From the Guidelines
Antispasmodics, such as mebeverine (135mg three times daily) or pinaverium bromide (50-100mg three times daily), are the most effective medications for treating gastrointestinal spasms, as they have been shown to reduce global symptoms and abdominal pain in patients with irritable bowel syndrome (IBS) 1.
Treatment Options
Several medications are commonly used to treat gastrointestinal spasms, with the choice depending on symptom severity and underlying cause.
- Antispasmodics like dicyclomine (10-20mg orally four times daily) and hyoscyamine (0.125-0.25mg every 4 hours as needed) work by relaxing smooth muscle in the digestive tract.
- Peppermint oil capsules (0.2-0.4mL three times daily) are a natural option that relaxes GI muscles through calcium channel effects.
- For more severe spasms, prescription medications such as mebeverine (135mg three times daily) or pinaverium bromide (50-100mg three times daily) may be prescribed.
- Tricyclic antidepressants like amitriptyline (10-50mg at bedtime) can help at low doses by affecting pain perception.
Mechanism of Action
These medications work by targeting different aspects of gut motility and pain signaling pathways.
- Antispasmodics reduce intestinal motility, whereas alverine and mebeverine are direct-acting intestinal smooth muscle relaxants.
- The proposed mechanism of action of these agents is based on the assumption that some IBS symptoms are a result of gastrointestinal spasm and dysmotility, which antispasmodics ameliorate 1.
Treatment Duration and Side Effects
Treatment typically continues for 4-8 weeks before reassessing effectiveness.
- Patients should be aware that side effects may include dry mouth, constipation, drowsiness, or blurred vision, and should avoid alcohol while taking these medications as it may enhance sedative effects.
- A recent study published in 2023 found that the efficacy of all drugs for the treatment of IBS is modest, and complete symptom resolution is often not achievable 1.
Recent Guidelines
The British Society of Gastroenterology guidelines on the management of irritable bowel syndrome recommend the use of antispasmodics as first-line treatment for IBS, with other medications such as eluxadoline and rifaximin being used as second-line treatments 1.
- However, the availability of these medications may vary depending on the country and region.
- It is essential to consider the patient's individual needs and medical history when selecting a treatment option.
From the FDA Drug Label
Dicyclomine relieves smooth muscle spasm of the gastrointestinal tract Animal studies indicate that this action is achieved via a dual mechanism: a specific anticholinergic effect (antimuscarinic) at the acetylcholine-receptor sites with approximately 1/8 the milligram potency of atropine and a direct effect upon smooth muscle (musculotropic) as evidenced by dicyclomine’s antagonism of bradykinin- and histamine-induced spasms of the isolated guinea pig ileum.
Medications for GI spasms include:
- Dicyclomine, which works by relieving smooth muscle spasm of the gastrointestinal tract through a dual mechanism of anticholinergic and direct musculotropic effects 2. Key words:
- Anticholinergic effect
- Musculotropic effect
- Gastrointestinal tract
- Smooth muscle spasm
From the Research
Medications for GI Spasms
The following medications are used to treat gastrointestinal (GI) spasms:
- Antispasmodics such as dicyclomine 3, 4
- Antidepressants like amitriptyline, trimipramine, desipramine, citalopram, fluoxetine, and paroxetine 3
- Loperamide for diarrhea-predominant symptoms 3, 5, 4
- Lubiprostone and linaclotide for constipation-predominant symptoms 3, 5, 6
- Peppermint oil for abdominal pain 3, 4
- Rifaximin for diarrhea-predominant symptoms 3, 5, 6
- Eluxadoline, a mu opioid receptor agonist and delta antagonist, for diarrhea-predominant symptoms 5, 6
Novel Pharmacological Therapies
Novel pharmacological therapies for irritable bowel syndrome (IBS) include:
- Plecanatide, ibudutant, and ebastine, which are currently in development 5
- Prucalopride, elobixibat, mesalazine, ondansetron, and colesevelam, which have potential applications in IBS 5, 6
- JNJ-27018966, a dual μ-opioid receptor agonist and δ-opioid antagonist, which is being investigated for the treatment of IBS 3
Gut-Directed Therapies
Gut-directed therapies for IBS include:
- Fiber supplementation, such as ispaghula, calcium polycarbophil, and psyllium 4
- Polyethylene glycol for constipation-predominant symptoms 4
- Tegaserod, a 5-HT(4) agonist, for constipation-predominant symptoms 4
- Probiotics, which may have efficacy in reducing symptoms, although the quality of trials is often suboptimal 6