Formulary
Hyoscine hydrobromide: Indications, Dosing, Side Effects and Interactions
Hyoscine hydrobromide clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 6 min read
Hyoscine hydrobromide: Indications, Dosing, Side Effects and Interactions
Hyoscine hydrobromide clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Motion sickness**
- **Child** (By Mouth): 10-17 years 150-300 micrograms, dose to be taken up to 30 minutes before the start of journey, then 150-300 micrograms every 6 hours if required; maximum 900 micrograms per day.
- **Adult** (By Mouth): 150-300 micrograms, dose to be taken up to 30 minutes before the start of journey, then 150-300 micrograms every 6 hours if required; maximum 900 micrograms per day.
- **Child** (By Transdermal Application): 10-17 years Apply 1 patch, apply behind ear 5-6 hours before journey, then apply 1 patch after 72 hours if required, remove old patch and site replacement patch behind the other ear.
- **Adult** (By Transdermal Application): Apply 1 patch, apply behind ear 5-6 hours before journey, then apply 1 patch after 72 hours if required, remove old patch and site replacement patch behind the other ear.
**Hypersalivation associated with clozapine therapy**
- **Adult** (By Mouth): 300 micrograms up to 3 times a day; maximum 900 micrograms per day.
**Excessive respiratory secretion in palliative care**
- **Adult** (By Subcutaneous Injection): 1.2-2 mg/24 hours.
**Bowel colic in palliative care**
- **Adult** (By Subcutaneous Injection): 400 micrograms every 4 hours as required, hourly use is occasionally necessary.
- **Adult** (By Subcutaneous Infusion): 1.2-2 mg/24 hours.
**Bowel colic pain in palliative care**
- **Adult** (By Mouth Using Sublingual Tablets): 300 micrograms 3 times a day, as Kwells .
**Premedication**
- **Adult** (By Subcutaneous Injection, Or By Intramuscular Injection): 200-600 micrograms, to be administered 30-60 minutes before induction of anaesthesia.
**Motion sickness for hyoscine hydrobromide**
- **Child 4-9 years** (By mouth): 75-150 micrograms, dose to be taken up to 30 minutes before the start of journey, then 75-150 micrograms every 6 hours if required; maximum 450 micrograms per day.
- **Child 10-17 years** (By mouth): 150-300 micrograms, dose to be taken up to 30 minutes before the start of journey, then 150-300 micrograms every 6 hours if required; maximum 900 micrograms per day.
- **Child 10-17 years** (By transdermal application): Apply 1 patch, apply behind ear 5-6 hours before journey, then apply 1 patch after 72 hours if required, remove old patch and site replacement patch behind the other ear.
**Hypersalivation associated with clozapine therapy for hyoscine hydrobromide**
- **Child 12-17 years** (By mouth): 300 micrograms up to 3 times a day; maximum 900 micrograms per day.
**Excessive respiratory secretions for hyoscine hydrobromide**
- **Child 2-11 years** (By mouth, or by sublingual administration): 10 micrograms/kg 4 times a day (max. per dose 300 micrograms).
- **Child 12-17 years** (By mouth, or by sublingual administration): 300 micrograms 4 times a day.
- **Child 1 month-2 years** (By transdermal application): 250 micrograms every 72 hours, dose equates to a quarter patch.
- **Child 3-9 years** (By transdermal application): 500 micrograms every 72 hours, dose equates to a half patch.
- **Child 10-17 years** (By transdermal application): 1 mg every 72 hours, dose equates to one patch.
**Excessive respiratory secretion in palliative care for hyoscine hydrobromide**
- **Child** (By subcutaneous injection, or by intravenous injection): 10 micrograms/kg every 4-8 hours (max. per dose 600 micrograms).
- **Child** (By continuous subcutaneous infusion, or by intravenous infusion): 40-60 micrograms/kg over 24 hours.
**Bowel colic pain in palliative care for hyoscine hydrobromide**
- **Child** (By mouth using sublingual tablets): 10 micrograms/kg 3 times a day (max. per dose 300 micrograms), as Kwells.
**Premedication for hyoscine hydrobromide**
- **Child 1-11 years** (By subcutaneous injection, or by intramuscular injection): 15 micrograms/kg (max. per dose 600 micrograms), to be administered 30-60 minutes before induction of anaesthesia.
- **Child 12-17 years** (By subcutaneous injection, or by intramuscular injection): 200-600 micrograms, to be administered 30-60 minutes before induction of anaesthesia.
- **Child 1-11 years** (By intravenous injection): 15 micrograms/kg (max. per dose 600 micrograms), to be administered immediately before induction of anaesthesia.
- **Child 12-17 years** (By intravenous injection): 200-600 micrograms, to be administered immediately before induction of anaesthesia.
Cautions
For all antimuscarinics (systemic) Acute myocardial infarction (in adults); arrhythmias (may be worsened); autonomic neuropathy; cardiac insufficiency (due to association with tachycardia); cardiac surgery (due to association with tachycardia); children (increased risk of side-effects) (in children); conditions characterised by tachycardia; congestive heart failure (may be worsened); coronary artery disease (may be worsened); diarrhoea; elderly (especially if frail) (in adults); gastro-oesophageal reflux disease; hiatus hernia with reflux oesophagitis; hypertension; hyperthyroidism (due to association with tachycardia); individuals susceptible to angle-closure glaucoma; prostatic hyperplasia (in adults); pyrexia; ulcerative colitis Cautions, further information Elderly In adults: Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: if treating extrapyramidal side-effects of antipsychotic medications (risk of antimuscarinic toxicity) with delirium or dementia (risk of exacerbation of cognitive impairment), angle-closure glaucoma (contra-indicated; risk of acute exacerbation of glaucoma), or chronic prostatism (risk of urinary retention) if two or more antimuscarinic drugs prescribed concomitantly (risk of increased antimuscarinic toxicity) Cautions For hyoscine hydrobromide Epilepsy Cautions, further information Anticholinergic syndrome With systemic use in adults: In some patients, especially the elderly, hyoscine may cause the central anticholinergic syndrome (excitement, ataxia, hallucinations, behavioural abnormalities, and drowsiness). Anticholinergic syndrome With systemic use in children: In some children hyoscine may cause the central anticholinergic syndrome (excitement, ataxia, hallucinations, behavioural abnormalities, and drowsiness).
Contraindications
For all antimuscarinics (systemic) Angle-closure glaucoma; gastro-intestinal obstruction; intestinal atony; myasthenia gravis (but some antimuscarinics may be used to decrease muscarinic side-effects of anticholinesterases); paralytic ileus; pyloric stenosis; severe ulcerative colitis; significant bladder outflow obstruction; toxic megacolon; urinary retention
Side effects
For all antimuscarinics (systemic) Common or very common Constipation; dizziness; drowsiness; dry mouth; dyspepsia; flushing; headache; nausea; palpitations; skin reactions; tachycardia; urinary disorders; vision disorders; vomiting Rare or very rare Angioedema; confusion (more common in elderly) Side-effects For hyoscine hydrobromide Common or very common With transdermal use Eye disorders; eyelid irritation Rare or very rare With transdermal use Concentration impaired; glaucoma; hallucinations; memory impairment; restlessness Frequency not known With oral use Asthma; cardiovascular disorders; central nervous system stimulation; gastrointestinal disorder; hallucination; hypersensitivity; hyperthermia; hypohidrosis; mydriasis; oedema; respiratory tract reaction; restlessness; seizure With parenteral use Agitation; angle closure glaucoma; arrhythmias; delirium; dysphagia; dyspnoea; epilepsy exacerbated; hallucination; hypersensitivity; idiosyncratic drug reaction; loss of consciousness; mydriasis; neuroleptic malignant syndrome (discontinue-potentially fatal); psychotic disorder; thirst With transdermal use Balance impaired; coma; delirium; hyperthermia; respiratory paralysis; seizure Side-effects, further information Since systemic absorption can follow transdermal use, also consider the side-effects of systemic antimuscarinics.
Interactions
**Other interactions (3):**
- The effects of hyoscine may be enhanced by other drugs with anticholinergic properties, including amantadine, some antihistamines, butyrophenones, phenothiazines and tricyclic antidepressants.
- Patients should also avoid alcohol.
- The reduction in gastric motility caused by hyoscine may also affect the absorption of other drugs.
Pregnancy
Use only if potential benefit outweighs risk. Injection may depress neonatal respiration.
Breast feeding
Amount too small to be harmful.
Hepatic impairment
Manufacturer advises caution.
Renal impairment
Use with caution. M
Medicinal forms
Solution,Tablet,Solution,Patch
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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