Buscopan is licenced by Boehringer Ingleheim, a large multinational pharmaceutical corporation based in Germany. It is the trade name for Hyoscine Butylbromide, a powerful antispasmodic, registered in 1956, that relieves the cramping abdominal pain associated with IBS by blocking receptors for acetylcholine, a transmitter that is released by enteric nerves and stimulates intestinal contractions. But acetylcholine has many effects throughout the body. It stimulates secretion of saliva, causes contraction of the bladder, slows the heart rate, and affects the ciliary muscles that alters the shape of the lens to accomodate to objects. So anticholinergic medication will have many side effects such as dry mouth, blurred vision, urinary retention and a rapid pulse. Nevertheless, Buscopan is only slowly absorbed through the gastrointestinal tract and is said to have most effects on the gut. Other antispasmodics, notably mebeverine (Colofac) or alverine citrate (Spasmanol) have more of a direct effect on intestinal smooth muscle and less side effects. Peppermint oil is also a useful antispasmodic and has the appeal of being a more natural product and relatively free of side effects. It is marketed as Mintec or Colpermin, which comes in a capsule that only releases the oil when it reaches the colon. It may has less antispasmodic effect that other products but patients have reported to me that if they suffer from flatulence, inadvertent release of gas can smell more sweetly of peppermint.
Antispasmodics can be useful for treating abdominal pain and occasionally bloating, when they are said to release the spasm that may be holding up the passage of gas in the bowel, but they should not be regarded as the answer for IBS. On her website, Barbara Bolen PhD states that ‘in general, studies have shown that antispasmodics are moderately effective in providing short-term relief of IBS pain, but there is not a lot of research as to the long-term effectiveness of antispasmodics’. They may make constipation much worse by blocking peristalsis and secretion. And since constipation may be associated intestinal distension which can stimulate intestinal contractions, patients can easily get into a vicious cycle of taking more Buscopan to relieve abdominal pain, which is generated by distension caused by the medication.
IBS is estimated to affect about 10 to 15% of the world’s population. That could translate into up to a billion people. Drugs for IBS are big business. No wonder there are so many different products. The larger companies can corner the market with major publicity campaigns including advertisements on the internet, social media and television. They can also commission large research projects that could lead to exaggerated claims based on a modest statistical significance. Buscopan is marketed as ‘IBS Relief’ and so are Imodium and Colpermin.
Two weeks ago, I overheard a news item that claimed that Boots, the retail Pharmacist, was selling Buscopan under two different names and at two different prices. I looked it up. Buscopan IBS Relief relieves abdominal cramps which cause pain and discomfort in irritable bowel syndrome (IBS). It works by an antispasmodic effect, relaxing the cramping muscle of your bowel. Hyoscine Butylbromide 10mg. It is manufactured under licence in Italy costs £3.49 for just 20 tablets. The manufacturers state that you can take up to 80mg a day (though I would suspect that people would get significant side effects at that dose). Buscopan Cramps contains the identical preparation and dose. It is manufactured under licence in France and retails at £4.79. Often these two products appear on the same shelves. No wonder customers are confused. Just to add to the perplexity, I also looked up Hyoscine Butylbromide in the British National Formulary and found that a 56 tab pack of Hyoscine Butybromide retails for just £3.00.
So do read the small print on the package and ask your pharmacist for the best buy. Remember that while antispasmodics may help in the short term, they are rarely a long term solution, though too many patients continue to take them as a kind of insurance policy. Try to think about what it might be about your life style and life situation that could be driving your IBS and whether you can do something about that.