2023-04-19 13:42:00
Medicines have such complicated names that it is sometimes difficult to remember them. So, when these two treatments have an almost similar name, the task becomes all the more difficult. In Spain, several people have been tricked and mixed two different treatments: scopolamine and butylscopolamine.
In a press release published on April 17, 2023, the Spanish Medicines Agency (AEMPS) warned of five cases of taking scopolamine instead of butylscopolamine, requiring medical assistance.
Scopolamine and butylscopolamine: what are the differences?
If the two treatments have an almost similar name, they differ in their indications and dosages. But in what cases are they used?
Scopolamine butylbromide (butylscopolamine), is used for the treatment of acute spasms of the gastrointestinal, biliary and genitourinary tracts. It is indicated for patients receiving palliative care. This injectable solution is found according to the ANSM (National Medicines Safety Agency) in the form of a 1ml ampoule (20mg/ml). The Spanish agency explains that butylscopolamine bromide, due to its chemical structure as a quaternary ammonium salt, “does not cross the blood-brain barrier (physical and metabolic barrier that isolates the brain from the rest of the body)”.
On the other hand, scopolamine hydrobromide (scopolamine), has a tertiary amine structure. It is for this reason that, unlike butylscopolamine, it crosses the blood-brain barrier, and therefore affects the brain. This treatment is indicated as premedication in anesthesia to reduce excessive salivation and respiratory tract secretions. This specialty is only available in hospital pharmacies and can exceptionally be retroceded by hospitals in this context to non-hospitalized patients”, details the ANSM. It is found in 2ml vials, with a concentration of 0.25mg/ml according to ANSM.
Scopolamine: serious adverse effects in case of overdose
Given these differences between the two treatments, poor administration can be harmful. In the 5 cases identified in Spain, the patients took scopolamine when they had been prescribed butylscopolamine. The Spanish government warns regarding the “side effects” related to the confusion of the two drugs.
Indeed, taking scopolamine with the dosage of butylscopolamine can lead to an overdose, and therefore to serious effects. Public Health France details as side effects of the treatment:
- thickening of bronchial secretions;
- a decrease in tear secretion and dry eyes;
- accommodation disorders resulting in visual disturbances;
- palpitations and rapid heartbeat;
- constipation ;
- urinary retention ;
- mental confusion, agitation, hallucinations, delirium especially in the elderly.
The Spanish agency concludes its press release by explaining that: “this confusion can cause an anticholinergic picture due to scopolamine overdose which can put the patient’s life in danger“. The organization calls for the vigilance of health professionals to avoid risks. On its site, the ANSM already called on health professionals to be attentive to “individual adjustment of doses”.
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