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Corsetti M, Forestier S, Jiménez M. Hyoscine butylbromide mode of action on bowel motility: From pharmacology to clinical practice. Neurogastroenterol Motil 2023; 35:e14451. [PMID: 35972266 DOI: 10.1111/nmo.14451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 06/25/2022] [Accepted: 08/01/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Hyoscine butylbromide (HBB) has been available for use as an antispasmodic since 1951 and is indicated for the treatment of abdominal pain associated with cramps. A previous review in 2007 summarized the evidence on the mode of action of HBB in vitro and in vivo in both animal and human studies. However, since then, novel publications have appeared within the literature and also our knowledge of what represents normal motility in humans has evolved. PURPOSE This review is the result of the collaboration between a basic scientist and clinicians with the aim of providing an updated overview of the mechanisms of action of HBB and its clinical efficacy to guide not only use in clinical practice, but also future research.
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Affiliation(s)
- Maura Corsetti
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham Digestive Diseases Biomedical Research Centre, Nottingham, UK
| | | | - Marcel Jiménez
- Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Barcelona, Spain
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Lageju N, Neupane D, Jaiswal LS, Phuyal U. Hyoscine butylbromide induced psychosis: A case report. Clin Case Rep 2022; 10:e05807. [PMID: 35540718 PMCID: PMC9069386 DOI: 10.1002/ccr3.5807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 11/09/2022] Open
Abstract
Hyoscine butylbromide-induced pyschosis, though rare, should be considered in a child presenting with deteriorating cognitive functions and psychotic features acutely as evident in our case of a 9-year-old child taking hyoscine for her non-specific abdominal pain.
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Affiliation(s)
- Nimesh Lageju
- MBBSB.P. Koirala Institute of Health SciencesDharanNepal
| | - Durga Neupane
- MBBSB.P. Koirala Institute of Health SciencesDharanNepal
| | - Lokesh Shekher Jaiswal
- Department of Surgery (Division of CTVS)B.P. Koirala Institute of Health SciencesDharanNepal
| | - Upama Phuyal
- The University of Texas at ArlingtonArlingtonTexasUSA
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Bilreiro C, Fernandes FF, Andrade L, Chavarrías C, Simões RV, Matos C, Shemesh N. Effective bowel motion reduction in mouse abdominal MRI using hyoscine butylbromide. Magn Reson Med 2021; 86:2146-2155. [PMID: 33977522 DOI: 10.1002/mrm.28824] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 03/15/2021] [Accepted: 04/12/2021] [Indexed: 11/07/2022]
Abstract
PURPOSE Bowel motion is a significant source of artifacts in mouse abdominal MRI. Fasting and administration of hyoscine butylbromide (BUSC) have been proposed for bowel motion reduction but with inconsistent results and limited efficacy assessments. Here, we evaluate these regimes for mouse abdominal MRI at high field. METHODS Thirty-two adult C57BL/6J mice were imaged on a 9.4T scanner with a FLASH sequence, acquired over 90 min with ~19 s temporal resolution. During MRI acquisition, 8 mice were injected with a low-dose and 8 mice with a high-dose bolus of BUSC (0.5 and 5 mg/kg, respectively). Eight mice were food deprived for 4.5-6.5 hours before MRI and another group of eight mice was injected with saline during MRI acquisition. Two expert readers reviewed the images and classified bowel motion, and quantitative voxel-wise analyses were performed for identification of moving regions. After defining the most effective protocol, high-resolution T2 -weighted and diffusion-weighted images were acquired from 4 mice. RESULTS High-dose BUSC was the most effective protocol for bowel motion reduction, for up to 45 min. Fasting and saline protocols were not effective in suppressing bowel motion. High-resolution abdominal MRI clearly demonstrated improved image quality and ADC quantification with the high-dose BUSC protocol. CONCLUSION Our data show that BUSC administration is advantageous for abdominal MRI in the mouse. Specifically, it endows significant bowel motion reduction, with relatively short onset timings after injection (~8.5 min) and relatively long duration of the effect (~45 min). These features improve the quality of high-resolution images of the mouse abdomen.
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Affiliation(s)
- Carlos Bilreiro
- Champalimaud Research, Champalimaud Centre for the Unknown, Lisbon, Portugal.,Radiology Department, Champalimaud Clinical Centre, Lisbon, Portugal.,Nova Medical School, Lisbon, Portugal
| | | | - Luísa Andrade
- Radiology Department, Champalimaud Clinical Centre, Lisbon, Portugal
| | - Cristina Chavarrías
- Champalimaud Research, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Rui V Simões
- Champalimaud Research, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Celso Matos
- Champalimaud Research, Champalimaud Centre for the Unknown, Lisbon, Portugal.,Radiology Department, Champalimaud Clinical Centre, Lisbon, Portugal
| | - Noam Shemesh
- Champalimaud Research, Champalimaud Centre for the Unknown, Lisbon, Portugal
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Mercadante S, Marinangeli F, Masedu F, Valenti M, Russo D, Ursini L, Massici A, Aielli F. Hyoscine Butylbromide for the Management of Death Rattle: Sooner Rather Than Later. J Pain Symptom Manage 2018; 56:902-907. [PMID: 30172864 DOI: 10.1016/j.jpainsymman.2018.08.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 08/22/2018] [Accepted: 08/22/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT Death rattle (DR) is a dramatic sign in the dying patient. Existing studies with anticholinergic agents are controversial, as this class of drugs has been commonly administered without considering the rationale of the mechanism of action. A meaningful use of these drugs may provide a better outcome. OBJECTIVES The aim of this study was to assess the efficacy of hyoscine butylbromide (HB), given prophylactically in comparison with HB administered once DR occurs. METHODS Dying patients having a score of ≥3 in the Richmond Agitation-Sedation Scale-palliative version were included in the study. HB (60 mg/day) was given when DR occurred (Group 1) or as pre-emptive treatment (Group 2). The onset of DR (death rattle free time) and intensity of DR were recorded at intervals until death. RESULTS Eighty-one and 51 patients were randomized to Group 1 and 2, respectively. Patients in Group 2 survived longer than those in Group 1 (P < 0.05). DR occurred in 49 (60.5%) and three patients (5.9%) in Group 1 and 2, respectively (P = 0.001). A significant difference in the number of patients reporting DR was found at intervals examined (30 minutes, one hour, and then every six hours until death [P = 0.001]). In Group 1 and 2, DR free time was 20.4 (20.5) and 27.3 hours (25.2), respectively (P = 0.001). In Group 1, the treatment was considered effective in 10 patients (20.4%) only, after a mean of 14.4 hours (SD 8.57). CONCLUSION The prophylactic use of HB is an efficient method to prevent DR, whereas the late administration produces a limited response, confirming data from traditional studies performed with anticholinergics. This could be considered a new paradigm to manage a difficult and dramatic sign, such as DR.
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Affiliation(s)
- Sebastiano Mercadante
- Main Regional Center for Pain Relief and Supportive/Palliative Care, La Maddalena Cancer Center, Palermo, Sicily, Italy.
| | - Franco Marinangeli
- Department of Life Health and Environmental Sciences, Anesthesiology and Pain Medicine, University of L'Aquila, L'Aquila, Italy
| | - Francesco Masedu
- Department of Biotechnological and Applied Clinical Sciences, Section of Clinical Epidemiology and Environmental Medicine, University of L'Aquila, L'Aquila, Italy
| | - Marco Valenti
- Department of Biotechnological and Applied Clinical Sciences, Section of Clinical Epidemiology and Environmental Medicine, University of L'Aquila, L'Aquila, Italy
| | | | - Laura Ursini
- "Casa Margherita" Hospice, ASL 01 Avezzano-Sulmona-L'Aquila, L'Aquila, Italy
| | | | - Federica Aielli
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
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Grześkowiak T, Zgoła-Grześkowiak A, Rusińska-Roszak D, Zaporowska-Stachowiak I, Jeszka-Skowron M. Fragmentation studies of selected drugs utilized in palliative care. Eur J Mass Spectrom (Chichester) 2018; 24:420-436. [PMID: 30400754 DOI: 10.1177/1469066718812459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The results of research on selected drugs used in palliative care are presented, including fentanyl, tramadol, metoclopramide, hyoscine butylbromide, midazolam, haloperidol, levomepromazine and clonazepam. Interpretation of their ESI mass spectra obtained by the use of a triple quadrupole linear ion trap mass spectrometer is given. As a result, fragmentation pathways described in the literature are complemented and presented with more details. On their basis, transitions for quantitative analysis are selected and chromatographic conditions for the determination of the palliative care drugs are proposed as well. These results enable future studies on palliative care drugs in elderly patients including both their quantitation in body fluids and easier identification of their metabolites.
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Affiliation(s)
- Tomasz Grześkowiak
- Institute of Chemistry and Technical Electrochemistry, Poznan University of Technology, Poznań, Poland
| | | | - Danuta Rusińska-Roszak
- Institute of Technology and Chemical Engineering, Poznan University of Technology, Poznań, Poland
| | | | - Magdalena Jeszka-Skowron
- Institute of Chemistry and Technical Electrochemistry, Poznan University of Technology, Poznań, Poland
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Maged AM, Mosaad M, AbdelHak AM, Kotb MM, Salem MM. The effect of hyoscine butylbromide on the duration and progress of labor in primigravidae: a randomized controlled trial. J Matern Fetal Neonatal Med 2018; 31:2959-2964. [PMID: 28738708 DOI: 10.1080/14767058.2017.1359828] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To assess the effect of hyoscine butylbromide (HBB) on duration of the first stage of labor in primigravdae. METHODS A case-control study conducted on 120 primigravida at term admitted in active labor were divided into three equal groups. A single dose of the drug (placebo or HBB 20 mg or HBB 40 mg) was injected intravenously slowly to groups A, B, and C. The duration of the first stage was calculated from the time of cervical dilatation of three to four centimeters in active labor until a fully dilated cervix was observed. RESULTS The duration of first stage was significantly shorter in women receiving 20 and 40 mg of HBB when controlled to control women (187.73 ± 20.92, 186.41 ± 19.40 versus 231.39 ± 33.14 min). There was no significant difference between the three study groups regarding duration of the second stage (36.76 ± 9.98, 35.72 ± 9.97 and 37.55 ± 10.57, respectively, p > .05), number of cases delivered by cesarean section (12.5%, 12.5%, and 15%, respectively, p > .05) and Apgar score of the neonates (p > .05). There was no significant difference between the three study groups regarding occurrence of side effects named dry mouth (7.5%, 12.5%, and 5%, p > .05), flushing (2.5%, 5% and 0%, p > .05), tachycardia (2.5%, 2.5%, and 2.5%, p > .05), or urinary retention (2.5%, 0%, and 0%, p > .05). CONCLUSION Intravenous injection of HBB decreases the duration of active phase of labor in primigravidae with no side effects.
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Affiliation(s)
- Ahmed Mohamed Maged
- a Department of Obstetrics and Gynecology , Kasr Aini Hospital, Cairo University , Cairo , Egypt
| | - Medhat Mosaad
- a Department of Obstetrics and Gynecology , Kasr Aini Hospital, Cairo University , Cairo , Egypt
| | - Ahmed M AbdelHak
- a Department of Obstetrics and Gynecology , Kasr Aini Hospital, Cairo University , Cairo , Egypt
| | - Mohamed M Kotb
- a Department of Obstetrics and Gynecology , Kasr Aini Hospital, Cairo University , Cairo , Egypt
| | - Maged M Salem
- a Department of Obstetrics and Gynecology , Kasr Aini Hospital, Cairo University , Cairo , Egypt
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Ahmed M, Asghar M, Yaqoob M, Munawar N, Shahid F, Asad M, Nabi A. Flow Injection-Chemiluminescence Method for Determination of Hyoscine Butylbromide Using Silver(III) as Oxidizing Agent. ANAL SCI 2017; 33:1259-1263. [PMID: 29129865 DOI: 10.2116/analsci.33.1259] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Diperiodatoargentate(III) (DPA)/silver(III) complex, [Ag(HIO6)2]5-, in sulfuric acid medium has been used to determine hyoscine butylbromide (HBB) by flow injection (FI) coupled with chemiluminescence (CL) detector. A linear standard curve between the CL intensity and concentration range from 0.005 to 20 mg L-1 was obtained. The determination coefficient (R2), limit of detection (3s × blank), relative standard deviation (RSD) for 0.5 mg L-1 HBB and analytical throughput were 0.9992 (n = 8), 5 × 10-4 mg L-1, 1.5% (n = 10) and 160 injections h-1, respectively. The developed method was applied for the determination of HBB in pharmaceutical formulations with recoveries from 92 ± 4 to 108 ± 3%. For comparison, a spectrophotometric method was used and the results obtained by both methods were in good agreement at a 95% confidence level. The effect of key chemical and physical variables (reagent concentration, flow rate, sample volume, PMT voltage) and interfering species (pharmaceutical excipients and inorganic ions) on the determination of HBB was examined. The possible CL mechanism of HBB on silver(III) complex in sulfuric acid medium was also discussed in brief.
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Affiliation(s)
| | | | | | - Nusrat Munawar
- Department of Chemistry, Sardar Bahadur Khan Women University
| | | | - Mida Asad
- Department of Chemistry, University of Balochistan
| | - Abdul Nabi
- Department of Chemistry, University of Balochistan
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Zhu CP, Jiang F, Wang RQ, Guo XZ, Hou XH, Xu H, Zeng Y, Du YQ, Li ZS. Comparison of efficacy and safety of hyoscine butylbromide versus anisodamine for acute gastric or intestinal spasm-like pain: A randomized, double-blinded, multicenter Phase III trial. J Dig Dis 2017; 18:453-460. [PMID: 28677349 DOI: 10.1111/1751-2980.12504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 05/29/2017] [Accepted: 06/28/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Acute gastric or intestinal spasm-like pain is common in clinical setting. Hyoscine butylbromide (HBB), an anti-cholinergic agent, relieves pain in stomach and bowel cramps by inhibiting smooth muscle contractility. In this study, we aimed to compare the efficacy and safety of parenteral HBB and anisodamine for treating acute gastric or intestinal pain. METHODS In this randomized, controlled, double-blind, parallel-group, multicenter non-inferiority trial, 299 Chinese patients were randomly assigned to HBB or anisodamine in a ratio of 1:1. They were administrated a single dose of either HBB 20 mg or anisodamine 10 mg, and a second dose was given when needed. The primary end-point was the difference in pain intensity (PID) from the pre-dose baseline at 20 min after the first injection. RESULTS Altogether 295 patients completed the protocol (153 in the HBB and 142 in the anisodamine group). For the primary end-point, the PID was -4.09 (95% confidence interval [CI]: -4.41, -3.76) for the HBB group and -3.66 (95% CI: -4.02, -3.31) for the anisodamine group (P < 0.0001 for non-inferiority). The percentage of patients with at least one adverse event was lower in the HBB group than in the anisodamine group (13.1% vs 17.6%), but there was no statistical significance (P = 0.279). The most frequent adverse events were thirst (7.8%) and dry mouth (2.6%) in the HBB group, and thirst (7.0%), dry mouth (3.5%) and nodal arrhythmia (2.1%) in the anisodamine group. CONCLUSIONS HBB 20 mg was not inferior to anisodamine 10 mg in pain relief of patients with acute gastric or intestinal spasm-like pain. Both drugs were safe and well tolerated.
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Affiliation(s)
- Chun Ping Zhu
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Fei Jiang
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Rong Quan Wang
- Department of Gastroenterology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Xiao Zhong Guo
- Department of Gastroenterology, General Hospital of Shenyang Military Area Command, Shenyang, Liaoning Province, China
| | - Xiao Hua Hou
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Hong Xu
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Ya Zeng
- Department of Gastroenterology, Changsha Central Hospital, Changsha, Hunan Province, China
| | - Yi Qi Du
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhao Shen Li
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
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Nagata K, Fujiwara M, Shimamoto T, Iida N, Mogi T, Mitsushima T. Colonic distention at CT colonography: randomized evaluation of both IV hyoscine butylbromide and automated carbon dioxide insufflation. AJR Am J Roentgenol. 2015;204:76-82. [PMID: 25539240 DOI: 10.2214/ajr.14.12772] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The purpose of this article is to evaluate the efficacy of IV hyoscine butylbromide as a bowel relaxant and automated carbon dioxide insufflation in CT colonography in terms of colonic distention and perceived burden. SUBJECTS AND METHODS; Two hundred twenty-four participants were randomly allocated to one of four groups: control (no bowel relaxant and IV saline placebo before CT colonography with manual carbon dioxide insufflation), hyoscine butylbromide (IV hyoscine butylbromide before examination with manual carbon dioxide insufflation), automated (no bowel relaxant before examination with automated carbon dioxide insufflation), and combined (hyoscine butylbromide before examination with automated carbon dioxide insufflation). The degree of colonic distention on a 4-point scale, examination time, and participants' satisfaction, as measured by their responses to a questionnaire, were assessed. RESULTS The mean distention grades of all the colonic segments and both positions were 3.22 in the control group, 3.28 in the hyoscine butylbromide group, 3.77 in the automated group, and 3.74 in the combined group. Compared with manual carbon dioxide insufflation, automated carbon dioxide insufflation significantly improved the clinical adequacy of colonic distention and shortened examination time. No statistically significant difference was seen in the clinical adequacy of distention between participants who received hyoscine butylbromide and those who did not, or in examination time. Overall, the participants' experiences were not different. CONCLUSION Colonic distention was statistically significantly improved by automated carbon dioxide insufflation, but not by the administration of hyoscine butylbromide. The participants' tolerance was similar in each group.
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Yakoot M, Salem A, Yousef S, Helmy S. Clinical efficacy of Spasmofen® suppository in the emergency treatment of renal colic: a randomized, double-blind, double-dummy comparative trial. Drug Des Devel Ther 2014; 8:405-10. [PMID: 24851039 PMCID: PMC4018316 DOI: 10.2147/dddt.s62571] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Renal colic is typically characterized by the sudden onset of severe pain radiating from the flank to the groin and its acute management in emergency departments essentially aims at rapid pain relief. Spasmofen® is a brand of Amriya Pharmaceutical Industries in the form of rectal suppositories containing ketoprofen 100 mg and hyoscine butylbromide 10 mg. This combination is intended for the rapid relief of severe colicky pain in the renal system, hepatobiliary system, or gastrointestinal tract. This trial aims to compare a single-dose of Spasmofen rectal suppository to a single intravenous (IV) ketorolac tromethamine 30 mg/2 mL dose in patients with acute renal colic. Methods A total of 80 eligible consecutive patients presenting to the emergency departments of two medical centers with acute renal colic were included in the study. Eligible patients who signed the informed consent were randomly assigned into two treatment groups: an experimental group (Spasmofen group) who received one Spasmofen rectal suppository plus an IV injection of 2 mL of normal saline solution; and a control group (ketorolac group) who received one ketorolac 30 mg/2 mL ampoule IV plus one placebo suppository. Treatment success, defined as a change in the verbal rating score from severe or moderate pain to none or mild at 60 minutes after the dose, was compared between groups using the chi-square/Fisher’s exact test. Percentage reductions in visual pain analog scale (VPAS) scores at 15 and 60 minutes after the dose were compared between groups using the Z-test for proportions. Results Successful treatment at 60 minutes occurred in 35 of 40 (87.5%) of Spasmofen-treated patients and in 33 of 40 (82.5%) of ketorolac-treated patients. The difference was not statistically significant by Fisher’s exact test (P=0.755). The mean percentage reduction of VPAS after 15 minutes was 61.82% in the Spasmofen-treated group and 64.76% in the ketorolac-treated group. The difference was also not statistically significant by the Z-test for proportions (P=0.795). Sixty minutes after being treated, Spasmofen was associated with a statistically significant greater reduction in VPAS (mean% reduction =92.36%) than ketorolac (75.06%; P=0.0466). Conclusion Single-dose Spasmofen rectal suppository might be a safe and effective first-aid treatment for the emergency department relief of acute renal colic.
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Affiliation(s)
| | - Amel Salem
- Alexandria Helmy Medical Center, Alexandria, Egypt
| | - Sameh Yousef
- Alexandria Helmy Medical Center, Alexandria, Egypt
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Krueger D, Michel K, Allam S, Weiser T, Demir IE, Ceyhan GO, Zeller F, Schemann M. Effect of hyoscine butylbromide (Buscopan®) on cholinergic pathways in the human intestine. Neurogastroenterol Motil 2013; 25:e530-9. [PMID: 23682729 DOI: 10.1111/nmo.12156] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 04/23/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hyoscine butylbromide (HBB, Buscopan(®) ) is clinically used to treat intestinal cramps and visceral pain. Various studies, mainly on animal tissues, suggested that its antimuscarinic action is responsible for its spasmolytic effect. However, functional in vitro studies with human tissue have not been performed so far. METHODS We wanted to provide a comprehensive study on the mode of action of HBB in human intestinal samples and investigated HBB (1 nmol L(-1) -10 μmol L(-1)) effects on muscle activity with isometric force transducers and calcium imaging, on epithelial secretion with Ussing chamber technique and on enteric neurons using fast neuroimaging. KEY RESULTS Hyoscine butylbromide concentration dependently reduced muscle contractions, calcium mobilization, and epithelial secretion induced by the muscarinic agonist bethanechol with IC50 values of 429, 121, and 224 nmol L(-1), respectively. Forskolin-induced secretion was not altered by HBB. Cholinergic muscarinic muscle and epithelial responses evoked by electrical nerve stimulation were inhibited by 1-10 μmol L(-1) HBB. Moreover, HBB significantly reduced the bethanechol-induced action potential discharge in enteric neurons. Interestingly, we observed that high concentrations of HBB (10 μmol L(-1)) moderately decreased nicotinic receptor-mediated secretion, motility, and nerve activity. CONCLUSIONS & INFERENCES The results demonstrated the strong antimuscarinic action of HBB whereas the nicotinic antagonism at higher concentrations plays at most a moderate modulatory role. The muscle relaxing effect of HBB and its inhibition of muscarinic nerve activation likely explain its clinical use as an antispasmodic drug. Our results further highlight a so far unknown antisecretory action of HBB which warrants further clinical studies on its use in secretory disorders.
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Affiliation(s)
- D Krueger
- Human Biology, Technische Universität München, Freising, Germany
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12
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Qahtani NHA, Hajeri FA. The effect of hyoscine butylbromide in shortening the first stage of labor: A double blind, randomized, controlled, clinical trial. Ther Clin Risk Manag 2011; 7:495-500. [PMID: 22241946 PMCID: PMC3253756 DOI: 10.2147/tcrm.s16415] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background and objectives Hyoscine butylbromide (HBB) is widely used in labor rooms. There have been many studies on the use of HBB during labor with conflicting results, involving both primiparous and multiparous women. The aim of this trial was to study the efficacy of HBB for shortening the first stage of labor in primiparous women. Methods The study was a randomized, double blind, controlled trial. Ninety-seven primigravid term pregnant women in spontaneous labor received either hyoscine butylbromide or a placebo intramuscularly once the women entered the active phase of labor. The primary outcome measured was the duration of the first stage of labor. Secondary outcomes were the duration of the second and third stages of labor, blood loss at delivery, rate of cesarean section, and Apgar scores for the neonates. Results A total of 97 women yielded data for analysis. Of these, 45 women received the placebo and 52 received HBB. The mean duration of the first stage in the control group was 215 minutes, compared with 165 minutes in the study group, representing a decrease of 23.3% (P = 0.001). There were no significant changes in the duration of the second (P = 0.063) or third (P = 0.0418) stages of labor, and no significant differences in blood loss or Apgar scores. There was a slightly higher (but statistically insignificant) rate of instrumental delivery in the control group, but no difference in the Cesarean section rate. There was a 60% reduction in opioid analgesic use in the HBB group. Conclusion HBB is effective in significantly reducing the duration of the first stage of labor, and is not associated with any apparent adverse maternal or neonatal outcomes.
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Affiliation(s)
- Nourah H Al Qahtani
- MRCOG, College of Medicine, Department of Obstetrics and Gynecology in King Fahad University Hospital, University of Dammam, Saudi Arabia.
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