What are the contraindications for Buscopan (hyoscine butylbromide)?

Contraindications for Buscopan (Hyoscine Butylbromide)

Buscopan (hyoscine butylbromide) is contraindicated in patients with glaucoma, obstructive uropathy, obstructive gastrointestinal disease, paralytic ileus, intestinal atony in elderly or debilitated patients, unstable cardiovascular status in acute hemorrhage, severe ulcerative colitis, toxic megacolon complicating ulcerative colitis, and myasthenia gravis. 1

Absolute Contraindications

• Glaucoma - Particularly concerning for undiagnosed angle closure glaucoma 1, 2
• Obstructive uropathy - Including bladder neck obstruction due to prostatic hypertrophy 1, 3
• Obstructive gastrointestinal disease - Such as achalasia and pyloroduodenal stenosis 1
• Paralytic ileus - Especially in elderly or debilitated patients 1
• Intestinal atony - Particularly in elderly or debilitated patients 1
• Unstable cardiovascular status in acute hemorrhage 1
• Severe ulcerative colitis 1
• Toxic megacolon complicating ulcerative colitis 1
• Myasthenia gravis 1
• Cardiac conditions - Including tachycardia, angina, and cardiac failure 3

Cardiovascular Considerations

Buscopan should be used with extreme caution in patients with cardiac comorbidities. According to clinical practice guidelines:

• Patients with tachycardia, angina, or cardiac failure should generally not receive Buscopan 3
• If Buscopan must be used in patients with heart disease, careful cardiac monitoring is required in an environment with resuscitation equipment and appropriately trained staff 3
• Cardiac complications have been reported more frequently than ocular complications in clinical practice (1.9% vs 0.8%) 2

Ocular Considerations

Despite traditional teaching about glaucoma being a contraindication:

• The primary risk is to patients with undiagnosed angle closure glaucoma, not those with known and treated glaucoma 2
• Routine questioning about glaucoma history may be of limited value 4
• Visual accommodation may be temporarily impaired, particularly in patients under 50 years of age 4
• Patients should be advised to seek urgent medical attention if they experience eye pain, redness, decreased vision, nausea, vomiting, or headache after receiving Buscopan 3

Administration Considerations

• Oral administration of Buscopan has very low systemic bioavailability (<1%) and may not produce significant therapeutic effects 5, 6
• Intravenous administration allows for greater efficacy but requires monitoring for potential adverse effects 6
• The drug has high affinity for muscarinic receptors in GI tract smooth muscle, which is the basis for its therapeutic effect 5

Clinical Practice Recommendations

• When administering Buscopan, especially intravenously, ensure appropriate monitoring for patients with cardiac risk factors 3
• Consider alternative agents (such as glucagon) for patients with absolute contraindications 2
• The risk-benefit ratio should be carefully evaluated in patients with prostatic hypertrophy with urinary retention 3
• Patients should be counseled about potential side effects and when to seek medical attention after administration 3, 4

Buscopan's anticholinergic properties are responsible for both its therapeutic effects and its contraindications, making careful patient selection essential for safe use 5.