1.2 Antispasmodics and other drugs altering gut motility

General guidance

• Antispasmodic: Antispasmodic drugs may be useful adjuncts in the management of non-ulcer dyspepsia, irritable bowel syndrome and diverticular disease.
• Antimuscarinic agents reduce intestinal motility and gastric secretion and may be useful in some forms of dyspepsia, irritable bowel syndrome and in diverticular disease. However, their usefulness may be limited by typical anticholinergic side-effects. There appears to be little to choose between the agents in terms of efficacy.
• Tricyclic antidepressants (often at full dosage) are an effective treatment for irritable bowel syndrome particularly if diarrhoea predominant. Mebeverine and peppermint oil are also indicated in irritable bowel syndrome and diverticular disease. There appears to be little to choose between the agents. An increase in dietary fibre is likely to be beneficial in constipation–predominant irritable bowel syndrome. If symptoms of bloating, loose stools and flatulence pre-dominate a reduction in fibre may be beneficial. Patients should be advised to avoid any foods which aggravate symptoms. Some cases of diarrhoea predominant IBS may respond to cholestyramine – seek advice from a gastroenterologist.
• Local gastroenterologists occasionally use mebeverine in doses higher (270mg tds) than those licensed, they have found these to be efficacious and not associated with significant side-effects. General practitioners are advised only to prescribe at these higher doses on specialist recommendation.
• Metoclopramide and domperidone stimulate gastric emptying, transit in the small intestine and enhance the strength of oesophageal sphincter contraction.
• There is little substantial evidence to indicate the superiority of any drug in this area.
• Domperidone: risks of cardiac side effects - click here - MHRA Drug Safety Update - Indication restricted to nausea and vomiting, new contraindications, and reduced dose and duration of use (30 May 2014
• Metoclopramide: risk of neurological adverse effects - click here.  MHRA Drug Safety Update - Restricted dose and duration of use (7 August 2013)

Recommended Drugs:

Alverine Citrate ££

Mebeverine Hydrochloride ££

Peppermint Oil ££

Imipramine Hydrochloride £

Amitriptyline Hydrochloride £

Domperidone £ - Domperidone: risks of cardiac side effects - click here

Metoclopramide Hydrochloride £ - Metoclopramide: risk of neurological adverse effects - click here

Drug Traffic Light Key:

Green – On Formulary

Amber – Restricted use, see local guidelines

Purple – Specialist use/initiation

Red – Non Formulary

Relative Costs Key (where indicated):

£££££ - high

£££ - moderate

£ - low