Buscopan and glaucoma: a survey of current practice

Area of Science:

• Radiology
• Pharmacology

Background:

• Hyoscine butylbromide (Buscopan) is a common hypotonic agent in UK gastrointestinal studies.
• A history of glaucoma is widely taught as a contraindication, despite risks primarily affecting undiagnosed angle closure glaucoma (ACG).

Purpose of the Study:

• To survey UK radiologists' current practices regarding Buscopan use and contraindications.
• To assess understanding of Buscopan contraindications, particularly glaucoma and heart disease.

Main Methods:

• A postal survey was distributed to members and fellows of the Royal College of Radiologists in the UK.
• The survey collected data on Buscopan usage, contraindications, and substitutions.

Main Results:

• A significant majority (81.6%) of radiologists withhold Buscopan with a glaucoma history.
• Despite understanding the low risk, many radiologists continue to withhold Buscopan based on outdated teaching.
• Caution with heart disease history is less consistently applied (52.4% substitute glucagon).
• A small percentage reported Buscopan-precipitated glaucoma (0.8%) or cardiac complications (1.9%).

Conclusions:

• Widespread misconceptions exist among UK radiologists regarding Buscopan contraindications.
• The practice of inquiring about glaucoma history should be abandoned.
• Emphasis should shift to advising patients with eye pain/visual loss to seek urgent care.
• Caution in patients with heart disease is more clinically significant than a glaucoma history.