Hyoscine

Hyoscine

Drug Nomenclature

Date of monograph revision: 10-Apr-1997; 02-Sep-1998; 28-Jun-1999; 14-Nov-2001; 01-Jun-2004; 08-Mar-2006; 20-Jul-2006
Synonyms: Escopolamina; Hyoscin; Hyoscinum; Hyoskiini; Scopolamine; Scopolaminum; Skopolamiini; Skopolamin
BAN: Hyoscine
Chemical name: (-)-(1S,3s,5R,6R,7S,8s)-6,7-Epoxy-3[(S)-tropoyloxy] tropane
Molecular formula: C17H21NO4 =303.4
CAS: 51-34-3
ATC code: A04AD01; N05CM05; S01FA02
Read code: y03Rs; y07je
Chemical Structure of Hyoscine

Chemical Structure of Hyoscine

Pharmacopoeias:

In Eur. (see Go to European Pharmacopoeia Convention Signatories).

Ph. Eur. 5.5 (Hyoscine). A white or almost white, crystalline powder or colourless crystals. M.p. 66 degrees to 70 degrees. Soluble in water; freely soluble in alcohol.

Hyoscine Butylbromide

Drug Nomenclature

Date of monograph revision: 10-Apr-1997; 02-Sep-1998; 28-Jun-1999; 14-Nov-2001; 01-Jun-2004; 08-Mar-2006; 20-Jul-2006
Synonyms: N-Butylscopolammonium Bromide; Butylscopolamine Bromide; Butylscopolaminii Bromidum; Butylscopolamonii Bromidum; Butylskopolaminium-bromid; Escopolamina, butilbromuro de; Hioscino butilbromidas; Hioszcin-butilbromid; Hyoscinbutylbromid; Hyoscine-N-butyl Bromide; Hyoscini Butylbromidum; Hyoskiinibutyylibromidi; Scopolamine N-Butyl Bromide; Scopolamine Butylbromide; Scopolamini Butylbromidum; Scopolomini Butylbromidum; Skopolamino butilbromidas; Szkopolamin-butilbromid
BAN: Hyoscine Butylbromide [BANM]
Chemical name: (-)-(1S,3s,5R,6R,7S,8r)-6,7-Epoxy-8-butyl-3-[(S)-tropoyloxy]tropanium bromide
Molecular formula: C21H30BrNO4 =440.4
CAS: 149-64-4
Read code: y01OV; y07jc; y07jd
Chemical Structure of Hyoscine Butylbromide

Chemical Structure of Hyoscine Butylbromide

Pharmacopoeias:

In Chin., Eur. (see Go to European Pharmacopoeia Convention Signatories), and Jpn.

Ph. Eur. 5.5 (Hyoscine Butylbromide). A white or almost white, crystalline powder. Freely soluble in water and in dichloromethane; sparingly soluble in dehydrated alcohol. A 5% solution in water has a pH of 5.5 to 6.5.

Hyoscine Hydrobromide

Drug Nomenclature

Date of monograph revision: 10-Apr-1997; 02-Sep-1998; 28-Jun-1999; 14-Nov-2001; 01-Jun-2004; 08-Mar-2006; 20-Jul-2006
Synonyms: Bromhidrato de Escopolamina; Escopolamina, hidrobromuro de; Hioscino hidrobromidas; Hioszcin-hidrobromid; Hyoscinhydrobromid; Hyoscini Hydrobromidum; Hyoskiinihydrobromidi; Ioscina Bromidrato; Scopolamine Bromhydrate; Scopolamine Hydrobromide; Scopolamini Hydrobromidum; Scopolamini Hydrobromidum Trihydricum; Skopolamiinihydrobromidi; Skopolamin-bromid trihydrát; Skopolaminhydrobromid; Skopolamino hidrobromidas; Szkopolamin-butilbromid
BAN: Hyoscine Hydrobromide [BANM]
Chemical name: (-)-(1S,3s,5R,6R,7S)-6,7-Epoxytropan-3-yl (S)-tropate hydrobromide trihydrate
Molecular formula: C17H21NO4,HBr,3H2O =438.3
CAS: 114-49-8 (anhydrous hyoscine hydrobromide); 6533-68-2 (hyoscine hydrobromide trihydrate)
ATC code: A04AD01; N05CM05; S01FA02
Read code: y00HA [Cns]; y00lv [Eye]; y08E2 [Anaesthesia]; y03Il; y07dV
Chemical Structure of Hyoscine

Chemical Structure of Hyoscine

NOTE:

HYO is a code approved by the BP 2005 for use on single unit doses of eye drops containing hyoscine hydrobromide where the individual container may be too small to bear all the appropriate labelling information.
Pharmacopoeias:

In Chin., Eur. (see Go to European Pharmacopoeia Convention Signatories), Jpn, Pol., and US.

Ph. Eur. 5.5 (Hyoscine Hydrobromide). A white or almost white, efflorescent, crystalline powder or colourless crystals. Freely soluble in water; soluble in alcohol. A 5% solution in water has a pH of 4.0 to 5.5. Store in well-filled airtight containers of small capacity. Protect from light.

USP 29 (Scopolamine Hydrobromide). Colourless or white crystals, or white granular powder. Is odourless and slightly efflorescent in dry air. Soluble 1 in 1.5 of water and 1 in 20 of alcohol; slightly soluble in chloroform; insoluble in ether. pH of a 5% solution in water is between 4.0 and 5.5. Store in airtight containers. Protect from light.

Hyoscine Methobromide

Drug Nomenclature

Date of monograph revision: 10-Apr-1997; 02-Sep-1998; 28-Jun-1999; 14-Nov-2001; 01-Jun-2004; 08-Mar-2006; 20-Jul-2006
Synonyms: Epoxymethamine Bromide; Escopolamina, metilbromuro de; Hyoscine Methylbromide; Methscopolamine Bromide; Scopolamine Methobromide; Scopolamine Methylbromide
BAN: Hyoscine Methobromide
Chemical name: (-)-(1S,3s,5R,6R,7S)-6,7-Epoxy-8-methyl-3-[(S)-tropoyloxy]tropanium bromide
Molecular formula: C18H24BrNO4 =398.3
CAS: 155-41-9
Chemical Structure of Hyoscine Methobromide

Chemical Structure of Hyoscine Methobromide

Pharmacopoeias:

In US.

USP 29 (Methscopolamine Bromide). Store in airtight containers. Protect from light.

Hyoscine Methonitrate

Drug Nomenclature

Date of monograph revision: 10-Apr-1997; 02-Sep-1998; 28-Jun-1999; 14-Nov-2001; 01-Jun-2004; 08-Mar-2006; 20-Jul-2006
Synonyms: Escopolamina, metilnitrato de; Hyoscine Methylnitrate; Methscopolamine Nitrate; Methylhyoscini Nitras; Methylscopolamine Nitrate; Methylscopolamini Nitras; Metylskopolaminnitrat; Metyyliskopolamiininitraatti; Scopolamine Methonitrate; Scopolamine Methylnitrate
BAN: Hyoscine Methonitrate [BANM]
Chemical name: (-)-(1S,3s,5R,6R,7S)-6,7-Epoxy-8-methyl-3-[(S)-tropoyloxy]tropanium nitrate
Molecular formula: C18H24N2O7 =380.4
CAS: 6106-46-3

Adverse Effects, Treatment, and Precautions

As for Atropine Sulfate, Go to Adverse Effects, Go to Treatment of Adverse Effects, and Go to Precautions. In contrast to atropine, hyoscine produces central depression at therapeutic doses and symptoms include drowsiness and fatigue. Toxic doses of hyoscine produce stimulation of the CNS in a similar manner to atropine. However, hyoscine does not stimulate the medullary centres and therefore does not produce the increases in respiration rate or blood pressure seen with atropine. Hyoscine may produce CNS stimulation rather than depression at therapeutic doses if used in the presence of pain without opioid analgesics; symptoms include excitement, restlessness, hallucinations, or delirium.

Patients who experience drowsiness should not drive or operate machinery. Caution has been advised in elderly patients and in patients with impaired liver, or kidney function, as adverse CNS effects have been stated to be more likely in these patients. There have been rare reports of an increase in frequency of seizures in epileptic patients.

The quaternary derivatives, such as the butylbromide, methobromide, or methonitrate, do not readily cross the blood-brain barrier, so central effects are rare.

Breast feeding.

The American Academy of Pediatrics1 states that there have been no reports of any clinical effect on the infant associated with the use of hyoscine by breast-feeding mothers, and that therefore it may be considered to be usually compatible with breast feeding.

  1. 1. American Academy of Pediatrics. The transfer of drugs and other chemicals into human milk. Pediatrics 2001; 108: 776–89. PubMed Correction. ibid.; 1029. Also available at: online (accessed 19/01/06)

Effects on the eyes.

Anisocoria.

Although bilateral mydriasis has occurred with the use of transdermal hyoscine, development of a unilateral fixed dilated pupil (anisocoria) may be due to contamination of a finger with hyoscine in handling the device, and then rubbing the eye.1-6 Similarly, anisocoria has been attributed7 to ocular contamination after handling broken hyoscine methobromide tablets.

  1. 1. Chiaramonte JS. Cycloplegia from transdermal scopolamine. N Engl J Med 1982; 306: 174. PubMed
  2. 2. Lepore FE. More on cycloplegia from transdermal scopolamine. N Engl J Med 1982; 307: 824. PubMed
  3. 3. McCrary JA, Webb NR. Anisocoria from scopolamine patches. JAMA 1982; 248: 353–4. PubMed
  4. 4. Bienia RA, et al. Scopolamine skin-disks and anisocoria. Ann Intern Med 1983; 99: 572–3. PubMed
  5. 5. Riddick FA, Jordan JD. Cruise ship anisocoria. Ann Intern Med 1992; 117: 95. PubMed
  6. 6. Lin Y-C. Anisocoria from transdermal scopolamine. Paediatr Anaesth 2001; 11: 626–7. PubMed
  7. 7. Nussdorf JD, Berman EL. Anisocoria associated with the medical treatment of irritable bowel syndrome. J Neuroophthalmol 2000; 20: 100–101. PubMed

Glaucoma.

A few cases of angle-closure glaucoma, both unilateral1 and bilateral,2 have been associated with transdermal hyoscine devices.

  1. 1. Hamill MB. et al. Transdermal scopolamine delivery system (TRANSDERM-V) and acute angle-closure glaucoma. Ann Ophthalmol 1983; 15: 1011–12. PubMed
  2. 2. Fraunfelder FT. Transdermal scopolamine precipitating narrow-angle glaucoma. N Engl J Med 1982; 307: 1079. PubMed

Strabismus.

Strabismus developed in a 4-year-old boy during treatment with transdermal hyoscine patches for drooling.1 The strabismus resolved shortly after stopping hyoscine.

  1. 1. Good WV, Crain LS. Esotropia in a child treated with a scopolamine patch for drooling. Pediatrics 1996; 97: 126–7. PubMed

Effects on mental function.

There have been reports of psychotic reactions associated with the transdermal use of hyoscine.1-6 Psychotic reactions have also occurred after instillation of hyoscine eye drops.7

  1. 1. Osterholm RK, Camoriano JK. Transdermal scopolamine psychosis. JAMA 1982; 247: 3081. PubMed
  2. 2. Rodysill KJ, Warren JB. Transdermal scopolamine and toxic psychosis. Ann Intern Med 1983; 98: 561. PubMed
  3. 3. MacEwan GW, et al. Psychosis due to transdermally administered scopolamine. Can Med Assoc J 1985; 133: 431–2. PubMed
  4. 4. Ziskind AA. Transdermal scopolamine-induced psychosis. Postgrad Med 1988; 84: 73–6. PubMed
  5. 5. Rubner O, et al. Ungewöhnlicher Fall einer Psychose infolge einer Langzeiteinwirkung mit einem Skopolaminmembranpflaster: Paranoid-halluzinatorische und delirante Symptomatik. Nervenarzt 1997; 68: 77–9. PubMed
  6. 6. Minagar A, et al. Transderm-induced psychosis in Parkinson's disease. Neurology 1999; 53: 433–4. PubMed
  7. 7. Barker DB, Solomon DA. The potential for mental status changes associated with systemic absorption of anticholinergic ophthalmic medications: concerns for the elderly. DICP Ann Pharmacother 1990; 24: 847–50. PubMed

Effects on the skin.

Contact dermatitis occurred in 16 men being treated for seasickness with transdermal hyoscine for 6 weeks to 15 months.1

  1. 1. Gordon CR, et al. Allergic contact dermatitis caused by transdermal hyoscine. BMJ 1989; 298: 1220–1. PubMed

Porphyria.

Hyoscine butylbromide has been associated with acute attacks of porphyria and is considered unsafe in porphyric patients.

Pregnancy.

A report1 of hyoscine toxicity in a neonate born to a mother who had received a total of 1.8 mg of hyoscine in divided doses with pethidine and levorphanol before delivery. The neonate was lethargic, barrel chested, and had a heart rate of 200 beats/minute. Symptoms subsided when physostigmine 100 micrograms was given intramuscularly.

  1. 1. Evens RP, Leopold JC. Scopolamine toxicity in a newborn. Pediatrics 1980; 66: 329–30. PubMed

Withdrawal.

A withdrawal syndrome of dizziness and nausea1,2 can occur in patients who have used transdermal hyoscine patches for several days; hypersalivation and diarrhoea has also been described.3 In reported cases, transdermal hyoscine had been used continuously for 7 or 10 days to prevent motion sickness. Symptoms usually begin 2 or 3 days after the last patch has been removed, and may last for a few days.

  1. 1. Meyboom RHB. More on Transderm Scop patches. N Engl J Med 1984; 311: 1377. PubMed
  2. 2. Saxena K, Saxena S. Scopolamine withdrawal syndrome. Postgrad Med 1990; 87: 63–6. PubMed
  3. 3. Feder RE. Transdermal scopolamine withdrawal syndrome. Clin Neuropharmacol 1999; 22: 120. PubMed

Interactions

As for antimuscarinics in general (see Atropine Sulfate, Go to Interactions).

The sedative effect of hyoscine may be enhanced by alcohol or other CNS depressants.

Pharmacokinetics

Hyoscine is readily absorbed from the gastrointestinal tract after oral doses of the hydrobromide. It is almost entirely metabolised, probably in the liver; only a small proportion of an oral dose is excreted unchanged in the urine. It crosses the blood-brain barrier and has been stated to cross the placenta. Hyoscine is also well absorbed after application to the skin.

The quaternary derivatives, such as the butylbromide or methobromide, are poorly absorbed from the gastrointestinal tract and do not readily pass the blood-brain barrier.

References.

  1. 1. Ebert U, et al. Pharmacokinetics and pharmacodynamics of scopolamine after subcutaneous administration. J Clin Pharmacol 1998; 38: 720–6. PubMed
  2. 2. Nachum Z, et al. Scopolamine bioavailability in combined oral and transdermal delivery. J Pharmacol Exp Ther 2001; 296: 121–3. PubMed

Uses and Administration

Hyoscine is a tertiary amine antimuscarinic with central and peripheral actions (see Go to Actions of antimuscarinics.). It is a more powerful suppressant of salivation than atropine, and usually slows rather than increases heart rate, especially in low doses. Its central action differs from that of atropine in that it depresses the cerebral cortex and produces drowsiness and amnesia. Hyoscine hydrobromide is also a tertiary amine, whereas hyoscine butylbromide, hyoscine methobromide, and hyoscine methonitrate are quaternary ammonium derivatives.

Hyoscine and hyoscine hydrobromide are used in the management of motion sickness and other forms of nausea and vomiting (Go to Nausea and vomiting.); hyoscine hydrobromide is also given as a premedicant in anaesthesia (Go to Anaesthesia.), and to produce mydriasis and cycloplegia (Go to Eye disorders.). Hyoscine butylbromide and other quaternary ammonium derivatives are used in conditions associated with visceral spasms. In addition, hyoscine methobromide has been employed as an adjunct in the treatment of peptic ulcer disease (Go to Gastrointestinal disorders.).

Other hyoscine salts or derivatives that have been used include hyoscine borate, hyoscine hydrochloride, and hyoscine oxide hydrobromide.

Anaesthesia.

The role of antimuscarinics, including hyoscine, in anaesthesia is discussed under Atropine on Go to Anaesthesia.. For the use of hyoscine in the prevention of postoperative nausea and vomiting, see Go to Nausea and vomiting..

For premedication hyoscine hydrobromide is injected subcutaneously or intramuscularly in doses of 200 to 600 micrograms, usually with papaveretum about half to one hour before induction of general anaesthesia. In the UK, a dose of 15 micrograms/kg is licensed in children (the BNFC suggests that this dose is appropriate from 1 to 12 years of age; older children may be given the adult dose). If necessary for acute use, the same doses may be given by intravenous injection.

Anoxic seizures.

For mention of the use of transdermal hyoscine as an alternative to atropine in the management of reflex anoxic seizures in children, see Go to Anoxic seizures..

Biliary and renal colic.

Hyoscine has been used as an adjunct to opioid analgesics for symptomatic relief of biliary or renal colic (see Go to Biliary and renal colic.) although the evidence for such use is weak. Hyoscine butylbromide 20 mg is given by intramuscular or slow intravenous injection; this may be repeated after 30 minutes if necessary to a maximum daily dose of 100 mg. See also Palliative Care, Go to Palliative care..

References.

  1. 1. Holdgate A, Oh CM. Is there a role for antimuscarinics in renal colic? A randomized controlled trial. J Urol (Baltimore) 2005; 174: 572–5. PubMed

Cardiac disorders.

Although hyoscine is not one of the conventional therapies for heart failure (Go to Heart failure) or myocardial infarction (Go to Myocardial infarction), low-dose transdermal hyoscine can increase cardiac vagal activity and thereby reduce the autonomic imbalance seen in patients with these conditions.1-3 Improved exercise tolerance has been reported after 1 week of treatment with transdermal hyoscine in a small open study in 14 patients with mild to moderate heart failure.4

  1. 1. Casadei B, et al. Low doses of scopolamine increase cardiac vagal tone in the acute phase of myocardial infarction. Circulation 1993; 88: 353–7. PubMed
  2. 2. La Rovere MT, et al. Scopolamine improves autonomic balance in advanced congestive heart failure. Circulation 1994; 90: 838–43. PubMed
  3. 3. Venkatesh G, et al. Double blind placebo controlled trial of short term transdermal scopolamine on heart rate variability in patients with chronic heart failure. Heart 1996; 76: 137–43. PubMed
  4. 4. De Vecchis R, et al. Different impact of carvedilol and transdermal scopolamine on cardiovascular performance of mild-moderate chronic heart failure patients: evidence of useful effects of scopolamine on tolerance to work load. Minerva Cardioangiol 2000; 48: 393–401. PubMed

Dysmenorrhoea.

Hyoscine as the butylbromide or hydrobromide has been used for its antispasmodic action in the treatment of dysmenorrhoea. (Go to Dysmenorrhoea.), but the BNF considers that antispasmodics do not generally provide significant relief.

Eye disorders.

Hyoscine hydrobromide is used in the eye for its mydriatic and cycloplegic actions (Go to Mydriasis and cycloplegia) usually in a concentration of 0.25%. It has a faster onset and shorter duration of action than atropine although the effects may still persist for up to 3 to 7 days. It may be useful for patients who are hypersensitive to atropine.

Gastrointestinal disorders.

Hyoscine has been used as an antispasmodic (Go to Antispasmodics) to relieve the pain of smooth muscle spasm associated with the gastrointestinal tract. In such conditions the licensed UK dose is 20 mg of hyoscine butylbromide intramuscularly or by slow intravenous injection, repeated after 30 minutes if necessary, up to a maximum of 100 mg daily; alternatively, 20 mg may be given by mouth four times daily. In irritable bowel syndrome (Go to Irritable bowel syndrome) the recommended starting dose by mouth is 10 mg three times daily which may be increased to 20 mg four times daily, if necessary. Children aged 6 to 12 years may be given 10 mg three times daily by mouth for gastrointestinal spasms. Hyoscine may also be useful as an antispasmodic in diagnostic procedures of the gastrointestinal tract. Hyoscine has been used as an adjunct in the treatment of peptic ulcer disease; hyoscine methobromide has been licensed in the USA in a dose of 2.5 mg half an hour before meals and 2.5 to 5 mg at bedtime. The antiemetic effect of hyoscine is discussed under Nausea and Vomiting, Go to Nausea and vomiting..

Hyperhidrosis.

Adverse effects of antimuscarinics given orally generally preclude their use by this route for the management of hyperhidrosis (Go to Hyperhidrosis), but some, such as hyoscine, have been applied topically as alternatives to aluminium salts. Hyoscine hydrobromide applied as a 3% cream was successful in reducing gustatory sweating, consisting of flushing and sweating over the right mandible during eating, in a patient who had previously undergone surgical excision of the right submandibular salivary gland.1 The use of transdermal or injectable hyoscine was reported2 to be effective for the control of opioid-associated sweating in 2 patients receiving palliative care (see also Go to Palliative care. for other uses of hyoscine in palliative care).

  1. 1. Bailey BMW, Pearce DE. Gustatory sweating following submandibular salivary gland removal. Br Dent J 1985; 158: 17–18. PubMed
  2. 2. Mercadante S. Hyoscine in opioid-induced sweating. J Pain Symptom Manage 1998; 15: 214–15. PubMed

Nausea and vomiting.

Hyoscine is an effective agent in the prevention of motion sickness and is one of the principal drugs used. It may be given by mouth for short-term protection or by transdermal patch for a prolonged duration of action.

In the UK, a usual dose of hyoscine hydrobromide by mouth is 300 micrograms taken 30 minutes before a journey, followed by 300 micrograms every 6 hours if required up to a maximum of 3 doses in 24 hours. Children aged 4 to 10 years may be given 75 to 150 micrograms and those over 10 years, 150 to 300 micrograms. Children aged 3 to 4 years may be given 75 micrograms 20 minutes before a journey, repeated if necessary to a maximum total dose of 150 micrograms in 24 hours. Hyoscine is also given via a transdermal patch which is placed behind the ear and supplies 1 mg over 3 days. The patch is licensed in the UK for adults and children aged 10 years and over and should be applied 5 to 6 hours before travelling or on the preceding evening and removed at the end of the journey.

An intranasal formulation of hyoscine hydrobromide has been investigated for the treatment and prevention of motion sickness.

Transdermal hyoscine has been used in adults and children for the prevention of postoperative nausea and vomiting.

Hyoscine hydrobromide has also been given by intravenous, subcutaneous, or intramuscular injection for its antiemetic effect in a usual dose of 300 to 600 micrograms.

The other drugs used in the management of motion sickness and postoperative nausea and vomiting are discussed on Go to Nausea and vomiting.

References.

  1. 1. Kranke P, et al. The efficacy and safety of transdermal scopolamine for the prevention of postoperative nausea and vomiting: a quantitative systematic review. Anesth Analg 2002; 95: 133–43. PubMed
  2. 2. Spinks AB, et al. Scopolamine for preventing and treating motion sickness. Available in The Cochrane Database of Systematic Reviews; Issue 3. Chichester: John Wiley; 2004 (accessed 19/01/06). PubMed

Palliative care.

The BNF includes doses for hyoscine in palliative care. Hyoscine hydrobromide is used in palliative care to reduce excessive respiratory secretions. A dose of 400 to 600 micrograms may be given by subcutaneous injection every 4 to 8 hours. Alternatively 0.6 to 2.4 mg may be given over 24 hours by continuous subcutaneous infusion. In younger patients from 1 month of age the BNFC suggests a dose of 10 micrograms/kg (up to a maximum of 400 micrograms) by subcutaneous or intravenous injection 3 or 4 times daily, adjusted according to response. Alternatively, 1.5 to 2.5 micrograms/kg per hour may be given by continuous subcutaneous or intravenous infusion. Care should be taken to avoid the discomfort of a dry mouth. Hyoscine may also be given as a transdermal patch in some countries.

Hyoscine hydrobromide may be given sublingually for the pain of bowel colic in a dose of 300 micrograms 3 times daily.

Hyoscine butylbromide is also used in palliative care in the treatment of bowel colic; however, it may not be adequate for the control of respiratory secretion. It is given as a subcutaneous infusion in a dose of 20 to 60 mg every 24 hours. A single subcutaneous dose of 20 mg reviewed after 30 minutes, has been suggested if it is tried for excessive respiratory secretion.1

The use of hyoscine in palliative care has been reviewed.2,3 Hyoscine hydrobromide may be more effective than glycopyrronium bromide in drying secretions, and has a rapid onset of action, but it can produce both sedation and agitation; there is no clear evidence favouring one antimuscarinic over another.1

  1. 1. Bennett M, et al. Using anti-muscarinic drugs in the management of death rattle: evidence-based guidelines for palliative care. Palliat Med 2002; 16: 369–74. PubMed
  2. 2. Muir JC, von Gunten CF. Antisecretory agents in gastrointestinal obstruction. Clin Geriatr Med 2000; 16: 327–34. PubMed
  3. 3. Spiller JA, Fallon M. The use of Scopoderm in palliative care. Hosp Med 2000; 61: 782–4. PubMed

Urinary incontinence.

Antimuscarinics have been used in the management of urge incontinence (Go to Urinary incontinence and retention.) but the incidence of adverse effects can be high. Results of a small study1 suggested that transdermal hyoscine might be of benefit in females with detrusor instability.

  1. 1. Muskat Y, et al. The use of scopolamine in the treatment of detrusor instability. J Urol (Baltimore) 1996; 156: 1989–90. PubMed

Vertigo.

Hyoscine has a long history of use in the management of vertigo, although other drugs are now preferred (Go to Vertigo).

Preparations

Single-ingredient Preparations

The symbol ¤ denotes a preparation which is discontinued or no longer actively marketed.

Argentina: Buscapina; Cifespasmo; Colobolina; Luar-G; Pasmodina; Rupe-N¤; Australia: Buscopan; Kwells; Pamine¤; Scop¤; Setacol; Travacalm HO; Austria: Buscopan; Scopoderm; Belgium: Aspasmine¤; Buscopan; Brazil: Algexin; Buscopan; Hiospan; Uni Hioscin; Canada: Buscopan; Transderm-V; Chile: Buscapina; Czech Republic: Buscolysin; Buscopan; Denmark: Buscopan; Scopoderm; Finland: Buscopan; Scopoderm; France: Buscopan¤; Genoscopolamine¤; Scoburen; Scopoderm TTS; Scopos¤; Germany: Boro-Scopol; BS Carino; BS-ratiopharm; Buscolysin¤; Buscopan; espa-butyl¤; Holopon¤; Scopoderm TTS; Skopyl¤; Spasman scop; Spasmowern; Greece: Buscopan; Hong Kong: Buscopan; Busopin; Copan; Dhacopan; Holopon¤; Hysopan; Scopoderm TTS¤; Vidaspan; India: Buscopan; Hyospan; Ireland: Buscopan; Kwells; Italy: Buscopan; Transcop; Japan: Buscopan; Malaysia: Buscopan; Colospan; Dhacopan; Fucon; Hyomide; Spasmoliv; Vacopan; Vascopan¤; Mexico: Alpin; Brolamina; Buscapina; Busina; Busprina-S¤; Buticina¤; Butiral; Cryopina; Espacil; Espasantral¤; Excosine-S; Grafin; Hiosinotil¤; Lemophar; Liliam¤; Selpiran-S; Serralpina; Tilosin¤; Netherlands: Buscopan; Scopoderm TTS; Norway: Buscopan; Scopoderm; New Zealand: Buscopan; Scopoderm TTS; Portugal: Buscopan; Vagotrope-S¤; Russia: Buscopan (Бускопан); South Africa: Buscopan; Hyospasmol; Scopaject; Scopex; Scopoderm TTS¤; Singapore: Buscopan; Colospan¤; Dhacopan; Fucon¤; Hyomide; Scopoderm TTS¤; Spasmoliv; Vacopan; Spain: Buscapina; Vorigeno¤; Sweden: Buscopan; Scopoderm; Switzerland: Buscopan; Scopoderm TTS¤; Thailand: Amcopan; Antispa; Bacotan; Buscono; Buscopan; Butyl; Cencopan; Eralga; Higan; Hy-Spa; Hybutyl; Hyosmed; Hyospan; Hyostan; Hyozin¤; Hytic; Kanin; Myspa; Scopas; Spascopan; Spasgone-H; Spatab; Vacopan; United Arab Emirates: Scopinal; United Kingdom: Buscopan; Joy-Rides; Kwells; Scopoderm TTS; Travel Calm¤; United States: Pamine; Scopace; Transderm Scop; Venezuela: Buscapina; Butilamina Compuesta; Hiocin;

Multi-ingredient Preparations

The symbol ¤ denotes a preparation which is discontinued or no longer actively marketed.

Argentina: 6 Copin; 6 Copin; Buscapina Compositum N; Buscapina Compositum; Cavodan; Cifespasmo Compuesto; Colobolina D; Dislembral; Espasmo Biotenk; Gastrolina Compuesta; Ibu-Buscapina; Lisalgil Compuesto; Luar-G Compositum; Novopasmil Compuesto; Pasmodina Compuesta; Rupe-N Compuesto; Australia: Benacine¤; Contac¤; Donnagel; Donnalix; Donnatab; Donnatal¤; Travacalm; Austria: Asthma¤; Buscopamol¤; Buscopan Compositum; Modiscop; Belgium: Buscopan Compositum; Spasma¤; Tranquo-Buscopan¤; Brazil: Analverin Composto; Analverin Plus; Binospan Composto; Bioscina Composta; Buscopan Composto; Buscopan Plus¤; Buscoveran Composto; Butilamin; Disbuspan; Dorspan; Ductopan; Espasmodid Composto; Hioariston; Hiospan Composto; Inib-Dor; Kindpasm; Neocopan; Sedabel¤; Sedobion¤; Tropinal; Uzara; Vagoplex; Veratropan Composto; Canada: Diban¤; Donnagel¤; Donnatal¤; Donnazyme¤; Chile: Algion; Buscapina Compositum; Dolcopin; Kordinol Compuesto¤; Novalona; France: Algo-Buscopan¤; Sedol¤; Supposedol¤; Vagantyl¤; Germany: B1-Neurischian¤; bella sanol¤; Brox-Aerosol N¤; Buscopan Compositum¤; Buscopan Plus; Circovegetalin compositum¤; Febenol¤; Felsolyn N¤; Ichthospasmin N¤; Oragallin S¤; Seda-Stenocrat-N¤; Spasmo-Bilicura¤; Tranquo-Buscopan¤; Greece: Buscopan Plus; Spasmo-Apotel; Hong Kong: Crema-U¤; Unigan; Virulex Forte; Ireland: Feminax; Italy: Buscopan Compositum; Spasmeridan; Tranquo-Buscopan¤; Mexico: Algosfar; Anadil; Bipasmin Compuesto NF¤; Buscapina Compositum N; Buscapina Compositum; Busconet; Busepan; Busprina; Colepren; Donodol Compuesto; Escapin-N; Espacil Compuesto; Espasmogress; Hiosinotil Compuesto¤; Infafren Compuesto; Ortran¤; Pasmodil; Pirobutil; Precicol; Prestodol Compuesto; Retodol Compositum; Selpiran; Serralpina Compuesta; Portugal: Buscopan Compositum N; South Africa: Allertac¤; Bellatard¤; Bellavern¤; Buscopan Compositum; Donnatal; Dyka-D¤; Dykatuss¤; Millerspas; Respinol Compound; Respinol; Scopex Co; Tropax¤; Virobis; Spain: Brom Hioscin Espasmoliti¤; Buscalide¤; Buscapina Compositum; Buscopax¤; Frenespan¤; Furantoina Sedante¤; Gestadramina¤; Lotanal¤; Midriati; Nolotil Compositum¤; Oportunin¤; Oragalin Espasmolitico; PH 3 Compuesto¤; Psico Blocan; Uro Hubber¤; Urogobens Antiespasmo¤; Sweden: Spasmofen; Switzerland: Buscopan Compositum¤; Nardyl; Viaggio¤; Thailand: Amcopan Plus; Buscopan Plus; Donnatal¤; Pacopan; Spasgone; Unigan; United Kingdom: Feminax; United States: Accuhist LA; AeroHist Plus; AeroKid; AH-chew; Alkabel; AlleRx; Antispasmodic Elixir; Atrohist Plus¤; Barbidonna¤; Bellahist-D; Bellatal; Chlor-Mes D; CPM PSE MSC; CPM/PE/MSC; DA Chewable; DA II; Dallergy; Deconhist LA¤; Dehistine; Donna-Sed¤; Donnagel-PG¤; Donnamor¤; Donnapine¤; Donnatal; DriHist; Dura-Vent/DA; Durahist D; Durahist; Ex-Histine; Extendryl; Hista-Vent DA; Histaspan-D¤; Histor-D Timecelles; Hyosophen; Kinesed¤; Librax; Malatal¤; Mescolor¤; Murocoll-2; Nacon; Norel DM; Omnihist LA; Pannaz; PCM; Phenacon¤; Phenahist-TR¤; Phenchlor SHA¤; Prehist D; PSE MSC; Ralix; Relaxadon¤; Rescon-MX; Rhinolar¤; Ru-Tuss¤; Ryneze; Spasmophen¤; Spasquid¤; Stahist; Susano; Xiral; Venezuela: Buscapina Compositum; Buscapina Plus; Diezol Compuesto; Fenopol; Hioscinol Compuesto; Sarifan Compuesto; Vuscobras;



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