Can drotaverine (Noxytiolin) and buscopan (Hyoscine butylbromide) be given together?

Drotaverine and Hyoscine Butylbromide (Buscopan) Combination Therapy

Yes, drotaverine (Noxytiolin) and hyoscine butylbromide (Buscopan) can be given together as they have complementary mechanisms of action and may provide synergistic effects in treating abdominal spasms and pain. 1

Pharmacological Mechanisms

• Drotaverine acts as a phosphodiesterase inhibitor that enhances the cAMP inhibitory pathway in smooth muscle, leading to relaxation 1
• Hyoscine butylbromide is an antimuscarinic agent that blocks muscarinic receptors in the gastrointestinal tract, inhibiting the excitatory pathway and producing a spasmolytic effect 2, 3
• These drugs work through different and complementary mechanisms - drotaverine stimulates the inhibitory pathway while hyoscine butylbromide inhibits the excitatory pathway 1

Evidence Supporting Combination Use

• A 2024 human ex-vivo study demonstrated that drotaverine and hyoscine butylbromide have complementary effects on human colon motility 1
• The combination provides dual action: drotaverine enhances the cAMP inhibitory pathway while hyoscine butylbromide blocks the excitatory muscarinic pathway 1
• Clinical guidelines support the use of antispasmodics for abdominal cramping and pain, with hyoscine butylbromide being one of the recommended options 4

Clinical Applications

• The combination is particularly useful for treating:
  • Abdominal pain associated with gastrointestinal spasms 2, 3
  • Irritable bowel syndrome with cramping 4, 2
  • Intestinal dysmotility disorders 2

Administration Considerations

• Hyoscine butylbromide has poor oral bioavailability (<1%) but maintains local action in the intestine due to high tissue affinity for muscarinic receptors 3
• Drotaverine is well absorbed after oral administration and is primarily excreted through bile 5
• For severe gastrointestinal spasms, intramuscular preparations of hyoscine butylbromide may be more effective than oral forms 2

Safety Considerations

• Hyoscine butylbromide is generally well tolerated as it barely crosses the blood-brain barrier 3
• Common anticholinergic side effects of hyoscine butylbromide include dry mouth, constipation, and urinary retention 4
• Hyoscine butylbromide is contraindicated in patients with:
  • Tachycardia, angina, and cardiac failure 6
  • Prostatic hypertrophy with urinary retention 6
• Temporary impairment of visual accommodation may occur with hyoscine butylbromide, particularly in patients under 50 years of age 7
• Drotaverine has no significant interaction with hyoscine butylbromide that would increase adverse effects 1

Conclusion

The combination of drotaverine and hyoscine butylbromide represents a rational pharmacological approach for treating abdominal spasms and pain, as they act through different but complementary mechanisms. Their combined use may provide better symptom relief than either agent alone without increasing adverse effects.