BNF for Children 2011-2012

40 1.2 Antispasmodics and other drugs altering gut motility BNFC 2011–20121 Gastro-intestinal systemHYOSCINE BUTYLBROMIDECautions see notes above; also intestinal and urinaryoutlet obstructionContra-indications see notes abovePregnancy manufacturer advises use only if potentialbenefit outweighs riskBreast-feeding amount too small to be harmfulSide-effects see notes aboveLicensed use tablets not licensed for use in childrenunder 6 years; injection not licensed for use inchildren (age range not specified by manufacturer)Indication and doseSymptomatic relief of gastro-intestinal or genito-urinarydisorders characterised by smoothmuscle spasm. By mouthChild 6–12 years 10 mg 3 times dailyChild 12–18 years 20 mg 4 times dailyExcessive respiratory secretions and bowelcolic in palliative care (see also p. 20). By mouthChild 1 month–2 years 300–500 micrograms/kg(max. 5 mg) 3–4 times dailyChild 2–5 years 5 mg 3–4 times dailyChild 5–12 years 10 mg 3–4 times dailyChild 12–18 years 10–20 mg 3–4 times daily. By intramuscular or intravenous injectionChild 1 month–4 years 300–500 micrograms/kg(max. 5 mg) 3–4 times dailyChild 5–12 years 5–10 mg 3–4 times dailyChild 12–18 years 10–20 mg 3–4 times dailyAcute spasm, spasm in diagnostic procedures. By intramuscular or intravenous injectionChild 2–6 years 5 mg repeated after 30 minutes ifnecessary (may be repeated more frequently inendoscopy), max. 15 mg dailyChild 6–12 years 5–10 mg repeated after 30minutes if necessary (may be repeated more frequentlyin endoscopy), max. 30 mg dailyChild 12–18 years 20 mg repeated after 30 minutesif necessary (may be repeated more frequentlyin endoscopy), max. 80 mg dailyAdministration for intravenous injection, may bediluted with Glucose 5% or Sodium Chloride 0.9%;give over at least 1 minute.For administration by mouth, injection solution maybe used; content of ampoule may be stored in arefrigerator for up to 24 hours after openingBuscopan c (Boehringer Ingelheim) ATablets, coated, hyoscine butylbromide 10 mg, netprice 56-tab pack = £2.25Note Hyoscine butylbromide tablets can be sold to the publicfor medically confirmed irritable bowel syndrome, providedsingle dose does not exceed 20 mg, daily dose does notexceed 80 mg, and pack does not contain a total of more than240 mgInjection, hyoscine butylbromide 20 mg/mL. Netprice 1-mL amp = 22pPROPANTHELINE BROMIDECautions see notes aboveContra-indications see notes aboveHepatic impairment manufacturer advises cautionRenal impairment manufacturer advises cautionPregnancy manufacturer advises avoid unless essentialBreast-feeding may suppress lactationSide-effects see notes aboveLicensed use tablets not licensed for use in childrenunder 12 yearsIndication and doseSymptomatic relief of gastro-intestinal disorderscharacterised by smooth muscle spasm. By mouthChild 1 month–12 years 300 micrograms/kg(max. 15 mg) 3–4 times daily at least one hourbefore foodChild 12–18 years 15 mg 3 times daily at leastone hour before meals and 30 mg at night (max.120 mg daily)Pro-Banthine c (Archimedes) ATablets, pink, s/c, propantheline bromide 15 mg, netprice 112-tab pack = £14.40. Label: 23Extemporaneous formulations available seeExtemporaneous Preparations, p. 6Other antispasmodicsAlverine, mebeverine, and peppermint oil arebelieved to be direct relaxants of intestinal smoothmuscle and may relieve pain in irritable bowelsyndrome and primary dysmenorrhoea. They have noserious adverse effects; peppermint oil occasionallycauses heartburn.ALVERINE CITRATEContra-indications paralytic ileusPregnancy use with cautionBreast-feeding manufacturer advises avoid—limitedinformation availableSide-effects nausea; headache, dizziness; pruritus,rash; hepatitis also reportedIndication and doseAdjunct in gastro-intestinal disorders characterisedby smooth muscle spasm, dysmenorrhoea. By mouthChild 12–18 years 60–120 mg 1–3 times dailySpasmonal c (Norgine)Capsules, alverine citrate 60 mg (blue/grey), netprice 100-cap pack = £9.47; 120 mg (Spasmonal cForte, blue/grey), 60-cap pack = £10.94MEBEVERINE HYDROCHLORIDECautions avoid in acute porphyria (section 9.8.2)Contra-indications paralytic ileusPregnancy not known to be harmful—manufacturersadvise cautionSide-effects allergic reactions (including rash, urticaria,angioedema) reported