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CHOLECYSTOKININ RECEPTOR AGENTS
Drugs acting at the cholecystokinin receptor may also be useful in acute
treatment of BTP. Ceruletide (1 ng/kg IV or 0.5 μg/kg IM) provides more
analgesia than placebo and compares favorably with pentacozine (0.5 mg/kg
IM) in efficacy and side effects. 19–21 Preliminary evidence indicates that the
cholecystokinin-1 receptor antagonist loxiglumide (50 mg IV) relieves BTP
faster and more effectively than scopolamine (hyoscine; 20 mg IV). 20 Data for
the cholecystokinin receptor agents are promising, but it is premature to
endorse use of these agents in the ED setting.
SPASMOLYTICS/ANTICHOLINERGICS
Spasmolytic and anticholinergic drugs have been investigated as treatment for
biliary colic. A large placebo-controlled trial assessing three dosing levels of
pargeverine (propinoxate) found pain relief (and no significant side effects)
after IV administration of either 20 mg or 30 mg of the mandelic acid derivative. 22
The analgesic/spasmolytic metamizole (2.5 g IV) fared well in a doubleblinded
trial comparing its efficacy with that of tramadol (100 mg IV) or the
pure spasmolytic butylscopolamine (hyoscine butylbromide; 20 mg IV). 23
Metamizole (not available in the USA owing to bone marrow risks) is significantly
more effective than both tramadol and butylscopolamine at reducing
pain and preventing need for rescue medication; it also has the shortest onset
time (about 10 min).
A study assessing glycopyrrolate (glycopyrronium bromide) for ED therapy
of biliary colic found no benefit over placebo. 24
CALCIUM CHANNEL BLOCKERS
Biliary tract pain 113
Calcium channel blockers are known to relax biliary tract smooth muscle.
For BTP, the most potent agent in this class appears to be nifedipine. 25 There
is currently insufficient evidence to support use of nifedipine for acute treatment
of BTP, and its outpatient efficacy is hindered by suboptimal pain relief
and frequent headache. 26