What is the recommended dosage of Buscopan (hyoscine) for managing menstrual cramps?

Buscopan (Hyoscine) for Menstrual Cramps

Recommended Dosage

For menstrual cramps in adults and adolescents 12 years and older, take 1-2 tablets of Buscopan (hyoscine butylbromide) every 4 hours as needed, not exceeding 12 tablets in 24 hours. 1

• For pediatric patients aged 2 to under 12 years, the dosage is ½ to 1 tablet every 4 hours as needed, not exceeding 6 tablets in 24 hours 1
• The tablets may be taken sublingually, orally, or chewed according to patient preference 1

Mechanism and Efficacy

Hyoscine butylbromide works as an anticholinergic agent with high affinity for muscarinic receptors on gastrointestinal smooth muscle, producing a spasmolytic effect that relieves cramping 2. The drug has extremely low systemic bioavailability (<1%) after oral administration, but maintains high tissue affinity at the site of action, allowing it to exert local effects without significant systemic absorption 2.

However, evidence specifically supporting Buscopan for menstrual cramps is limited. The available clinical trials evaluated its efficacy primarily for abdominal cramping and gastrointestinal spasms, not dysmenorrhea 2. While the drug is marketed for menstrual pain in some countries, this indication lacks robust clinical trial evidence comparable to NSAIDs.

Superior Alternatives with Stronger Evidence

NSAIDs are the evidence-based first-line treatment for menstrual cramps, with substantially stronger efficacy data than Buscopan:

• Naproxen sodium 440 mg provides significantly greater pain relief than acetaminophen over 12 hours, with effects becoming significant as early as 4-6 hours post-dose 3
• Diclofenac potassium 50 mg three times daily (150 mg total daily dose) provides consistent, significant pain reduction across 24 hours in women with severe primary dysmenorrhea 4
• NSAIDs work by inhibiting prostaglandin synthesis, directly addressing the underlying mechanism of menstrual cramping 3, 4

Critical Safety Considerations

Buscopan is pregnancy category C and should be avoided during pregnancy. Animal studies demonstrate negative effects on embryonic neural tube development, with dose-dependent decreases in cell proliferation and adverse effects on early nervous system development 5. While human data are insufficient, the teratogenic potential in animal models warrants extreme caution 5.

Clinical Algorithm for Menstrual Cramp Management

1. First-line: Start with naproxen sodium 440 mg or diclofenac potassium 50 mg at onset of pain, repeated every 8-12 hours as needed 3, 4
2. Second-line: If NSAIDs are contraindicated (GI bleeding risk, renal impairment, aspirin allergy), consider Buscopan 1-2 tablets every 4 hours, maximum 12 tablets daily 1
3. Avoid in pregnancy: Do not use Buscopan in women who are pregnant or may become pregnant due to teratogenic concerns 5

Common Pitfalls

• Do not assume Buscopan has equivalent efficacy to NSAIDs - the evidence base for menstrual cramps specifically is weak compared to robust NSAID data 3, 4, 2
• Do not exceed maximum daily dosing of 12 tablets (adults) or 6 tablets (children under 12) in 24 hours 1
• Do not use as first-line therapy when NSAIDs are appropriate and not contraindicated, as NSAIDs have superior evidence for dysmenorrhea 3, 4