Can Hyoscine Butylbromide Be Given for Abdominal Pain in Children?
Hyoscine butylbromide can be used for nonspecific colicky abdominal pain in children aged 8-17 years, but it is not superior to acetaminophen and should be considered as an alternative rather than first-line option. 1
Evidence-Based Recommendation
The American Academy of Pediatrics recommends oral ibuprofen (5-10 mg/kg every 6-8 hours) or acetaminophen (10-15 mg/kg every 4-6 hours) as first-line treatment for mild to moderate abdominal pain in children if no contraindications exist. 2, 3 Hyoscine butylbromide may be considered when functional abdominal pain is provoked by meals, though supporting evidence in children remains limited. 2
Pediatric Evidence for Hyoscine Butylbromide
A 2020 randomized controlled trial in children aged 8-17 years with nonspecific colicky abdominal pain demonstrated that:
- Hyoscine butylbromide 10 mg orally was not superior to acetaminophen 15 mg/kg (adjusted difference 1 mm on visual analogue scale, 95% CI -7 to 7). 1
- Both agents produced clinically important pain reduction, with mean pain scores of 29 mm (hyoscine) versus 30 mm (acetaminophen) at 80 minutes. 1
- Both medications were safe and well-tolerated with no serious adverse effects observed. 1
- Adverse effects occurred in 27.6% with hyoscine versus 24.3% with acetaminophen (p = 0.5). 1
Dosing for Children
Based on the pediatric trial, the appropriate dose is 10 mg orally for children aged 8-17 years presenting with nonspecific colicky abdominal pain. 1 This is lower than adult dosing (20-100 mg/day). 4
When to Consider Hyoscine Butylbromide
Hyoscine butylbromide may be considered as an alternative antispasmodic agent when functional abdominal pain is provoked by meals, particularly when cramping or spasm-like pain is the predominant feature. 2 The drug works by blocking muscarinic receptors on gastrointestinal smooth muscle, producing a local spasmolytic effect. 5
Safety Profile
Hyoscine butylbromide has favorable safety characteristics in children:
- Minimal systemic absorption (bioavailability <1%) means it acts locally in the intestine without significant central nervous system effects. 5
- It does not cross the blood-brain barrier due to its quaternary ammonium structure. 6, 5
- The drug has been used safely for over 60 years with few reported adverse events. 5, 7
Critical Limitations and Caveats
Do not withhold pain medication while awaiting diagnosis - this outdated practice impairs examination without improving diagnostic accuracy. 2, 3 Pain relief should be provided immediately upon presentation. 2
Hyoscine butylbromide should not replace standard first-line analgesics (ibuprofen or acetaminophen) in children, as it offers no superiority and has less pediatric evidence. 1, 2
Avoid in children with contraindications to anticholinergics, including narrow-angle glaucoma, myasthenia gravis, or megacolon. 5
Practical Algorithm for Use
First-line: Administer oral ibuprofen (5-10 mg/kg) or acetaminophen (10-15 mg/kg) for mild-moderate abdominal pain. 2, 3
Consider hyoscine butylbromide 10 mg orally as an alternative if:
Escalate to IV opioids (morphine) for severe pain unresponsive to oral agents. 2, 3
Comparison to Adult Use
In adults, hyoscine butylbromide is commonly used as a gastrointestinal antispasmodic, though it is poorly absorbed orally and intramuscular preparations may be more effective. 6 For diagnostic imaging in adults, hyoscine butylbromide is the spasmolytic agent of choice to improve bowel distension during MR enterography. 6