1.2 Antispasmodics and other drugs altering gut motility
In this section
Dicycloverine (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.
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.
Alverine (capsules) may be used as an alternative to other drugs.
Hyoscine butylbromide (injection) is useful during endoscopy and radiology procedures, and as a safe short-acting antispasmodic for abdominal pain.
Peppermint water [unlicensed] may be used to relieve wind pain after abdominal surgery.
PRESCRIBING POINTS FOR ANTISPASMODICS
- All antispasmodics should be avoided in paralytic ileus.
- Absorption of other drugs may be affected by altering gut transit time.
Domperidone (tablets, suspension, suppositories) is a dopamine antagonist which stimulates gastric emptying and reduces small intestinal transit time, and enhances the strength of oesophageal sphincter contraction. A course of treatment with domperidone should not exceed 12 weeks.
Note: metoclopramide should no longer be used to treat conditions such as indigestion, heartburn and acid reflux, or chronic (long-term) disorders due to slow emptying of the stomach, see Drug Safety Update vol 7 issue 1, August 2013: S2.
PRESCRIBING POINTS FOR MOTILITY STIMULANTS
- Domperidone 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.