Anticholinergic·Gastrointestinal - Antiemetics

Hyoscine hydrobromide

Prevention of motion sickness, control of 'death rattle' (excessive respiratory secretions) in palliative care

PBSANTIEMETICKwells, Scopoderm (Patch)Tablets (300 mcg)S4+1

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At a glance

Max Dose

1.5 mg Patch/72h

Half-life

9.5 h

Caution: Sedation

PROFOUND

High risk: Anticholinergic

CRITICAL RISK

Cautions

Avoid / Cautions

Narrow-angle glaucoma (will precipitate acute blindness), severe BPH with urinary retention.

Where it stands

Rapid Summary

Overview

Centrally acting, highly lipid-soluble antimuscarinic agent. The most effective drug for severe motion sickness and drying up terminal palliative secretions.

Clinical Focus

Unlike Hyoscine Butylbromide (Buscopan), Hydrobromide (Kwells) rapidly crosses the blood-brain barrier, causing profound sedation and delirium.

Bottom Line

Hyoscine hydrobromide is an anticholinergic used for motion sickness and palliative secretion management, but crosses the blood-brain barrier causing sedation and confusion unlike hyoscine butylbromide.

Formulation & Access

Brand Names

Kwells, Scopoderm (Patch)

Oral Routes

Tablets (300 mcg).

Topical

Transdermal patch (1.5 mg).

Parenteral

Ampoules (400 mcg/1 mL) for SC / IM / IV.

Prescribing & PBS

Pharmacy Medicine (S2). Palliative ampoules are S4.

Indications & Use

Primary

PBSTGA

Prevention of motion sickness, control of 'death rattle' (excessive respiratory secretions) in palliative care.

Clinical Place

First-line for severe motion/sea sickness. Cornerstone of end-of-life care pathways.

Quick reference

Class & Role

Anticholinergic — Centrally acting, highly lipid-soluble antimuscarinic agent.

Route / Formulation

Tablets (300 mcg). (Kwells, Scopoderm (Patch))

Usual Dose & Max

Topical Apply 1 patch (1.5 mg) behind the ear 5-6 hours before travel. Leave on for 72 hours. OR PO 300 mcg STAT. Max 1.5 mg patch every 72 hours (Topical) or 1.2 mg/day (Oral/IV).

Key Indication Doses

Motion Sickness: Topical Apply 1 patch (1.5 mg) behind the ear 5-6 hours before travel. Leave on for 72 hours. OR PO 300 mcg STAT. Palliative Care (Secretions): SC / IV 400 mcg q4h PRN or via 24-hour syringe driver (1.2 - 2.4 mg/24h).

Best Uses

Key Risks

Neurological: Toxic delirium, hallucinations, profound sedation, severe confusion (especially in the elderly). Gastrointestinal: Severe dry mouth, constipation, paralytic ileus. Ocular: Blurred vision, pupillary dilation (mydriasis).

Key Interactions

TCAs, Promethazine, Olanzapine. Additive anticholinergic burden causes fatal hyperthermia and toxic megacolon.

Monitoring

Ensure the patch is applied to a clean, hairless area behind the ear. Warn patients to wash their hands immediately after applying the patch, or they will accidentally dilate their own pupil if they rub their eye.

Clinical Pearl

Hyoscine HYDRObromide (Kwells/Scopoderm) crosses the BBB and puts you to sleep. Hyoscine BUTYLbromide (Buscopan) stays in the gut and fixes stomach cramps. Confusing them on the ward will result in a delirious or seizing patient.

Access

Kwells, Scopoderm (Patch)Tablets (300 mcg)

Brand: Kwells, Scopoderm (Patch)
Formulation: Tablets (300 mcg).

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