Antispasmodics can be divided into two main classifications:

  • Anti-muscarinics (reduce intestinal motility, has opposite activity to ‘rest and digest’)
  • Smooth muscle relaxants (direct relaxants of intestinal smooth muscles)   


Cuases 
  • Irritable Bowel Disease 
  • Inflammatory Bowel Disorder 
  • Bowel Colic in palliative care 


Atmuscarincs 
  • Tertiary amines: atropine sulfate and dicycloverine hydrochloride
  • Quaternary ammonium (less well absorbed from GI tract: propantheline bromide and hyoscine butylbromide.
  • Quaternary ammonium are less lipid soluble, therefore less likely to cross the blood brain barrier meaning they are at a lower risk for central nervous system side-effects. They are also less well absorbed from the gastro-intestinal tract 

Treatments

Anti-muscarincs

Atropine
Dose: 0.6–1.2 mg daily, dose to be taken at night.

Hyoscine Butyl-bromide
Dose: 20 mg 4 times a day

(Hysoscine Butyl-bromide MHRA alert)- Risk of serious adverse effects in patients with underlying cardiac diseases Contraindicated in tachycardia)

Side effects:
Urinary Retention
Blurry Vision
Constipation
Dry Mouth
Tachycardia, palpitations and irregular heart beat. 

Cautions
Angle-closure glaucoma 

Contraindications: Prostatic enlargement and urinary retention
Toxic Megacolon
Myasthenia Gravis
Paralytic ileus
GI obstruction  






Antispasmodics

Mebeverine 
Dose: 135-150mg TDS as needed at least 20 minutes before meals

Alverine 
Dose: 60–120 mg 1–3 times a day

Contraindications 
Intestinal obstruction (alverine only) and paralytic ileus 









 

Antispasmodics

Peppermint Oil 
1–2 capsules 3 times a day for up to 3 months if necessary, capsule to be swallowed whole with water