Hyoscine hydrobromide parenteral
- Drugs List
- Therapeutic Indications
- Dosage
- Administration
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Parenteral formulations of hyoscine hydrobromide.
Drugs List
Therapeutic Indications
Uses
Nausea and vomiting
Premedication - anticholinergic
Unlicensed Uses
Bowel colic in palliative care
Reducing respiratory secretions in palliative care
Dosage
Adults
Pre-medication
200micrograms to 600micrograms administered by intramuscular or subcutaneous injection 30 to 60 minutes before induction of anaesthesia.
Nausea, vomiting, vertigo, labyrinthine disorders and motion sickness
200micrograms as single dose administered by intramuscular or subcutaneous injection.
Bowel colic in palliative care (unlicensed)
400micrograms every 4 hours, or as necessary, administered by subcutaneous injection. Dose may be administered hourly if considered necessary.
If symptoms persist patients may require 1.2mg to 2mg continuous subcutaneous infusion over 24 hours.
Excessive respiratory secretion in palliative care (unlicensed)
400micrograms every 4 hours, or as necessary, administered by subcutaneous injection. Dose may be administered hourly if considered necessary.
If symptoms persist patients may require 1.2mg to 2mg continuous subcutaneous infusion over 24 hours.
Children
Pre-medication
Children aged 4 month to 18 years
15micrograms/kg administered by intramuscular or subcutaneous injection 30 to 60 minutes before induction of anaesthesia.
The following alternative dosing schedule may also be suitable:
Children aged 12 to 18 years
200micrograms to 600micrograms administered by intramuscular or subcutaneous injection 30 to 60 minutes before induction of anaesthesia.
Children aged 1 to 12 years
15micrograms/kg administered by intramuscular or subcutaneous injection 30 to 60 minutes before induction of anaesthesia. Maximum dose should not exceed 600micrograms.
The following dosing schedule may also be suitable (unlicensed route in children):
Children aged 12 to 18 years
200micrograms to 600 micrograms administered by intravenous injection immediately before induction of anaesthesia.
Children aged 1 to 12 years
15micrograms/kg administered by intravenous injection immediately before induction of anaesthesia. Maximum dose should not exceed 600micrograms.
Nausea, vomiting, vertigo, labyrinthine disorders and motion sickness.
Children aged 4 month to 18 years
6microgram/kg as single dose administered by intramuscular or subcutaneous injection.
Excessive respiratory secretion in palliative care (unlicensed)
10microgram/kg every 4 to 8 hours, administered by subcutaneous or intravenous injection. Maximum dose should not exceed 600micrograms.
If symptoms persist patients may require 40microgram/kg to 60microgram/kg continuous subcutaneous or intravenous infusion over 24 hours.
Administration
For subcutaneous or intramuscular injection.
Some manufacturers state that the injection may also be given to adults by the intravenous route for acute use, if required. Alternative sources also suggest doses in children by the unlicensed intravenous route for pre-medication and the unlicensed use of excessive respiratory secretion in palliative care.
Contraindications
Children under 4 months
Benign prostatic hyperplasia
During or immediately prior to labour
Gastrointestinal obstruction
Myasthenia gravis
Narrow angle glaucoma
Paralytic ileus
Pyloric stenosis
Tachycardia
Toxic megacolon
Urinary retention
Precautions and Warnings
Diarrhoea
Down's syndrome
Elderly
Pyrexia
Breastfeeding
Cardiovascular disorder
Epileptic disorder
Hepatic impairment
Pregnancy
Renal impairment
Ulcerative colitis
Advise ability to drive/operate machinery may be affected by side effects
Not all available brands are licensed for all indications
May cause heat prostration when used in high environmental temperatures
Advise patient to avoid alcohol during treatment
There have been reports of an increase of seizures in patients who suffer from epilepsy.
Hyoscine may cause central anticholinergic syndrome, especially in the elderly. Symptoms include excitement, ataxia, hallucinations, behavioural abnormalities and drowsiness.
Hyoscine should not be given by intramuscular injection to patients being treated with anticoagulant drugs since intramuscular haematoma may occur.
Pregnancy and Lactation
Pregnancy
Use hyoscine hydrobromide with caution during pregnancy.
Use at the onset of labour is contra-indicated.
The use of hyoscine in pregnancy may cause respiratory depression in the neonate and it should only be used in pregnancy where the potential benefit outweighs the risk to the foetus.
Hyoscine readily crosses the placenta. There have been reports of foetal effects such as tachycardia, decreased heart rate variability, decreased heart rate deceleration, and newborn toxicity (Briggs, 2015).
Studies conducted with rats showed no foetal harm, however, in rabbits there was a marginal embryotoxic effect.
Lactation
Use hyoscine hydrobromide with caution during breastfeeding.
Hyoscine is excreted into breast milk but the amount available to the infant is considered too small to be harmful.
Long-term use of hyoscine might reduce milk production or milk letdown (LactMed).
Side Effects
Anaphylactic shock
Anaphylaxis
Angioedema
Arrhythmias
Ataxia
Behavioural disturbances
Blurred vision
Bradycardia
Central anticholinergic syndrome
Confusion
Constipation
Decreased bronchial secretions
Delirium
Difficulty in micturition
Disturbances in accommodation
Dizziness
Drowsiness
Dry mouth
Dry skin
Dyshidrosis
Dyspnoea
Erythema
Excitement
Flushing
Giddiness
Glaucoma (closed angle)
Hallucinations
Headache
Hypotension
Idiosyncratic hypersensitivity
Increased thirst
Local pain (injection site)
Loss of consciousness (transient)
Nausea
Neuroleptic malignant syndrome
Palpitations
Photophobia
Pruritus
Psychotic disorder
Pupillary dilatation
Rash
Tachycardia
Urinary retention
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: August 2019
Reference Sources
Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.
Summary of Product Characteristics: Hyoscine 400microgram/ml Solution for Injection. Martindale Pharma. Revised September 2017.
Summary of Product Characteristics: Hyoscine 600microgram/ml Solution for Injection. Martindale Pharma. Revised September 2017.
Summary of Product Characteristics: Hyoscine hydrobromide solution for injection 400microgram/ml. Wockhardt UK Ltd. Revised September 2015.
Summary of Product Characteristics: Hyoscine hydrobromide solution for injection 600microgram/ml. Wockhardt UK Ltd. Revised September 2015.
NICE Evidence Services Available at: www.nice.org.uk Last accessed: 14 August 2019
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: 31 October 2018
Last accessed: 14 August 2019
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