Drugs List

Therapeutic Indications

Uses

Motion sickness

Unlicensed Uses

Drying secretions
Hypersalivation associated with clozapine therapy

Contraindications

Children under 2 years
Benign prostatic hyperplasia
Myasthenia gravis
Narrow angle glaucoma
Paralytic ileus
Pyloric stenosis

Precautions and Warnings

Diarrhoea
Down's syndrome
Elderly
Pyrexia
Breastfeeding
Cardiac failure
Cardiac surgery
Cardiovascular disorder
Central nervous system disorder
Epileptic disorder
Gastroesophageal reflux
Gastrointestinal disorder
Hepatic impairment
Hypertension
Hyperthyroidism
Metabolic disorder
Myocardial infarction
Pregnancy
Renal impairment
Tachycardia
Ulcerative colitis
Urinary retention

Advise patient drowsiness may affect ability to drive or operate machinery
Not all available brands are licensed for all age groups
Not all available brands are licensed for all indications
Reduce dose if anhidrosis occurs due to the risk of hyperthermia
Advise patient to avoid alcohol during treatment
Advise patients with cardiovascular disease to seek medical advice

Patients with renal and hepatic impairment are more likely to experience adverse CNS effects.

Pregnancy and Lactation

Pregnancy

Use hyoscine hydrobromide with caution in pregnancy.

Hyoscine hydrobromide readily crosses the placental barrier and can cause anticholinergic symptoms such as tachycardia and decreased heart rate variability in the foetus. The safety of this medicine in pregnancy has not been fully established. As such, it should be avoided during the first trimester and thereafter only be taken up on medical advice for the duration of the pregnancy (Briggs, 2011).

Reproduction studies in rats with daily IV doses did not observe foetal harm. A marginal embryotoxic effect was seen in rabbits at daily IV doses that produced plasma concentrations approximately 100 times the level achieved in humans with the transdermal delivery system (Briggs, 2011).

Several reports on human pregnancy exposure have been documented. One study states that out of 881 human exposures to hyoscine, 309 in the first trimester, no evidence was found for an association with malformations. In another study of 27 newborns exposed during the first trimester, one major defect was observed. However, details of this defect are not available. In a third study of 309 pregnant women exposed to transdermal hyoscine in the first trimester, no increase in the rate of birth defects was seen (Briggs, 2011).

Briggs (2008) reported a case of hyoscine administered to a mother at term, foetal effects included tachycardia, decreased heart rate variability and decreased heart rate deceleration.

Schaeffer (2007) concludes that hyoscine should only be used as an antiemetic when first line agents have failed. The use of hyoscine is not an indication either for invasive diagnostic procedures or for termination of pregnancy.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use hyoscine hydrobromide with caution in breastfeeding.

Hyoscine hydrobromide is secreted in human breast milk, however, the amount is thought to be too small to be harmful.

Hyoscine may decrease lactation, but this effect is not well documented. Anticholinergic agents inhibit lactation in animals by inhibiting growth hormone and oxytocin secretion.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Allergic reaction
Anaphylactic reaction
Arrhythmias
Asthma
Blurred vision
Bradycardia
Chest discomfort
Confusion
Constipation
Decreased bronchial secretions
Dizziness
Drowsiness
Dry mouth
Dry skin
Flushing
Gastro-intestinal motility decreased
Glaucoma (closed angle)
Hallucinations
Hypersensitivity reactions
Hyperthermia
Mydriasis
Nausea
Oedema
Photophobia
Pruritus
Pupillary dilatation
Rash
Restlessness
Sedation
Seizure frequency increased
Somnolence
Urinary retention
Urinary urgency
Urticaria
Vomiting

Presentation

Oral formulations of hyoscine hydrobromide

Drugs List

Therapeutic Indications

Uses

Motion sickness

Unlicensed Uses

Drying secretions
Hypersalivation associated with clozapine therapy

Dosage

Take initial dose up to 30 minutes prior to the start of the journey or on onset of symptoms.

Adults

Children

Contraindications

Children under 2 years
Benign prostatic hyperplasia
Myasthenia gravis
Narrow angle glaucoma
Paralytic ileus
Pyloric stenosis

Precautions and Warnings

Diarrhoea
Down's syndrome
Elderly
Pyrexia
Breastfeeding
Cardiac failure
Cardiac surgery
Cardiovascular disorder
Central nervous system disorder
Epileptic disorder
Gastroesophageal reflux
Gastrointestinal disorder
Hepatic impairment
Hypertension
Hyperthyroidism
Metabolic disorder
Myocardial infarction
Pregnancy
Renal impairment
Tachycardia
Ulcerative colitis
Urinary retention

Advise patient drowsiness may affect ability to drive or operate machinery
Not all available brands are licensed for all age groups
Not all available brands are licensed for all indications
Reduce dose if anhidrosis occurs due to the risk of hyperthermia
Advise patient to avoid alcohol during treatment
Advise patients with cardiovascular disease to seek medical advice

Patients with renal and hepatic impairment are more likely to experience adverse CNS effects.

Pregnancy and Lactation

Pregnancy

Use hyoscine hydrobromide with caution in pregnancy.

Hyoscine hydrobromide readily crosses the placental barrier and can cause anticholinergic symptoms such as tachycardia and decreased heart rate variability in the foetus. The safety of this medicine in pregnancy has not been fully established. As such, it should be avoided during the first trimester and thereafter only be taken up on medical advice for the duration of the pregnancy (Briggs, 2011).

Reproduction studies in rats with daily IV doses did not observe foetal harm. A marginal embryotoxic effect was seen in rabbits at daily IV doses that produced plasma concentrations approximately 100 times the level achieved in humans with the transdermal delivery system (Briggs, 2011).

Several reports on human pregnancy exposure have been documented. One study states that out of 881 human exposures to hyoscine, 309 in the first trimester, no evidence was found for an association with malformations. In another study of 27 newborns exposed during the first trimester, one major defect was observed. However, details of this defect are not available. In a third study of 309 pregnant women exposed to transdermal hyoscine in the first trimester, no increase in the rate of birth defects was seen (Briggs, 2011).

Briggs (2008) reported a case of hyoscine administered to a mother at term, foetal effects included tachycardia, decreased heart rate variability and decreased heart rate deceleration.

Schaeffer (2007) concludes that hyoscine should only be used as an antiemetic when first line agents have failed. The use of hyoscine is not an indication either for invasive diagnostic procedures or for termination of pregnancy.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use hyoscine hydrobromide with caution in breastfeeding.

Hyoscine hydrobromide is secreted in human breast milk, however, the amount is thought to be too small to be harmful.

Hyoscine may decrease lactation, but this effect is not well documented. Anticholinergic agents inhibit lactation in animals by inhibiting growth hormone and oxytocin secretion.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Allergic reaction
Anaphylactic reaction
Arrhythmias
Asthma
Blurred vision
Bradycardia
Chest discomfort
Confusion
Constipation
Decreased bronchial secretions
Dizziness
Drowsiness
Dry mouth
Dry skin
Flushing
Gastro-intestinal motility decreased
Glaucoma (closed angle)
Hallucinations
Hypersensitivity reactions
Hyperthermia
Mydriasis
Nausea
Oedema
Photophobia
Pruritus
Pupillary dilatation
Rash
Restlessness
Sedation
Seizure frequency increased
Somnolence
Urinary retention
Urinary urgency
Urticaria
Vomiting

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: January 2015

Reference Sources

Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

Martindale: The Complete Drug Reference, 37th edition (2011) ed. Sweetman, S. Pharmaceutical Press, London.

Summary of Product Characteristics: Joy-rides tablets. Forest Laboratories UK Ltd. Revised July 2015.

Summary of Product Characteristics: Kwells 300 microgram tablets. Bayer plc. Revised June 2015.

Summary of Product Characteristics: Kwells kids. Bayer plc. Revised June 2015.

US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Scopolamine Last revised: 7 September, 2013
Last accessed: 6 January, 2015

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 25 August 2017