Antispasmodics and Other Drugs Altering Gut Motility

Warning

Antispasmodics

Preferred list (P)

MEBEVERINE HYDROCHLORIDE tablets

HYOSCINE BUTYLBROMIDE tablets

 

Total list (T)

PEPPERMINT OIL gastro-resistant capsules 

  • Restriction: Excludes modified-release gastro-resistant capsules such as Colpermin®.

ALVERINE CITRATE capsules 

Prescribing notes:

  • Older patients are particularly susceptible to the antimuscarinic effects of antispasmodics.

Motility Stimulants

Total list (T)

DOMPERIDONE

  • Domperidone is associated with a small increased risk of serious cardiac side effects. The MHRA have advised that it is contraindicated in those with underlying cardiac conditions, those receiving medicines known to prolong the QT or potent CYP3A4 inhibitors and those with severe hepatic impairment. The lowest effective dose up to 10mg three times daily should be used for the shortest possible time.

METOCLOPRAMIDE

  • Metoclopramide has been associated with neurological adverse effects. The MHRA have advised that it should only be prescribed for up to 5 days with maximum dose of 10mg three times daily. It is best avoided if possible in patients under 20 years old as this age group of patients are high risk of dystonic reactions.

Prescribing notes:

  • The MHRA have advised that both metoclopramide and domperidone should be used at the lowest effective dose for short courses in the treatment of nausea and vomiting only.

NHSL Joint Adult Formulary Key

To indicate the category of a formulary medicine, updated sections adopt the following key:

Preferred list (P): First-line formulary choices.

Total list (T): Alternative choices when preferred list options not effective/not tolerated, or not indicated.

Specialist initiation (S1): Specialist initiation, or on the advice of a Consultant or Specialist Practitioner in this therapeutic area. Continuation in primary care is acceptable.

Specialist use only (S2): Supply via hospital, Homecare Service or a hospital based prescription (HBP) for dispensing by community pharmacy. Not prescribed in primary care setting.

Editorial Information

Last reviewed: 31/01/2022

Next review date: 31/01/2025

Author(s): NHSL.

Version: Please refer to the introduction section for an explanation of the review dates above.

Approved By: ADTC

Reviewer name(s): ADTC.