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In conjunction with BMJ Case Reports, DTB will feature occasional drug-related cases that are likely to be of interest to readers. These will include cases that involve recently marketed drugs for which there is limited knowledge of adverse effects and cases that highlight unusual reactions to drugs that have been marketed for several years.
Summary
This case report highlights the potentially serious side effects of hyoscine and how a seemingly innocuous patch may confound patients and doctors alike. It demonstrates how easy it is to miss an obvious diagnosis when in fact a thorough medical history including an exhaustive drug history can easily point us in the direction of the diagnosis fairly quickly. Finally, hyoscine may cause potentially serious side effects and patients who are taking it, either orally or transdermally, should be made aware of these.
Background
Hyoscine is a belladonna alkaloid with anticholinergic properties. It competes with acetylcholine and other parasympathomimetic agents thus blocking their effects at parasympathetic sites at the nicotinic and muscarinic receptors. It causes decreased motility in the gastrointestinal and urogenital tract as well as having inhibitory actions on salivary glands, respiratory tract and the oral cavity.
Hyoscine is available as an over-the-counter medication for nausea, vomiting as well as motion sickness. It is commonly used to treat abdominal pain seen in gastroenteritis, colitis, inflammatory bowel disease, ureteric colic and primary dysmenorrhoea.
The side effects of hyoscine can be as follows1 2:
Very common—dryness of mouth, visual disturbance (blurred vision, cycloplegia, myopia, mydriasis), hot skin, dizziness, dyspepsia, palpitations.
Common—skin irritation.
Rare—confusion, memory impairment, disorientation, restlessness, urinary retention.
Side effects can be remembered by the phrase ‘blind as a bat, dry as a bone, full as a flask (urinary retention), hot as a hare, red as a beet, and mad as a hatter’.3
Case presentation
An 80-year-old …
Footnotes
Contributors The following members PA (SHO, Acute medicine), AM (Medical Registrar, Acute Medicine) and TK (Consultant, Infectious disease) are involved in preparing case report. TK identified the idea for case report collaborating with PA and AM. All three of them were managing the patient during his stay. PA planned, gained patient’s consent, collected details and data, case history, wrote draft paper, and searched the literature. AM revised the collected data, initial draft paper. TK again revised the paper and searched the literature. PA is the corresponding author and guarantor for the case report. The patient’s next of kin had signed the consent for writing the case report as the patient was not able to do so. She provided the patient’s medical history and background details.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.