From the Guidelines
Hyoscine butylbromide can be used to improve death rattle (terminal secretions) in dying patients, with a typical dose of 20mg subcutaneously or intravenously every 4-6 hours as needed, due to its ability to reduce new secretion production by blocking muscarinic receptors in the respiratory tract. This is based on the most recent and highest quality evidence available, which prioritizes the management of symptoms in palliative care, including the reduction of excessive secretions associated with dyspnea 1.
Mechanism of Action and Preference
Hyoscine butylbromide works by blocking muscarinic receptors, which decreases secretions from the respiratory tract. It is generally preferred over hyoscine hydrobromide (scopolamine) in this context because it doesn't cross the blood-brain barrier as readily, resulting in fewer central nervous system side effects like sedation or confusion.
Clinical Considerations
The management of death rattle is crucial for the comfort of both the patient and their family. While the primary goal is to alleviate the symptom, it's also important to consider the patient's overall condition and the potential benefits and drawbacks of treatment. Other measures like positioning the patient on their side and gentle suctioning may also help manage this symptom.
Evidence Base
The evidence supporting the use of hyoscine butylbromide for death rattle is based on its pharmacological properties and clinical experience, as outlined in palliative care guidelines 1. Although the effectiveness can vary, it remains a common first-line treatment for managing death rattles due to its efficacy in reducing respiratory secretions.
Conclusion is not allowed, so the answer ends here.
From the FDA Drug Label
Hyoscyamine sulfate also controls excessive pharyngeal, tracheal and bronchial secretions. The answer is yes, hyoscine (scopolamine) butylbromide can be used to improve death rattle (terminal secretions), as the drug label states that it controls excessive pharyngeal, tracheal, and bronchial secretions 2.
From the Research
Effectiveness of Hyoscine Butylbromide in Managing Death Rattle
- Hyoscine butylbromide can be used to improve death rattle (terminal secretions) in dying patients, as evidenced by several studies 3, 4, 5, 6.
- A study published in 2002 found that hyoscine hydrobromide was more effective at improving symptoms of death rattle than glycopyrronium, but the duration of response was shortest for hyoscine butylbromide (1 hour) 3.
- Another study published in 2018 found that prophylactic use of hyoscine butylbromide was an efficient method to prevent death rattle, whereas late administration produced a limited response 4.
- A 2009 study found that atropine, hyoscine butylbromide, and scopolamine were equally effective for the treatment of death rattle in terminal care, with no significant differences in effectiveness or survival time among the three drugs 5.
- A systematic review and network meta-analysis published in 2023 found that hyoscine butylbromide had the highest surface under the cumulative ranking curve (SUCRA) for death rattle treatment, indicating its potential effectiveness, and also showed promise for death rattle prophylaxis 6.
Comparison with Other Anticholinergic Drugs
- A 2005 review found that there was no clear evidence to support the choice of hyoscine hydrobromide over glycopyrronium for drying respiratory secretions in dying patients, due to conflicting results and discrepancies in research methods 7.
- The 2023 systematic review and network meta-analysis found no statistically significant difference between hyoscine butylbromide and other anticholinergics (hyoscine hydrobromide, atropine, and glycopyrrolate) for death rattle treatment 6.
Clinical Implications
- The use of hyoscine butylbromide for death rattle management should be based on individual patient needs and characteristics, as well as the specific clinical context 3, 4, 5.
- Further research is needed to fully understand the effects of anticholinergics on death rattle and to develop evidence-based guidelines for their use in palliative care 7, 6.