Antispasmodics & Other Drugs Altering Gut Motility: Antimuscarinics

• Antimuscarinics:

Antimuscarinics that are used for gastro-intestinal smooth muscle spasm include Atropine sulphate and Hyoscine (Scopolamine) Butylbromide. The side effects frequently associated with the use of antimuscarinics include xerostoma (dry mouth), blurred vission, cycloplegia, mydriasis, photophobia، anhidrosis, urinary hesitancy and retention, tachycardia, palpitation، and constipation. Side effects that occur occasionally include confusion (particularly in elderly), nausea, vomiting and giddiness. Antimuscarinics may interact with antacids or antidiarrheals (reduce absorption of anticholinergics.

Atropine Sulphate:

Indications: – dyspepsia, irritable bowel syndrome, diverticular disease; premeditation; mydriasis and cycloplegia; poisoning see also notes above Contraindications: Antimuscarinics are contra-indicated in myasthenia gravis, paralytic ileus, pyloric stenosis and prostatic enlargement.

Dose and Administration: Adults – IM, S.C., I.V. – 0.4 – 0.6 mg. Every four to six hours. Children – SC – 0.01 mg/kg of body weight, not to exceed 0.4 mg, every for to six hours.

Hyoscine (Scopolamine) Butyl bromide:

Indications: – symptomatic relief of visceral spasms of the gastro- intestinal tract, painful spasm of the biliary and genito-urinary system.

Contraindications: Antimuscarinics are contra-indicated in myasthenia gravis, paralytic ileus, pyloric stenosis and prostatic enlargement.

Dose and Administrations: By mouth, 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.

• Other Antispasmodics: 

Mebeverine Hydrochloride;

Indications: adjunct in gastro-intestinal disorders characterized by smooth muscle spasm, irritable bowel syndrome.

Contraindications: paralytic ileus.

Dose and Administration: adults and child over 10 years 1 tablet 3 times daily preferably 20 minutes before meals or 1 capsule twice daily preferably 20 minutes before meals.

Pinaverium Bromide:

Indications: pain of gastrointestinal or biliary disease, also for preparation for barium enema.

Contraindications: during pregnancy and breast-feeding also in case of galactosemia.

Dose and Administration: 3-4 tablets/day within meals, dose can be increased to 6 tablets/day

Prifinium Bromide:

Indications: pain of gastritis, gastro-duodenal ulcer, enteritis, colitis, post gastrectomy syndrome and irritable colon.

Contraindications: patients with prostatic hypertrophy and patients with glaucoma.

Dose and Administration: Adults: 30-60mg 3 times daily. Children: 6-12 years old may take 15-30mg 3 times daily.

Alverine Citrate:

Indications: adjunct in gastro-intestinal disorders characterised by smooth muscle spasm; dysmenorrhoea.

Contraindications: children under 12 years old, pregnancy, and breast-feeding and paralytic ileus; when combined with sterculia, intestinal obstruction, faecal impaction, and colonic atony.

Dose and Administration: 60–120 mg 1–3 times daily; child under 12 years not recommended.