page68
Contra-indications
see notes above;
also infants
under 6 months
Pregnancy
not known to be harmful; manufacturer
advises use only if essential
Breast-feeding
avoid—present in milk; apnoea
reported in infant
Side-effects
see notes above
Dose
. 10–20 mg 3 times daily;
INFANT
6–24 months 5–10 mg
3–4 times daily,
15 minutes before feeds;
CHILD
2–12
years 10 mg 3 times daily
Merbentyl
c
(Sanofi-Aventis) A
Tablets
, dicycloverine hydrochloride 10 mg, net price
100-tab pack = £4.84;
20 mg (
Merbentyl 20
c
),
84-tab
pack = £8.14
Syrup
,
dicycloverine hydrochloride 10 mg/5 mL,
net
price 120 mL = £1.77
Note
Dicycloverine hydrochloride can be sold to the public
provided that max. single dose is 10 mg and max. daily dose
is 60 mg
Compound preparations
Kolanticon
c
(Peckforton)
Gel
,
sugar-free,
dicycloverine hydrochloride 2.5 mg,
dried aluminium hydroxide 200 mg,
light magnesium
oxide 100 mg,
simeticone 20 mg/5 mL, net price
200 mL = £2.21,
500 mL = £3.35
Dose
ADULT and CHILD over 12 years, 10–20 mL every 4 hours
when required
HYOSCINE BUTYLBROMIDE
Indications
symptomatic relief of gastro-intestinal or
genito-urinary disorders characterised by smooth
muscle spasm;
bowel colic and excessive respiratory
secretions (see Prescribing in Palliative Care,
p.
23)
Cautions
see notes above
Contra-indications
see notes above
Pregnancy
manufacturer advises use only if potential
benefit outweighs risk
Breast-feeding
amount too small to be harmful
Side-effects
see notes above
Dose
. By mouth (but poorly absorbed,
see notes above),
smooth muscle spasm,
20 mg 4 times daily;
CHILD
6–
12 years, 10 mg 3 times daily
Irritable bowel syndrome,
10 mg 3 times daily,
increased if required up to 20 mg 4 times daily
. By intramuscular
or
slow intravenous injection, acute
spasm and spasm in diagnostic procedures, 20 mg
repeated after 30 minutes if necessary (may be
repeated more frequently in endoscopy), max. 100 mg
daily;
CHILD
2–18 years see
BNF for Children
Buscopan
c
(Boehringer Ingelheim) A
Tablets,
coated, hyoscine butylbromide 10 mg,
net
price 56-tab pack = £2.25
Note
Hyoscine butylbromide tablets
can be sold to the
public for medically confirmed irritable bowel syndrome,
provided single dose does not exceed 20 mg, daily dose does
not exceed 80 mg, and pack does not contain a total of more
than 240 mg
Injection
,
hyoscine butylbromide 20 mg/mL,
net
price 1-mL amp = 22p
PROPANTHELINE BROMIDE
Indications
symptomatic relief of gastro-intestinal
disorders characterised by smooth muscle spasm;
urinary frequency (section 7.4.2);
gustatory sweating
(section 6.1.5)
Cautions
see notes above
Contra-indications
see notes above
Hepatic impairment
manufacturer advises caution
Renal impairment
manufacturer advises caution
Pregnancy
manufacturer advises avoid unless essen-
tial
Breast-feeding
may suppress lactation
Side-effects
see notes above
Dose
.
ADULT
and
CHILD
over 12 years, 15 mg 3 times daily at
least 1 hour before meals and 30 mg at night,
max.
120 mg daily
Pro-Banthine
c
(Archimedes) A
Tablets
,
pink,
s/c,
propantheline bromide 15 mg,
net
price 112-tab pack = £14.40.
Label:
23
Other antispasmodics
Alverine,
mebeverine,
and
peppermint
oil
are
believed to be direct
relaxants
of
intestinal
smooth
muscle
and
may
relieve
pain
in
irritable
bowel
syndrome
and
diverticular disease
.
They have no ser-
ious adverse effects but, like all antispasmodics, should
be avoided in paralytic ileus.
Peppermint oil
occasion-
ally causes heartburn.
ALVERINE CITRATE
Indications
adjunct in gastro-intestinal disorders
characterised by smooth muscle spasm;
dysmenorr-
hoea
Contra-indications
paralytic ileus
Pregnancy
use with caution
Breast-feeding
manufacturer advises avoid—limited
information available
Side-effects
nausea;
headache,
dizziness;
pruritus,
rash;
hepatitis also reported
Dose
.
ADULT
and
CHILD
over 12 years,
60–120 mg 1–3 times
daily
Spasmonal
c
(Norgine)
Capsules
,
alverine citrate 60 mg (blue/grey),
net
price 100-cap pack = £9.47;
120 mg (
Spasmonal
c
Forte
,
blue/grey),
60-cap pack = £10.94
MEBEVERINE HYDROCHLORIDE
Indications
adjunct in gastro-intestinal disorders
characterised by smooth muscle spasm
Cautions
avoid in acute porphyria (section 9.8.2.)
Contra-indications
paralytic ileus
Pregnancy
not known to be harmful; manufacturers
advise caution
Side-effects
allergic reactions (including rash,
urti-
caria,
angioedema) reported
48
1.2 Antispasmodics and other drugs altering gut motility
BNF 61
1
Gastro-intestinal system