DIAGNOSTIC AGENTS
Urea (13C)
lINDICATIONS AND DOSE
Diagnosis of gastro-duodenalHelicobacter pylori infection
▶BY MOUTH
▶Child:(consult product literature) lMEDICINAL FORMS
There can be variation in the licensing of different medicines containing the same drug.
Tablet
▶Diabact UBT(Seahorse Laboratories Ltd)
Urea [13-C] 50 mgdiabact UBT50mg tablets|1tabletP £21.25
|10tabletP no price available (Hospital only) Soluble tablet
▶Pylobactell(Torbet Laboratories Ltd)
Urea [13-C] 100 mgPylobactell breath test kit|1kitP£20.75 Powder
▶Helicobacter Test INFAI(INFAI UK Ltd)
Urea [13-C] 45 mgHelicobacter Test INFAI for children breath test kit sugar-free|1kitP £19.10
Urea [13-C] 75 mgHelicobacter Test INFAI breath test kit sugar-free
|1kitP£21.70
5 Food allergy
Food allergy
Management
Allergy with classical symptoms of vomiting, colic and diarrhoea caused by specific foods such as cow’s milk or shellfish should be managed by strict avoidance. The condition should be distinguished from symptoms of occasional food intolerance in those with irritable bowel syndrome. Sodium cromoglicate p.157may be helpful as an adjunct to dietary avoidance.
Other drugs used for Food allergyChlorphenamine maleate, p.168
6 Gastro-intestinal smooth muscle spasm
Antispasmodics
Antimuscarinics
The intestinal smooth muscle relaxant properties of antimuscarinic and other antispasmodic drugs may be useful inirritable bowel syndrome.
Antimuscarinics (formerly termed‘anticholinergics’) reduce intestinal motility. They are occasionally used for the management ofirritable bowel syndrome. However, evidence of their value has not been established and response varies.
Antimuscarinics that are used for gastro-intestinal smooth muscle spasm includes the tertiary amine dicycloverine hydrochloride p.57and the quaternary ammonium compounds propantheline bromide p.58and hyoscine butylbromide p.57. The quaternary ammonium compounds are less lipid soluble than atropine and are less likely to cross the blood-brain barrier; they are also less well absorbed from the gastro-intestinal tract.
Dicycloverine hydrochloride, may also have some direct action on smooth muscle. Hyoscine butylbromide is advocated as a gastro-intestinal antispasmodic, but it is poorly absorbed; the injection may be useful in endoscopy and radiology.
Other indications for antimuscarinic drugs include asthma and airways disease, motion sickness, urinary frequency and enuresis, mydriasis and cycloplegia, premedication, palliative care and as an antidote to organophosphorus poisoning.
Other antispasmodics
Alverine citrate p.58, mebeverine hydrochloride p.58, and peppermint oil p.32are believed to be direct relaxants of intestinal smooth muscle and may relieve pain inirritable bowel syndrome, andprimary dysmenorrhoea. They have no serious adverse effects but, like all antispasmodics, should be avoided in paralytic ileus.
Motility stimulants
Domperidone is a dopamine receptor antagonist which stimulates gastric emptying and small intestinal transit, and enhances the strength of oesophageal sphincter contraction.
The MHRA/CHM has issued restrictions on its use because domperidone is associated with a small increased risk of serious cardiac side effects.
A low dose of erythromycin p.310stimulates gastro-intestinal motility and may be used on the advice of a paediatric gastroenterologist to promote tolerance of enteral
Gastro-intestinalsystem
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feeds; erythromycin may be less effective as a prokinetic drug in preterm neonates than in older children.
ANTIMUSCARINICS
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Dicycloverine hydrochloride
(Dicyclomine hydrochloride)
lINDICATIONS AND DOSE
Symptomatic relief of gastro-intestinal disorders characterised by smooth muscle spasm
▶BY MOUTH
▶Child 6–23 months:5–10mg3–4times a day, dose to be taken15minutes before feeds
▶Child 2–11 years:10mg3times a day
▶Child 12–17 years:10–20mg3times a day lCONTRA-INDICATIONSChild under6months
lPREGNANCYNot known to be harmful; manufacturer advises use only if essential.
lBREAST FEEDINGAvoid—present in milk; apnoea reported in infant.
lEXCEPTIONS TO LEGAL CATEGORYDicycloverine hydrochloride can be sold to the public provided that max.
single dose is10mg and max. daily dose is60mg.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines containing the same drug.
Tablet
▶Dicycloverine hydrochloride (Non-proprietary)
Dicycloverine hydrochloride 10 mgDicycloverine10mg tablets| 100tabletP £190.80DT price = £159.30
Dicycloverine hydrochloride 20 mgDicycloverine20mg tablets| 84tabletP£203.42DT price = £169.86
Oral solution
▶Dicycloverine hydrochloride (Non-proprietary) Dicycloverine hydrochloride 2 mg per 1 mlDicycloverine 10mg/5ml oral solution|100mlPno price available| 120mlP£189.49DT price = £158.25|300mlPno price available
Dicycloverine hydrochloride with aluminium hydroxide, magnesium oxide and simeticone
The properties listed below are those particular to the combination only. For the properties of the components please consider, dicycloverine hydrochloride above, aluminium hydroxide p.558, simeticone p.48.
lINDICATIONS AND DOSE
Symptomatic relief of gastro-intestinal disorders characterised by smooth muscle spasm
▶BY MOUTH
▶Child 12–17 years:10–20mL every4hours as required lMEDICINAL FORMS
There can be variation in the licensing of different medicines containing the same drug.
Oral suspension
▶Kolanticon(Peckforton Pharmaceuticals Ltd)
Dicycloverine hydrochloride 500 microgram per 1 ml, Simeticone 4 mg per 1 ml, Magnesium oxide light 20 mg per 1 ml, Aluminium hydroxide dried 40 mg per 1 mlKolanticon gel sugar-free| 200mlp £4.00sugar-free|500mlp £6.00
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Hyoscine butylbromide
lINDICATIONS AND DOSE
Symptomatic relief of gastro-intestinal or genito-urinary disorders characterised by smooth muscle spasm
▶BY MOUTH
▶Child 6–11 years: 10mg3times a day
▶Child 12–17 years:20mg4times a day Acute spasm|Spasm in diagnostic procedures
▶INITIALLY BY INTRAMUSCULAR INJECTION, OR BY SLOW INTRAVENOUS INJECTION
▶Child 2–5 years:5mg, then (by intramuscular injection or by slow intravenous injection)5mg after30minutes if required, dose may be repeated more frequently in endoscopy; maximum15mg per day
▶Child 6–11 years: 5–10mg, then (by intramuscular injection or by intravenous injection)5–10mg after 30minutes if required, dose may be repeated more frequently in endoscopy; maximum30mg per day
▶Child 12–17 years:20mg, then (by intramuscular injection or by slow intravenous injection)20mg after 30minutes if required, dose may be repeated more frequently in endoscopy; maximum80mg per day Excessive respiratory secretions in palliative care
▶BY MOUTH
▶Child 1 month–1 year:300–500micrograms/kg3–4times a day (max. per dose5mg)
▶Child 2–4 years:5mg3–4times a day
▶Child 5–11 years:10mg3–4times a day
▶Child 12–17 years:10–20mg3–4times a day
▶BY INTRAMUSCULAR INJECTION, OR BY INTRAVENOUS INJECTION
▶Child 1 month–4 years:300–500micrograms/kg 3–4times a day (max. per dose5mg)
▶Child 5–11 years:5–10mg3–4times a day
▶Child 12–17 years:10–20mg3–4times a day Bowel colic (in palliative care)
▶BY MOUTH
▶Child 1 month–1 year:300–500micrograms/kg3–4times a day (max. per dose5mg)
▶Child 2–4 years:5mg3–4times a day
▶Child 5–11 years:10mg3–4times a day
▶Child 12–17 years:10–20mg3–4times a day
▶BY INTRAMUSCULAR INJECTION, OR BY INTRAVENOUS INJECTION
▶Child 1 month–4 years:300–500micrograms/kg 3–4times a day (max. per dose5mg)
▶Child 5–11 years:5–10mg3–4times a day
▶Child 12–17 years:10–20mg3–4times a day PHARMACOKINETICS
Administration by mouth is associated with poor absorption.
lUNLICENSED USETabletsnot licensed for use in children under6years.Injectionnot licensed for use in children (age range not specified by manufacturer).
lPREGNANCYManufacturer advises avoid.
lBREAST FEEDINGAmount too small to be harmful.
lDIRECTIONS FOR ADMINISTRATION
▶With oral useFor administration bymouth, injection solution may be used; content of ampoule may be stored in a refrigerator for up to24hours after opening.
▶With intravenous useForintravenous injection, may be diluted with Glucose5% or Sodium Chloride0.9%; give over at least1minute.
BNFC2016–2017
Gastro-intestinal smooth muscle spasm 57
Gastro-intestinalsystem
1
lMEDICINAL FORMS
There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: oral suspension, oral solution Tablet
▶Buscopan(Boehringer Ingelheim Ltd)
Hyoscine butylbromide 10 mgBuscopan10mg tablets| 56tabletP£3.00DT price = £3.00
Solution for injection
▶Buscopan(Boehringer Ingelheim Ltd)
Hyoscine butylbromide 20 mg per 1 mlBuscopan20mg/1ml solution for injection ampoules|10ampouleP £2.92DT price =
£2.92
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Propantheline bromide
lINDICATIONS AND DOSE
Symptomatic relief of gastro-intestinal disorders characterised by smooth muscle spasm
▶BY MOUTH
▶Child 1 month–11 years:300micrograms/kg3–4times a day (max. per dose15mg), dose to be taken at least one hour before food
▶Child 12–17 years:15mg3times a day, dose to be taken at least one hour before food and30mg, dose to be taken at night; maximum120mg per day
lUNLICENSED USETabletsnot licensed for use in children under12years.
lSIDE-EFFECTSFacialflushing
lPREGNANCYManufacturer advises avoid unless essential—no information available.
lBREAST FEEDINGMay suppress lactation.
lHEPATIC IMPAIRMENTManufacturer advises caution.
lRENAL IMPAIRMENT Manufacturer advises caution.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: oral suspension, oral solution Tablet
CAUTIONARY AND ADVISORY LABELS23
▶Propantheline bromide (Non-proprietary)
Propantheline bromide 15 mgPropantheline bromide15mg tablets
|100tabletP no price available
▶Pro-Banthine(ProStrakan Ltd)
Propantheline bromide 15 mgPro-Banthine15mg tablets| 112tabletP £20.74DT price = £20.74
ANTISPASMODICS
Alverine citrate
24.2.2016 lINDICATIONS AND DOSESymptomatic relief of gastro-intestinal disorders characterised by smooth muscle spasm|Dysmenorrhoea
▶BY MOUTH
▶Child 12–17 years:60–120mg1–3times a day lCONTRA-INDICATIONSIntestinal obstruction
.
paralyticileus
lSIDE-EFFECTSDizziness
.
dyspnoea.
headache.
hepatitis.
jaundice (resolves with cessation)
.
nausea.
pruritus.
wheezing
lPREGNANCYManufacturer advises avoid—limited information available
lBREAST FEEDINGManufacturer advises avoid—limited information available.
lPATIENT AND CARER ADVICE Driving and skilled tasks
Dizziness may affect performance of skilled tasks (e.g.
driving).
lMEDICINAL FORMS
There can be variation in the licensing of different medicines containing the same drug.
Capsule
▶Alverine citrate (Non-proprietary)
Alverine citrate 60 mgAlverine60mg capsules|100capsulep
£19.49DT price = £19.48
Alverine citrate 120 mgAlverine120mg capsules|60capsulep
£23.30DT price = £23.11
▶Audmonal(Auden McKenzie (Pharma Division) Ltd)
Alverine citrate 60 mgAudmonal60mg capsules|100capsulep
£14.80DT price = £19.48
Alverine citrate 120 mgAudmonal Forte120mg capsules| 60capsulep £17.75DT price = £23.11
▶Spasmonal(Meda Pharmaceuticals Ltd)
Alverine citrate 60 mgSpasmonal60mg capsules|100capsulep
£16.45DT price = £19.48
Alverine citrate 120 mgSpasmonal Forte120mg capsules| 60capsulep £19.42DT price = £23.11
Mebeverine hydrochloride
lINDICATIONS AND DOSE
Adjunct in gastro-intestinal disorders characterised by smooth muscle spasm
▶BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶Child 3 years:25mg3times a day, dose preferably taken20minutes before meals
▶Child 4–7 years:50mg3times a day, dose preferably taken20minutes before meals
▶Child 8–9 years:100mg3times a day, dose preferably taken20minutes before meals
▶Child 10–17 years:135–150mg3times a day, dose preferably taken20minutes before meals Irritable bowel syndrome
▶BY MOUTH USING MODIFIED-RELEASE MEDICINES
▶Child 12–17 years:200mg twice daily
lUNLICENSED USETablets and liquidnot licensed for use in children under10years.Granulesnot licensed for use in children under12years.Modified-release capsulesnot licensed for use in children under18years.
lCONTRA-INDICATIONSParalytic ileus
lSIDE-EFFECTSAllergic reactions
.
angioedema.
rash.
urticaria
lPREGNANCYNot known to be harmful—manufacturers advise avoid.
lBREAST FEEDINGManufacturers advise avoid—no information available.
lPATIENT AND CARER ADVICE
Medicines for Children leaflet: Mebeverine for intestinal spasm www.medicinesforchildren.org.uk/mebeverine-for-intestinal-spasms
Patients or carers should be given advice on the timing of administration of mebeverine hydrochloride tablets and oral suspension.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines containing the same drug.
Tablet
▶Mebeverine hydrochloride (Non-proprietary)
Mebeverine hydrochloride 135 mgMebeverine135mg tablets| 15tabletP £4.50|100tabletP£20.00DT price = £7.59
▶Colofac(BGP Products Ltd)
Mebeverine hydrochloride 135 mgColofac135mg tablets| 100tabletP£9.02DT price = £7.59
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Modified-release capsule CAUTIONARY AND ADVISORY LABELS25
▶Colofac MR(BGP Products Ltd)
Mebeverine hydrochloride 200 mgColofac MR200mg capsules| 60capsuleP£6.92DT price = £6.92
Oral suspension
▶Mebeverine hydrochloride (Non-proprietary)
Mebeverine hydrochloride (as Mebeverine pamoate) 10 mg per 1 mlMebeverine50mg/5ml oral suspension sugar free sugar-free| 300mlP£163.43DT price = £163.43