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Covid -19 Specific information
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Advice & Guidance for GPs
Advice & Guidance Services Advice and Guidance Best Practice RAS on e-Referral
Biochemistry
Alkaline Phosophatase Clinical Biochemistry in Primary Care Creatinine Kinase Hyperkalaemia Hyperlipidaemia Hypomagnesaemia Lipid Advice & Guidance Service
Breast
Advice & Guidance Service Axillary masses Breast Implants (non-cancer) Breast Pain Breast Surgery Breastfeeding Family History of Breast Cancer Male Breast Symptoms Mastitis and Breast Abscess Nipple conditions
Cancer Screening
Bowel Cancer Screening Breast Cancer Screening Cervical Cancer Screening Pancreatic Cancer Surveillance Programme
Cancer Support
Advice & Guidance Service LD & Cancer Living with and beyond cancer (LWBC) Nutrition in cancer Physio for NBT Cancer patients Toxicity Risk Assessment Tool Rehab / prehab
Cardiology
Advice & Guidance Service Angina Arrhythmia Atrial Fibrillation and Flutter Cardiac Rehabilitation Cardiac Rhythm Analysis Dilated Ascending Aorta ECG - Open Access ECHO - requesting Heart Failure Hypertension Inherited Cardiac Conditions NT Pro BNP Testing Pacemakers Postural Orthostatic Tachycardia Syndrome (PoTS) Rapid Access Chest Pain Clinics Syncope and TLOC
Care of the Elderly
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
Community Therapy
Community Therapy
Coroner
Avon Coroner
COVID-19
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Dermatology
Acne vulgaris Actinic Keratosis Advice & Guidance and guidelines Alopecia Basal Cell Carcinoma Benign Skin Lesions Bowens Disease Community Dermatology Service Cosmetic skin treatments Eczema Hidradenitis Suppurativa Hyperhidrosis Leg Ulcer Mole Mapping/Surveillance Pityriasis Rosea Pityriasis Versicolor Polymorphic Light Eruption Pruritis Psoriasis Rosacea Scabies Seborrhoeic Dermatitis Skin Camouflage Tinea Tissue Viability/Wound Care Service Unusual Appearance - Outlook Urticaria Vulval Skin Care Warts and Verrucas
Diabetes
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
Dietetics & Nutrition
Advice & Guidance Service Local Services Malnutrition & Oral Nutritional Supplements Vitamin D Deficiency Weight management
Drug and Alcohol Misuse
Alcohol Misuse Opiate Dependence Non-opiate drug dependence Bristol Drug and Alcohol Service North Somerset Drug & Alcohol Service South Gloucestershire Drug & Alcohol Service Bristol Shared Care Breaking Free (Bristol & South Glos)
DVT and PE
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Enablement
Bristol Centre for Enablement Wheelchair Services
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Endocrinology
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ENT
Advice & Guidance Service Anosmia Audiology (adult) Dizziness and Vertigo Ear wax and microsuction ENT HOT Clinic Epistaxis Hearing Problems Middle ear problems Moulded Ear Plugs Nasal Treatment Neck Lumps (including Goitre) Otitis Externa Rhinosinusitis & Nasal Polyps Snoring Speech & Language Tinnitus Tonsils Uvula
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Gynaecology
Advice & Guidance Service Abnormal vaginal bleeding Cervical Conditions Dyspareunia Early Pregnancy Assessment Clinic Emergency Gynaecology Endometriosis Female Cosmetic Surgery Female Genital Mutilation Female Genitalia Surgery Female Urinary Incontinence Fibroids Hyperemesis Gravidarum Menopause Menstrual Disorders Mesh Complications Open Access Gynae Imaging Ovarian Conditions PCOS Pelvic Organ Prolapse Persistent Pelvic Pain (women) Premature Ovarian Insufficiency (POI) Recurrent Miscarriage Termination of Pregnancy Vaginal Discharge Vulval Skin Conditions
Haematology
Advice & Guidance Service Anaemia Blood Transfusions & Iron infusions Genetic Haemochromatosis Guidelines for Primary Care Leucocytosis (including neutrophilia and lymphocytosis) Macrocytosis Polycythaemia Sickle Cell & Thalassaemia Vitamin B12 Warfarin monitoring
Hepatology
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Imaging - see Radiology
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Oncology
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Orthopaedics
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Prescribing
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Self Care
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Sexual Health
Advice & Guidance Service Chronic Pelvic Pain Syndrome (men) Contraception Emergency Contraception Gonorrhoea HIV LARC LARC Complex referrals Loss of Libido Monkeypox Pelvic Inflammatory Disease Post Birth Contraception Psychosexual Service Sexual assault/ abuse support Sexual Health Guidelines and Referral Syphilis
Sleep Medicine
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Surgery
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Vascular
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ENT
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1. Gastro-intestinal System 2. Cardiovascular system 3. Respiratory System 4. Nervous system 5. Infections 6. Endocrine system 7. Obstetrics, gynaecology, and urinary-tract disorders 8. Malignant Disease and Immunosuppression 9. Nutrition and Blood 10. Musculoskeletal and joint diseases 11. Eye 12. Ear, Nose and Oropharynx 13. Skin 14. Immunological products and vaccines 15. Anaesthesia 16. Palliative Care Guidelines 17. Miscellaneous Preparations
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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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