved table)
  • Not known (post-marketing): anaphylactic shock including cases with fatal outcome, anaphylactic reactions, dyspnoea and other hypersensitivity
  • Not known: mydriasis, increased intraocular pressure; blood pressure decreased, flushing; skin reactions (e.g. urticaria, rash, erythema, pruritus), abnormal sweating; urinary retention
  • Injection site pain, particularly after intramuscular use
  • Psychiatric disorders (e.g. confusion) cannot totally be ruled out under certain circumstances, although hyoscine butylbromide does not readily pass the blood-brain barrier

Interactions

  • Anticholinergic effect intensified by tri- and tetracyclic antidepressants, antihistamines, quinidine, amantadine, antipsychotics (e.g. phenothiazines, butyrophenones), disopyramide and other anticholinergics (e.g. tiotropium, ipratropium, atropine-like compounds)
  • Tachycardic effects of beta-adrenergic agents may be enhanced
  • Dopamine antagonists such as metoclopramide: effects of both drugs on the gastrointestinal tract may be diminished

Monitoring

  • Patients receiving the injection should be kept under observation (cases of anaphylaxis including shock have been observed after parenteral administration); emergency equipment and trained personnel must be readily available
  • Monitor patients with cardiac conditions (cardiac failure, coronary heart disease, arrhythmia, hypertension) and during cardiac surgery
  • Watch for blood pressure drop during intravenous injection; inject slowly
  • Caution in patients with pyrexia (anticholinergics may reduce sweating)
  • Patients should seek urgent ophthalmological advice if they develop a painful, red eye with loss of vision after injection (possible untreated narrow angle glaucoma)
  • Investigate the cause if severe, unexplained abdominal pain persists or worsens

Clinical monograph

How it works

As a quaternary-ammonium antimuscarinic it blocks acetylcholine at muscarinic receptors on visceral smooth muscle, relaxing spasm in the gut and urinary tract.

Prescribing in practice

  • Given parenterally it can cause tachycardia, hypotension and, rarely, serious anaphylaxis, so injectable use needs caution and monitoring, especially in patients with cardiac disease.
  • Avoid in conditions worsened by antimuscarinic action, such as untreated angle-closure glaucoma, myasthenia gravis, paralytic ileus and significant bladder outflow obstruction.
  • Poor oral bioavailability means the injectable route is used when a rapid antispasmodic effect is required.

Monitoring

No routine laboratory monitoring is needed; observe heart rate and blood pressure when given by injection and review symptom relief.

Counselling the patient

  • It is used for short-term relief of cramping spasm pain.
  • Report eye pain or sudden visual disturbance, which could indicate raised intraocular pressure.

Evidence & guidelines

Hyoscine butylbromide is an established antispasmodic for visceral smooth-muscle colic, with long-standing clinical use supported by the SPC.

Reference: RCEM Clinical Standards; Cochrane Review (antispasmodics for renal colic, 2014); EAU Urolithiasis Guidelines 2024; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

Pathways