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Hyoscine (scopolamine)
See also Anticholinergic drugs
General information
Hyoscine is an anticholinergic drug, a stereoisomer of atropine. It is available in different salts, hyoscine hydrobromide and hyoscine butylbromide.
When given parenterally hyoscine butylbromide is effective but very short-acting; when given by mouth it is virtually inactive, even in doses up to 1 g, since it is hardly absorbed.
Hyoscine hydrobromide is used primarily in motion sickness; doses of 0.6 mg appear to be effective, particularly in combination with drugs having a mild central stimulant effect, such as ephedrine.
Organs and systems
Nervous system
Despite being a stereoisomer of atropine, hyoscine tends to have central depressant effects in conditions in which atropine might be expected to cause excitation; however, excitation can occur [ ]. Hyoscine hydrobromide produces somnolence and dryness of the mouth in a high proportion of patients, and when ephedrine is not given the somnolence is likely to be present in the majority; some individuals also have headache, giddiness, and blurred vision.
Transdermal hyoscine is used by some anesthetists to minimize postoperative nausea and vomiting. The safety and efficacy of this form of treatment has been reviewed in an analysis of data from 23 trials involving 979 patients treated with hyoscine and 984 with placebo [ ]. The authors concluded that of 100 patients who are treated with hyoscine, 17 will escape postoperative nausea and vomiting that would otherwise have occurred; however, 18 will have visual disturbances, eight will complain of dry mouth, two will complain of dizziness, and one will become agitated. Although these are not necessarily prohibitive problems, they certainly do need to be considered when choosing a drug for this indication.
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