Hyoscine butylbromide injection – supply issues

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Hyoscine butylbromide 20mg/1ml injection (Buscopan injection) is included in NECN Palliative Care guidelines and linked care plans as an option for pharmacological management of distressing excess secretions – and for prescription in anticipation of possible need.

The Palliative Care & Pharmacy Teams at County Durham & Darlington NHS Foundation Trust have become aware of a widespread supply problem and have circulated the following advice (full text here: CD&DFT Memo – Supply Issues with Hyoscine Butylbromide 20mg Injection).

There is currently a supply issue with Hyoscine Butylbromide 20mg injection. Stock is not expected at wholesalers for another 2-3 weeks and stock levels have been depleted within the Trust.  Hyoscine Hydrobromide 400microgram and 600microgram injection remain available, as well as the oral tablets.  

First Line

Where sufficient stocks are available, please continue to use hyoscine butylbromide injection

Second Line

For patients with normal renal function (eGFR or Creatinine Clearance >40mL/min): Hyoscine Hydrobromide 400micrograms SC hourly as required for secretions max 6 doses in 24 hours

In renal impairment (eGFR or Creatinine Clearance <40mL/min): Glycopyrronium 200micrograms SC hourly as required for secretions max 6 doses in 24 hours.

Please discuss the current stock and supply situation with local community pharmacies before prescribing hyoscine butylbromide, hyoscine hydrobromide or glycopyrronium injections. Contact local palliative care specialist teams for further advice or clarification, if needed.