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100 mg/5 mL.
Contains 2.3 mmol Na
+
,
1 mmol K
+
/
5 mL,
net price 250 mL = £2.56,
500 mL = £5.12
Dose
ADULT and CHILD over 12 years, 5–10 mL after meals and at
bedtime; CHILD 2–12 years, 2.5–5 mL after meals and at bedtime
(under medical
advice only)
Gaviscon Infant
c
(Reckitt Benckiser)
Oral powder
,
sugar-free,
sodium alginate 225 mg,
magnesium alginate 87.5 mg, with colloidal silica and
mannitol/dose.
Contains 0.92 mmol Na
+
/dose.
Net
price 30 doses = £2.46
Dose
INFANT body-weight under 4.5 kg, 1 ‘dose’
mixed with
feeds (or water in breast-fed infants) when required (max. 6 times
in 24 hours); body-weight over 4.5 kg, 2 ‘doses’ mixed with feeds
(or water in breast-fed infants) when required (max. 6 times in 24
hours);
CHILD 2 ‘doses’ in water after each meal (max.
6 times in
24 hours)
Note
Not
to be used in preterm neonates,
or where excessive
water loss likely (e.g.
fever,
diarrhoea,
vomiting, high room tem-
perature),
or if intestinal obstruction.
Not to be used with other
preparations containing thickening agents
Important
Each half of the dual-sachet is identified as ‘one dose’.
To avoid errors prescribe with directions in terms of ‘dose’
Topal
c
(Fabre)
Tablets
,
alginic acid 200 mg,
dried aluminium hydro-
xide 30 mg,
light magnesium carbonate 40 mg with
lactose 220 mg,
sucrose 880 mg,
sodium bicarbonate
40 mg (low Na
+
).
Net price 42-tab pack = £1.67
Cautions
diabetes mellitus (high sugar content)
Dose
ADULT and CHILD over 12 years, 1–3 tablets chewed 4 times
daily (after meals and at bedtime)
1.2
Antispasmodics and
other drugs altering gut
motility
Drugs in this section include antimuscarinic compounds
and drugs believed to be direct relaxants of
intestinal
smooth muscle. The smooth muscle relaxant properties
of
antimuscarinic and other antispasmodic drugs may
be useful in
irritable bowel syndrome
and in
diverticular
disease
.
The
dopamine-receptor
antagonists
metoclopramide
and domperidone (section 4.6) stimulate transit in the
gut.
Antimuscarinics
Antimuscarinics
(formerly
termed
‘anticholinergics’)
reduce intestinal motility. They are used for the manage-
ment of
irritable bowel
syndrome
and
diverticular dis-
ease
. However, their value has not been established and
response varies.
Other
indications for
antimuscarinic
drugs include arrhythmias (section 2.3.1),
asthma and
airways disease (section 3.1.2), motion sickness (section
4.6),
parkinsonism (section 4.9.2),
urinary incontinence
(section 7.4.2), mydriasis and cycloplegia (section 11.5),
premedication (section 15.1.3)
and as an antidote to
organophosphorus poisoning (p.
41).
Antimuscarinics
that
are
used
for
gastro-intestinal
smooth muscle spasm include the tertiary amines atro-
pine sulphate and dicycloverine hydrochloride and
the quaternary ammonium compounds propantheline
bromide and hyoscine butylbromide.
The quaternary
ammonium compounds are less lipid soluble than atro-
pine and are less likely to cross the blood–brain barrier;
they are also less well
absorbed from the gastro-intes-
tinal tract.
Dicycloverine hydrochloride has a much less marked
antimuscarinic action than atropine and may also have
some direct action on smooth muscle.
Hyoscine butyl-
bromide is advocated as a gastro-intestinal
antispas-
modic,
but it is poorly absorbed;
the injection is useful
in endoscopy and radiology.
Atropine and the bella-
donna alkaloids are outmoded treatments,
any clinical
virtues being outweighed by atropinic side-effects.
Cautions
Antimuscarinics should be used with caution
in Down’s syndrome, in children and in the elderly; they
should also be used with caution in gastro-oesophageal
reflux disease,
diarrhoea,
ulcerative colitis,
autonomic
neuropathy,
acute myocardial
infarction,
hypertension,
conditions
characterised
by
tachycardia
(including
hyperthyroidism, cardiac insufficiency, cardiac surgery),
pyrexia,
and in individuals susceptible to angle-closure
glaucoma.
Interactions: Appendix 1 (antimuscarinics).
Contra-indications
Antimuscarinics are contra-indi-
cated in myasthenia gravis (but may be used to decrease
muscarinic side-effects of
anticholinesterases—section
10.2.1),
paralytic ileus,
pyloric stenosis,
toxic megaco-
lon,
and prostatic enlargement.
Side-effects
Side-effects of
antimuscarinics include
constipation,
transient bradycardia (followed by tachy-
cardia, palpitation and arrhythmias), reduced bronchial
secretions,
urinary urgency and retention,
dilatation of
the pupils with loss of
accommodation,
photophobia,
dry mouth, flushing and dryness of the skin. Side-effects
that occur occasionally include confusion (particularly
in the elderly),
nausea,
vomiting,
and giddiness;
very
rarely,
angle-closure glaucoma may occur.
ATROPINE SULPHATE
Indications
symptomatic relief of gastro-intestinal
disorders characterised by smooth muscle spasm;
mydriasis and cycloplegia (section 11.5);
premedi-
cation (section 15.1.3); see also notes above
Cautions
see notes above
Contra-indications
see notes above
Pregnancy
not known to be harmful; manufacturer
advises caution
Breast-feeding
small amount present in milk—man-
ufacturer advises caution
Side-effects
see notes above
Dose
. 0.6–1.2 mg at night
Atropine
(Non-proprietary) A U
Tablets
, atropine sulphate 600 micrograms. Net price
28-tab pack = £17.59
DICYCLOVERINE HYDROCHLORIDE
(Dicyclomine hydrochloride)
Indications
symptomatic relief of gastro-intestinal
disorders characterised by smooth muscle spasm
Cautions
see notes above
BNF 61
1.2 Antispasmodics and other drugs altering gut motility
47
1
Gastro-intestinal system