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Active Ageing - South Glos Advice and guidance - Care of the Elderly Assistive Technology Service Falls & Balance Fracture Liaison Service Frailty Hearing Services Live Longer Better Movement Disorders NHS@home - Frailty pathway Rapid Assessment Clinic For Older People
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Community Diabetes Specialist Service Diabetes & Nutrition Diabetes Advice and Guidance Diabetes Foot Care Diabetes Mellitus - Guidelines Diabetes self-management Diabetes Structured Education Diabetic Eye Screening Monogenic Diabetes Neuropathic Pain (Diabetic) Non-diabetic Hyperglycaemia and the National Diabetes Prevention Program Pregnancy and diabetes Rapid Access Diabetes Clinic Type 2 diabetes management Type 2 Path to Remission Programme
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Advice & Guidance Service Local Services Malnutrition & Oral Nutritional Supplements Vitamin D Deficiency Weight management
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ENT
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Home > Formulary : Adult > Chapters > 1. Gastro-Intestinal System >

BNSSG Adult Joint Formulary

1.6 Gastro-intestinal smooth muscle spasm

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Last edited: 15-04-2024

First line drugs Second line drugs Specialist drugs Secondary care drugs

 

NICE Guidance CG61 Irritable bowel syndrome in adults: diagnosis and management of irritable bowel syndrome in primary care

 

Antimuscarinics

Alternatives: (TLS Blue)

Hyoscine butylbromide

Specific indication: (TLS Blue)

Propantheline

In myasthenia gravis to reduce antimuscarinic side-effects of anticholinesterases.

 

Antispasmodics 

Recommended: (TLS Green)

Mebeverine 135mg tablets

Mebeverine 200mg modified-release capsules

Alternatives: (TLS Blue)

Alverine citrate

 

Motility Stimulants

Recommended: (TLS Green)

Metoclopramide

  • Metoclopramide should be given for a maximum of 5 days, see MHRA link above

Alternative: (TLS Blue)

Domperidone

 

Endoscopic Treatment of GI Smooth Muscle Disorders

Botulinum toxin type A (TLS Red)

  • For oesophageal achalasia in patients unfit for cardiomyotomy surgery
  • For pyloric spasm in post-oesophagectomy patients
  • For use 4 weeks prior to abdominal wall reconstruction where giant incisonal hernia, defined by intra-abdominal loss of domain >25% or fascial defect where the distance between the medial border of the recti muscles is ≥10cm, in who midline fascial closure is unlikely to be achieved by abdominal wall reconstruction (AWR) and component separation techniques (CSTs) alone

See Botulinum Toxin A Pathways page for more information on Abdominal wall reconstruction, Pyloric Spasm and Oesophageal Achalasia

 

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