What do you think about Buscopan?

RE: What do you think about Buscopan?

Rob Loxley — Fri, 30 Jun 2023 07:07:50 GMT

Interestingly in other countries Buscopan is marketed as a syrup

RE: What do you think about Buscopan?

Sara Ramsey — Tue, 27 Jun 2023 23:51:08 GMT

For interest, the local pharmacy said the unlicensed syrup is £400 to £700 a bottle!

I didn't go down that route!

They said they had a generic uncoated one, but by this time my maropitant plan was working.

RE: What do you think about Buscopan?

Michael Woodhouse — Tue, 27 Jun 2023 23:43:27 GMT

Think link suggests crushing ok as a last resort. Whilst described as 'coated' I can see nothing specific about an enteric coating and the product should be active in the stomach - working on abdominal cramps

https://www.swallowingdifficulties.com/product/hyoscine-butylbromide/

RE: What do you think about Buscopan?

Alasdair Hotston Moore — Tue, 27 Jun 2023 22:51:11 GMT

[quote userid="3169" url="~/f/clinical-questions/30569/what-do-you-think-about-buscopan/241797#241797"]But they are cheap. What I have done in similar situations (not with Buscopan but worth a try) is pull a syringe apart, drop tablet in, fill with known quantity of water, leaving some space. Draw in some air, shake syringe to dissolve[/quote]

The human instructions specifically tell you not to break or dissolve the tablets. Presumably they are enteric coated?

RE: What do you think about Buscopan?

Michael Woodhouse — Mon, 26 Jun 2023 23:44:23 GMT

[quote userid="7002" url="~/f/clinical-questions/30569/what-do-you-think-about-buscopan/241783#241783"]The tablets are 10mg and coated so not easy to split.[/quote]

But they are cheap. What I have done in similar situations (not with Buscopan but worth a try) is pull a syringe apart, drop tablet in, fill with known quantity of water, leaving some space. Draw in some air, shake syringe to dissolve. Discard unwanted material and then squirt into mouth/mix with food.

so if you want 0.5mg/kg in your 5kg dog = 2.5mg. 10mg tablet, 4ml of water, discard 3ml and administer 1ml.

I wouldn't personally keep for subsequent doses, but you can if you want

(and treat the campy - I'm sure it helps)

RE: What do you think about Buscopan?

Alasdair Hotston Moore — Mon, 26 Jun 2023 15:34:04 GMT

crying now.....

shattered dreams

RE: What do you think about Buscopan?

Sara Ramsey — Mon, 26 Jun 2023 09:43:32 GMT

I agree, the owner has 4 dogs, two of which are puppies, two are 6 years old. She has significant mobility issues and is going to need support poop scooping and bathing..d

Difficult as it is, I hope this the issue, his poo is also positive for campylobacter upsialensis (again).

I will suggest Purina HA I think and a probiotic...with a view to added fibre too

Thank you much for the input

RE: What do you think about Buscopan?

Andrew Kent — Mon, 26 Jun 2023 09:14:09 GMT

[quote userid="7002" url="~/f/clinical-questions/30569/what-do-you-think-about-buscopan/241787#241787"]

Could I ask how how you would tackle the giardia? He has had several panacur courses. I will obviously tackle the hygiene aspect.

Longer courses? Treat the asymptomatic dogs? Test at the end of treatment?

[/quote]

I think this comes down to how significant we think it is. I would wonder, from what you describe, whether this is just a result of the dysbiosis rather than any kind of cause. Particularly if we are sometimes identifying this when clinical signs are not present.

My standard approach to Giardia is to treat with 7-10 days of fenbendazole, to address environmental reservoirs and to get the owner to bath the dog (or at least the perineum) daily during treatment. If the signs don't change, even when on treatment, I consider the possibility its not really significant.

I think playing around with diet sounds sensible - I might start with an alternative novel protein/hydrolysed option first. But it does sound like scavenging may be a problem!

Andy

RE: What do you think about Buscopan?

Andrew Kent — Mon, 26 Jun 2023 09:11:11 GMT

[quote userid="8663" url="~/f/clinical-questions/30569/what-do-you-think-about-buscopan/241792#241792"] Or I am being naive?[/quote]

yep

The evidence in people (as I don't think anybody has done the work in dogs/cats) is that around 40% of people will still react to a hydrolysed protein if they are allergic to the parent protein so we have moved away from thinking hydrolysation is the solution and towards the idea it may just be one aspect. So I think most internists would now favour hydrolysed AND novel protein where possible.

It does also come down to the extent of hydrolysis and the resulting size of the resultant products but again this lacks clear definitions.

Andy

RE: What do you think about Buscopan?

Alasdair Hotston Moore — Mon, 26 Jun 2023 08:59:28 GMT

[quote userid="2451" url="~/f/clinical-questions/30569/what-do-you-think-about-buscopan/241786#241786"]Z/D is hydrolysed chicken so not the best option for a diet trial[/quote]

surely the point of hydrolysed protein sources is that they are non allergenic? Or I am being naive?

RE: What do you think about Buscopan?

Sara Ramsey — Sun, 25 Jun 2023 12:03:13 GMT

Thanks Andy, yes he has had ultrasound, all the bloods and also endoscopic biopsies last year - showed mild inflammation and helicobacter which he was treated for (I know the presence doesn't prove aetiology) He has had campylobacter twice, often tests positive for giardia though V+, Borborygmi, and anorexia are more prominent than diarrhoea.

He is a typical stressy, fussy mini poodle who eats poo. Owner got two puppies at the beginning of the year and his flare ups have worsened..suspect there is more poo eating, maybe eating puppy food..and stress. He also won't eat after 6pm so suspect some BVS occurs too!

It's a tough case..sorry for the drip feed.

I have been considering a high fibre diet

Could I ask how how you would tackle the giardia? He has had several panacur courses. I will obviously tackle the hygiene aspect.

Longer courses? Treat the asymptomatic dogs? Test at the end of treatment?

Many thanks,

RE: What do you think about Buscopan?

Andrew Kent — Sun, 25 Jun 2023 11:49:31 GMT

I have no useful advice about the Buscopan as it will likely not surprise you (given my comments above) that I would not use it in your case.

have any investigations been performed? It would be useful to try to work out what the episodes are - pancreatitis? Gastroenteritis? Addisons? So I would be looking at blood work, B12, folate, cortisol and abdo ultrasound.

you can then determine what the best intervention might be, particularly with regards to diet (do we need low fat? Higher fibre?). In the interim you could consider a diet trial with a different protein source - Z/D is hydrolysed chicken so not the best option for a diet trial. Maybe try Purina HA (soya based?).

hope that helps,

Andy

RE: What do you think about Buscopan?

Alasdair Hotston Moore — Sun, 25 Jun 2023 11:14:23 GMT

the tablets are not intended to be split I'm afraid. I have no useful suggestions however

RE: Buscopan

Sara Ramsey — Sat, 24 Jun 2023 08:10:55 GMT

Hi,

I'm ressurecting this thread to ask if anyone one knows how I could treat a 4.8kg miniature poodle with buscopan. The tablets are 10mg and coated so not easy to split.

A local pharmacy has said they can order a syrup but it's £400 a bottle.

Its a tricky case, dog get squeaky tummy and goes off food, looses weight quickly, owners very distressed and keep getting omeprazole and ranitidine prescribed which I am trying to stop. It's on z/d but also keep testing positive for giardia ( this is something I am also trying to tackle)

I have dispensed maropitant tablets for owner to use at home and paracetamol.

RE: Buscopan

Aine Seavers — Tue, 28 Feb 2023 05:51:42 GMT

Thanks Dinu, glad you are finding the same. Pain can occur in absence of stones or coels so its acalulous pain and we forget that. A medic mate almost ended up a pethidine addict aged 40 because it was the only thing that reduced their agony until a radical gall bladder op-they had no stones or coeles, just sludge, yet were bedridden for months. Now they run full marathons so we dismiss GBD impact in our patients.

I am now aware there is some controversy over the 2 papers but let's not throw the baby out with the bathwater-the authors have raised our consciousness about GBD, we can disagree on how they came to that information or how they managed those cases but we cannot invalidate the concern they raised that until now, the vast majority of vets did not pay GBD the respect it deserves. You and I are both sceptics, we question everything but animals don't lie. In A year's time, vets reading this thread now-even the ones who disagreed with me or like David superbly questioned me, all of us will have considered GBD more, will probably have medically treated more, will keep Ursofalk and Buscopan on our drug shelves and will refer or do in-house a % as a surgical removal solution. I doubt without those 2 papers, GBD would have raised to our minds like it has.

My surgical cohort were sent to an amazing surgeon-at zero kickback to me so no conflict of interest -at a specialist centre-Rachel does the op routinely and with no issues if they can be sent before they rupture-and even then she manages those superbly so side effects and death at high rates may be a reflection on the surgeon or outdated techniques as much as the operation itself.

As I discussed privately with other Vet surgeon members-My own belief is the best and real peer review starts once any paper is published and applied against real life patients and situations-. These papers do stack up re the need to add GBD to the d/d in animals with :

Compelling clinical signs,
A history of time related anorexia that sees the pet cut out the 2nd meal of the day and
where U/s and
always where Triglyceride markers are of concern-( which is often but not always)

The difference nailing GBD has made to those patients was a wonderful source of joy to me in practice. After many years in practice one gets jaded as the magic of taking on a new disease gets experienced less and less the more experience one becomes-so for me personally, these papers made me sit up and read them all-made me curious-and then made sense and a joyous difference when applied in practice. I hope other vets get to try this info out-and report back- either way re findings.

I note on other threads elsewhere that Apoquel blamed and equally a peer paper suggesting RMB diet to blame. In fairness to both accusations, and much as I dislike both culprits-I don’t think they are to blame as much as we are just getting better diagnosing these issues as we do more U/S as a routine daily event. That said, I use low fat id and Hills W/d to then maintain these dogs on-they still have a lipid disorder and sensitive pancreas I don’t want to annoy. I like the higher fibre and the stabilising of the blood sugars as again just to err on caution side. I know the whole Egg/Diet Cholesterol/Production fallacy/endogenous production argument but I find these animals did the best on the low fat id/wd combination.

Post op, one of the main complications seems to be nausea and abd pain for 72hours-in my hands Cerenia knocks that pain out of the ball park so I put my op cases back out after 24hrs to me on that drug.

Thanks

Aine

RE: Buscopan

Dinu Catilina — Mon, 27 Feb 2023 12:37:35 GMT

[quote userid="6473" url="~/001/veterinary-clinical/small-animal/medicine/f/discussions/30569/buscopan/240899#240899"]

I took its overall message as take better attention to history taking and gallbladder sludge.

[/quote]

Aine, we saw in the last years quite a few dogs like this, many of them Bull Terriers. I am now quicker to remove the gall bladder without diagnosing a mucocele and these patients do great. We are not a specialist centre and I don't agree that the mortality is high in these patients post surgery

RE: Buscopan

Aine Seavers — Sat, 25 Feb 2023 23:40:58 GMT

David-Thank you for the detailed reply. Whilst your concerns have validity, they don’t invalidate the take home message that we dismiss the significance of gall bladder sludge in an animal-with-illness to the detriment of our patient.

Addressing this concern Medically with Ursofalk and diet (and buscopan) can release these patients from silent suffering.

Paying attention when a client tells us the dog has gone off its morning meal instead of dismissing it can be life changing for this dog.

You don't need go the surgical route to dramatically improve their lives-that is not what I read this paper to recommend.

I took its overall message as take better attention to history taking and gallbladder sludge.

Re the concerns re surgery, again these are less of a concern with modern techniques in a `specialist setting which is where I sent my surgical cases-wherein mucocoele or heavily sludge filled gallbladders are now if not a daily then a frequent weekly event. The risks rise with the longer you leave the diseased organ there-a ruptured removal is a totally different surgical ball game to a contained one.

The Clinician in me hates having to resort to surgery, I love the challenge to work from causes to cure or control, but I would be arrogant to not admit that the complete change in quality of life within 24-72hrsof that surgery offers these cases-an immediate cessation to pain and nausea etc is confronting in its benefit . Owners comment just like they do post a pyometra surgery-Wow, we have a puppy back-she must have been ill for months-undetected gallbladder disease is in that same category and surgery resolves the severe ones.

To see a 4kg dog with constant illness have its gallbladder sludge be detected on ultrasound and ignored serially over 2 years then not scanned until it came to me and we found a Six cm coele of considerable weight- whose constant history in that time was waxing and waning episodes of pain of unknown origin and no morning appetite. 72hrs post-op-he resumed eating his breakfast and does so every day in ensuing many months.

Listening to what our patients tell us assisted mein then detecting a cohort of similar suffering pets, one with heavy sludge with a history of hiding under the bed and moaning-with NAD despite intensive investigation elsewhere-but with serial persistent increasing sludge and the other marker of concern which is present in many not all-elevated Triglycerides- that one went for surgery and quality of life soared immediately post op. The others went on low fat id and hills wd combo and Ursofalk and other supportive meds-the Doggy Day care manager noted to the owner that the anti-social rescue dog of 3 years they both knew was transformed-at the age of 11 she had begun to join the main group and be playful and sociable-so tell me that that dog didn’t have temperament issues from an increased menace arc due to pain and nausea...

There were so many I could mention since that paper highlighted the need to address gall bladder dysfunction-which to me was the main take home message of those papers- which obeys Primum non-Nocera, adds to our diagnostic armoury and treatment options.

In summary, whilst the concerns you raise have validity, the actually true representative patient cohort seen in a first or referral clinical setting that correlate to the findings of those papers and respond to the attention given to the sludge are the real indicators that the paper 's observations are true and valid and need implementation in first opinion practice in consultation with specialist surgical services where appropriate.

Yours in Respect

Aine

RE: Buscopan

David Mills — Sat, 25 Feb 2023 21:47:31 GMT

Well, just reading the papers, removal of the gall bladder for an unknown pathology without an immediately established indication (e.g. mucocoele) is arguably experimental. The numbers are small. There is no data on overall mortality post-op. Cholecystectomy even at referral level is associated with significant morbidity and mortality. These procedures were carried out at first opinion level.

I've no doubt GB disease is underestimated and undertreated. I will relatively regularly aspirate bile for cytology and C/S in animals with waxing and waning signs and bacterial/inflammatory cell presence is more common than I thought.

However, removing the GB because of sludge seems somewhat extreme to me as it is a common finding in anorexic animals. Buscopan may well work well for these. I am skeptical that the removal of the GB is the treatment of choice however.

The theory that GB distension diminishes throughout the day is a theory not supported by strong evidence.

There are, allegedly, other issues with these papers but it is not my place to comment publicly.

RE: Buscopan

Aine Seavers — Fri, 24 Feb 2023 21:04:11 GMT

What was the concern about the sources? Aside from hoping the JSAP reviewers are on the ball, the real peer review takes place post publication when the information contained within the paper is then tested in real life. So my taking what they found re diurnal appetite and applying it in real life against a cohort reflective not random to my clientele-the claims back up. Animals who go off a morning meal, in the presence of blood and ultrasonic markers of gall bladder dysorder/dysfunction-these pets have an extraordinarypositive response to having this disorder addressed either medically or surgically and do so when attention to all the other parameters of concern have been addressed without success. The pathophysiology of the increased pressure in the GB overnight didnt seem heretical either so I am intrigued to know more about what has caused you concern about where they sourced their information from.

RE: Buscopan

David Mills — Fri, 24 Feb 2023 13:26:41 GMT

[quote userid="6473" url="~/001/veterinary-clinical/small-animal/medicine/f/discussions/30569/buscopan/240885#240885"]GBD in the JSAP in 2021 were outstanding and a game changer and a clinical lifeline.[/quote]

If you are talking about the Viljoen articles then I would strongly urge caution regarding the source of the data in those papers.

RE: Buscopan

Aine Seavers — Thu, 23 Feb 2023 21:03:56 GMT

Start with the JSAP articles from 2020-2021-they make anything before then out of date. If you have an ultrasound-start using it on those odd 'bad backs' sounds like ivdd dogs hiding under beds and whimpering and have an increased menace arc-and you probably will find more than sludge-probably a mucocoele. Have Ursofalk in stock-aside from gall bladder assistance, just a great liver support drug-sort of like Denosyl/Denamarin. Here in Oz we stopped having those supplements and only had the new hepatoadanced-I am concerned about continuing VIt E long term so no so keen on it-Ursofalk has bridged that gap. The biggest clue it gallbladder is they go off their breakfast and eat in the evening-not because the day is too hot but because the dog is in pain until the gallbladder tension eases over the day. Just think how many owners casually drop that line to us and we fob it off as insignificant because the dog eats happily in the eventing. Prepare to be amazed.

RE: Buscopan

Jenny Tu — Thu, 23 Feb 2023 20:53:13 GMT

This is all really interesting, thanks everyone. Of course I’m going to study more gallbladder stuff now…

RE: Buscopan

Aine Seavers — Thu, 23 Feb 2023 20:38:31 GMT

Use it all the time for acute presentations without vomiting as often prefer to address the vomiting first so no point giving buscopan having moved contents from the stomach to then just sit in dormant intestinal tract.

DO so Love it for Gallbladder dysmotility case that are so often missed in the havoc they cause in our canine patients-GBD to me is probale a bigger imposter player than Hypothyroidism. Once you click that sludge is not insignificant-despite what peer papers up to 2020 told us, and accept the mysterious failure of an animal to come good re its 'pancreatitis' its IBD, it looks like HyperA but isn’t , the whimpering 'lame' dog -is the agonising gall bladder pain-then drugs like Buscopan come into their own. I have/do read an enormous number of peer-reviewed -papers-so it takes a lot to make me sit up and switch off the Cynic gene-but the series of papers on GBD in the JSAP in 2021 were outstanding and a game changer and a clinical lifeline.

I didn’t click on how important their findings were until I had a case from 11 other vets and 3 specialist centres and 4 years of ill health-until I focused on the gallbladder and 24hrs after the surgery-that dog had the best 12 months of its life before I left the practice. More cases resolved with attention to the GBD So yes to Buscopan and Yes to getting curious when a dog gets superb relief from it that maybe you should not be dismissing the sludge therein even if the sludge it is non-gravity dependent.

RE: Buscopan

Miriam Lodewyks — Thu, 23 Feb 2023 11:53:36 GMT

I use it regularly in my dog when she gets “the gurgles”, I can see the relief on her face within a half hour and the borborygmi stop. I’ve used it on myself and on horses (back in the day). It’s great and I vehemently refute any suggestion that it’s placebo!

RE: Buscopan

David Mills — Wed, 08 Feb 2023 20:02:24 GMT

What toxins would they be?

whatever is being shot out also comes with a lot of third space fluid that could have been absorbed and it’s probably one of the main killers of Parvo pups, hypovolaemia.

anti pyretic, anti spasmodic, analgesic, what’s not to like. We use it like water for GI cases. Great drug.