EXPLORING THE COMBINED THERAPEUTIC POTENTIAL OF HYOSCINE BUTYLBROMIDE AND PARACETAMOL FOR RELIEF IN SPASMODIC CONDITIONS

Nikhil Bangale*, Aditi Gulhane, Auditi Narayan, B. S. Susheela Rani, Indrakumar Singh, Jayamala G., K. Chandrika Kanne, K. Shilpi Reddy, Lata K., Mani Kapur, Monica Saha, Narendra Malhotra, P. Madhavi, Rakhi Gupta, Shaveta Garg, Sheela V. Mane, Shipra Roy, Suneetha Gudipati, Sunita Chandra, Vidya V. Bhat and Poonam Shah

ABSTRACT

Menstruation, a fundamental aspect of women's reproductive health, often introduces discomfort, with dysmenorrhea affecting about 81% – 93% of women, alongside other distressing symptoms such as abdominal cramps, headache, back pain, body aches, and fatigue, impacting nearly 3 out of 4 women. This poses significant challenges to daily routines and activities, profoundly affecting quality of life. While over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used for pain management, they often provide only partial relief, necessitating a holistic approach to address pain and discomfort, as well as distressing menstrual symptoms, without severe adverse events. Paracetamol offers significant safety advantages over traditional NSAIDs like mefenamic acid, which carry higher risks of gastrointestinal bleeding, heartburn, nausea, and gastric ulcers, alongside recent alerts regarding DRESS syndrome. Similarly, while dicyclomine effectively manages spasmodic pain, it is associated with an increased incidence of dry mouth, blurred vision, and constipation compared to hyoscine butylbromide (HBB) derived from natural source. The minimal systemic side effects and absence of central effects of HBB ensure safer clinical usage. Additionally, the minimal anti-inflammatory activity of paracetamol offers superior gastrointestinal safety compared to mefenamic acid and dicyclomine combination, rendering HBB+paracetamol a safer alternative, enhancing tolerability and compliance in patients with spasmodic pain conditions. The combination of HBB and paracetamol has emerged as a potent pharmacotherapeutic option over decades, with a faster onset and longer duration of action. Its versatility extends beyond dysmenorrhea and related symptoms, effectively addressing a broad spectrum of spasmodic conditions, including specific or non-specific abdominal pain with or without cramping, colicky pain, irritable bowel syndrome, and post-operative spasmodic pain. Additionally, it is effective in managing urinary tract infections, polycystic ovary disease, pelvic inflammatory disease, endometriosis, fibroids, and ovarian cysts, thus widening its adaptability and clinical utility, establishing it as a valuable addition to children (>10 years) and women across all age groups and settings. Backed by strong clinical evidence and favourable safety, the combination of HBB+paracetamol is established as a clinically effective and well-tolerated treatment for menstrual pain, its related symptoms, and a range of spasmodic conditions. Embracing this combination heralds a path towards better women's health, where efficient symptom relief leads to an overall enhancement in quality of life amidst the challenges posed by menstruation.

Keywords: Spasmodic conditions, menstrual pain, distressing symptoms, hyoscine butylbromide, paracetamol, safety, quality of life.