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BNSSG Adult Joint Formulary

1.6 Gastro-intestinal smooth muscle spasm

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



Alternatives: (TLS Blue)

Hyoscine butylbromide

Specific indication: (TLS Blue)


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



Recommended: (TLS Green)

Mebeverine 135mg tablets

Mebeverine 200mg modified-release capsules

Alternatives: (TLS Blue)

Alverine citrate


Motility Stimulants

Recommended: (TLS Green)


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

Alternative: (TLS Blue)



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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