Antispasmodics and other drugs altering gut motility

ANTISPASMODICS

Choices: DICYCLOVERINE/DICYCLOMINE
                  MEBEVERINE

 

Dicycloverine/dicyclomine (tablets, syrup) is an anti-muscarinic drug which also has direct muscle relaxant properties. It is used as an adjunct in the treatment of gastro-intestinal disorders such as irritable bowel syndrome and diverticular disease. It has less marked anti-muscarinic action than atropine but atropine-like side-effects are common. It is contra-indicated in patients with glaucoma and urinary retention. It should be avoided in patients with oesophageal reflux.


Mebeverine (tablets, liquid) is believed to act as a direct relaxant of intestinal smooth muscle and has no anti-muscarinic actions. It is well tolerated. It may be used with bulk-forming agents in irritable bowel syndrome.
 

SPECIAL INDICATIONS

 Peppermint water [unlicensed] may be used to relieve wind pain after abdominal surgery.

 Peppermint oil(e/c capsules) has a direct relaxant effect and may be useful for relief of abdominal colic and distension. It may cause heartburn. The capsules should be swallowed whole as peppermint oil can cause irritation of the mouth or oesophagus. Peppermint oil capsules are more expensive than mebeverine tablets.
Hyoscine butylbromide injection is useful in endoscopy and radiology, and as a safe short-acting antispasmodic for abdominal pain.

Alverine (capsules) may be used as an alternative to other drugs.

PRESCRIBING POINTS FOR ANTISPASMODICS

• All antispasmodics should be avoided in paralytic ileus.
• Absorption of other drugs may be affected by altering gut transit time.

PAEDIATRIC NOTES - ANTISPASMODICS

Dicycloverine/dicyclomine may be used for infantile colic. It is not recommended below the age of six months. It should be given before food.
Mebeverine is occasionally used in children.

GERIATRIC NOTES - ANTISPASMODICS

The elderly are particularly susceptible to the anti-muscarinic side-effects of antispasmodics and care should be taken in their use.
Mebeverine is the preferred drug.

MOTILITY STIMULANTS

First choice: DOMPERIDONE
                        METOCLOPRAMIDE

 

Domperidone (tablets, suspension, suppositories) and metoclopramide (tablets, oral solution) are both dopamine antagonists which stimulate gastric emptying and reduce small intestinal transit time, and enhance the strength of oesophageal sphincter contraction. Domperidone is less likely than metoclopramide to cause central effects such as sedation and dystonic reactions, and has thus replaced it as the drug of choice. A course of treatment with domperidone should not exceed 12 weeks.

SPECIAL INDICATIONS
Metoclopramide injection is the only injectable drug in this category. See BNF for cautions.

PRESCRIBING POINTS FOR MOTILITY STIMULANTS

• These agents may be used in the treatment of oesophageal reflux and gastric stasis, and in the long-term management of non-ulcer dyspepsia, although domperidone should not be used longer than 12 weeks.
• Avoid use immediately after abdominal surgery.

PAEDIATRIC NOTES - MOTILITY STIMULANTS

Domperidone may be used for the treatment of resistant gastro-oesophageal reflux. It is not licensed in children for this indication. It is available in suppository form.