title: Hyoscine N-butylbromide (Buscopan®) in the treatment of acute ureteral colic: what is the evidence?
abstract: OBJECTIVE
  To investigate the evidence for the use of hyoscine N-butylbromide (HBB) in the treatment of acute renal colic.
  
  
  METHODS
  A literature search was performed using the keywords 'hyoscine N-butylbromide', 'ureteral colic', 'spasmolytic', 'anticholinergic' and 'analgesia'. The articles were given the appropriate level of evidence according to the Oxford Centre for Evidence-Based Medicine Levels of Evidence guidelines.
  
  
  RESULTS
  The analgesic effect of HBB as monotherapy is inferior to that of opioids and/or non-steroidal anti-inflammatory drugs (NSAIDs). It does provide an analgesic and antispasmodic effect, but not as long-lasting as NSAIDs. HBB does not serve as an adjunct to opioids. Furthermore, it does not facilitate passage of ureteral stones and has no effect on expulsion rate.
  
  
  CONCLUSIONS
  HBB is often used where urinary tract smooth muscle spasm is thought to be part of the pathophysiological process. According to the evidence, administration of HBB follows non-peer-reviewed protocols which are based on empiric recommendations. Its role is still unclear, as it appears to have no advantage when used as monotherapy over established forms of analgesia. There appears to be a time-dependent relation to pain reduction following parenteral administration, but this needs to be confirmed by more prospective randomized cohorts.
authors.affiliation: Endourology and Stone Services, Barts Health NHS Trust, London, UK.
authors.forename: George
authors.initials: G
authors.lastname: Papadopoulos
authors.forename: Andreas
authors.initials: A
authors.lastname: Bourdoumis
authors.forename: Stefanos
authors.initials: S
authors.lastname: Kachrilas
authors.forename: Christian
authors.initials: C
authors.lastname: Bach
authors.forename: Noor
authors.initials: N
authors.lastname: Buchholz
authors.forename: Junaid
authors.initials: J
authors.lastname: Masood
mesh_terms: D000208:Acute Disease; D000700:Analgesics / Q000009:adverse effects / Q000627:therapeutic use*; D002086:Butylscopolammonium Bromide / Q000009:adverse effects / Q000627:therapeutic use*; D019317:Evidence-Based Medicine; D006801:Humans; D018727:Muscarinic Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D056844:Renal Colic / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D018727:Muscarinic Antagonists; D002086:Butylscopolammonium Bromide