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Dose
.
ADULT
and
CHILD
over 10 years 135–150 mg 3 times
daily preferably 20 minutes before meals;
CHILD
under
10 years see
BNF for Children
1
Mebeverine Hydrochloride
(Non-proprietary) A
Tablets
,
mebeverine hydrochloride 135 mg,
net price
100-tab pack = £4.21
Oral suspension
,
mebeverine hydrochloride (as
mebeverine embonate) 50 mg/5 mL, net price 300 mL
= £137.00
1.
Mebeverine hydrochloride can be sold to the public for
symptomatic relief of irritable bowel
syndrome provided
that max.
single dose is 135 mg and max.
daily dose is
405 mg;
for uses other than symptomatic relief of irritable
bowel
syndrome provided that max.
single dose is 100 mg
and max.
daily dose is 300 mg
Colofac
c
(Solvay) A
Tablets
,
s/c,
mebeverine hydrochloride 135 mg,
net
price 100-tab pack = £7.52
Modified release
Colofac
c
MR
(Solvay) A
Capsules
,
m/r,
mebeverine hydrochloride 200 mg,
net price 60-cap pack = £6.67.
Label:
25
Dose
irritable bowel syndrome, 1 capsule twice daily preferably
20 minutes before meals; CHILD 12–18 years see
BNF for Children
Compound preparations
1
Fybogel
c
Mebeverine
(Reckitt Benckiser) A
Granules
,
buff, effervescent,
ispaghula husk 3.5 g,
mebeverine hydrochloride 135 mg/sachet,
net price
10 sachets = £2.50.
Label:
13,
22,
counselling,
see
below
Excipients
include aspartame (section 9.4.1)
Electrolytes
K
+
2.5 mmol/sachet
Dose
irritable bowel syndrome, ADULT and CHILD over 12 years,
1 sachet in water, morning and evening 30 minutes before food; an
additional sachet may also be taken before the midday meal if
necessary
Counselling
Preparations that swell in contact with liquid should
always be carefully swallowed with water and should not be taken
immediately before going to bed
1.
10-sachet pack can be sold to the public
PEPPERMINT OIL
Indications
relief of abdominal colic and distension,
particularly in irritable bowel syndrome
Cautions
sensitivity to menthol
Pregnancy
not known to be harmful
Breast-feeding
significant levels of menthol in breast
milk unlikely
Side-effects
heartburn,
perianal irritation;
rarely,
allergic reactions (including rash,
headache,
brady-
cardia, muscle tremor,
ataxia)
Local irritation
Capsules should not be broken or chewed
because peppermint oil may irritate mouth or oesophagus
Dose
. See preparations
Colpermin
c
(McNeil)
Capsules
,
m/r,
e/c,
light blue/dark blue,
blue band,
peppermint oil 0.2 mL.
Net price 100-cap pack =
£12.05.
Label:
5,
22,
25
Excipients
include arachis (peanut) oil
Dose
ADULT and CHILD over 15 years, 1–2 capsules, swallowed
whole with water,
3 times daily for up to 3 months if necessary
Mintec
c
(Almirall)
Capsules
,
e/c,
green/ivory,
peppermint oil 0.2 mL.
Net price 84-cap pack = £7.04.
Label:
5,
22,
25
Dose
ADULT over 18 years, 1–2 capsules swallowed whole with
water,
3 times daily before meals for up to 2–3 months if neces-
sary
Motility stimulants
Metoclopramide and domperidone (section 4.6)
are
dopamine receptor antagonists which stimulate gastric
emptying and small
intestinal
transit,
and enhance the
strength of oesophageal sphincter contraction. They are
used in some patients with
functional
dyspepsia
that
has not responded to a proton pump inhibitor or a H
2
-
receptor
antagonist.
Metoclopramide is also used to
speed the transit
of
barium during intestinal
follow-
through examination,
and as accessory treatment
for
gastro-oesophageal reflux disease
. For the management
of
gastroparesis in patients with diabetes,
see section
6.1.5.
Metoclopramide and domperidone are useful
in
non-specific and in cytotoxic-induced nausea and vomi-
ting.
Metoclopramide and occasionally domperidone
can cause
acute
dystonic
reactions,
particularly in
young women and children—for further details of
this
and other side-effects,
see section 4.6.
1.3
Antisecretory drugs and
mucosal protectants
1.3.1 H
2
-receptor antagonists
1.3.2 Selective antimuscarinics
1.3.3 Chelates and complexes
1.3.4 Prostaglandin analogues
1.3.5 Proton pump inhibitors
Peptic ulceration commonly involves the stomach, duo-
denum,
and lower oesophagus;
after gastric surgery it
involves the gastro-enterostomy stoma.
Healing can be promoted by general measures, stopping
smoking and taking antacids and by antisecretory drug
treatment,
but
relapse
is
common when treatment
ceases.
Nearly all
duodenal
ulcers
and most
gastric
ulcers
not
associated with NSAIDs
are
caused by
Helicobacter pylori
.
The management of
H. pylori
infection and of NSAID-
associated ulcers is discussed below.
Helicobacter pylori infection
Eradication of
Helicobacter pylori
reduces recurrence
of gastric and duodenal ulcers and the risk of rebleeding.
It also causes regression of most localised gastric muco-
sa-associated lymphoid-tissue (MALT) lymphomas. The
presence of
H. pylori
should be confirmed before start-
ing eradication treatment.
Acid inhibition combined
with antibacterial
treatment
is highly effective in the
eradication of
H.
pylori
;
reinfection is rare.
Antibiotic-
associated colitis is an uncommon risk.
For initial treatment, a one-week triple-therapy regimen
that comprises a proton pump inhibitor, clarithromycin,
BNF 61
1.3 Antisecretory drugs and mucosal protectants
49
1
Gastro-intestinal system