Is Buscopan (hyoscine butylbromide) effective for treating hiccups?

Buscopan (Hyoscine Butylbromide) for Hiccups

Effectiveness and Recommendation

Buscopan (hyoscine butylbromide) is not recommended as a first-line treatment for hiccups as there is insufficient evidence supporting its efficacy for this specific indication. 1, 2, 3

Evidence Assessment

• Hyoscine butylbromide (Buscopan) is primarily indicated as a gastrointestinal antispasmodic that acts by suppressing spasms of the digestive system 1
• Despite its antispasmodic properties, there is no high-quality evidence in clinical guidelines supporting Buscopan's use specifically for hiccups 2, 3
• The American Academy of Pediatrics and other major medical societies do not include Buscopan in their recommendations for hiccup management 2
• Chlorpromazine remains the only FDA-approved medication specifically for hiccups treatment 3

Mechanism and Limitations

• Buscopan belongs to the class of quaternary ammonium compounds with antimuscarinic properties 1
• It has poor penetration across the blood-brain barrier, limiting its central effects 1
• Hiccups often involve central nervous system pathways, which may explain why Buscopan's peripheral action might be insufficient 3, 4

Alternative Evidence-Based Treatments

• Baclofen has shown efficacy in randomized controlled trials for persistent hiccups and should be considered before Buscopan 3, 5
• Gabapentin and metoclopramide have also been studied in prospective trials for hiccups management 3
• For severe cases, chlorpromazine remains the standard FDA-approved treatment 3

Potential Side Effects of Buscopan

• Common side effects include dry mouth and other anticholinergic effects 1, 6
• Buscopan is contraindicated in patients with tachycardia, angina, and cardiac failure 6
• Caution is required in patients with prostatic hypertrophy with urinary retention 6

Clinical Considerations

• Hiccups lasting more than 48 hours warrant thorough diagnostic workup to identify underlying causes 2, 4
• Male gender and greater height are associated with increased risk of hiccups 7
• Certain medications, particularly those used in chemotherapy (dexamethasone, levofolinate, fluorouracil, oxaliplatin, carboplatin, and irinotecan), are associated with higher risk of hiccups 7

Treatment Algorithm

1. For brief episodes (<48 hours): Conservative measures (breathing techniques, stimulation of pharynx) 4
2. For persistent hiccups (>48 hours):
   • First-line pharmacological treatment: Baclofen 5-25 mg three times daily 3, 5
   • Second-line options: Gabapentin or metoclopramide 3
   • For refractory cases: Chlorpromazine (FDA-approved option) 3
3. Buscopan should only be considered when other evidence-based treatments have failed 1, 3