From the Guidelines
Alternatives to hyoscyamine for managing abdominal spasms include antispasmodic medications like dicyclomine and glycopyrrolate, as well as smooth muscle relaxants such as mebeverine and peppermint oil capsules. The most recent and highest quality study, published in 2022 1, suggests that antispasmodics can be effective in reducing abdominal pain associated with irritable bowel syndrome (IBS). Some key alternatives to hyoscyamine are:
- Antispasmodic medications:
- Dicyclomine (10-20mg orally four times daily)
- Glycopyrrolate (1-2mg orally three times daily)
- Smooth muscle relaxants:
- Mebeverine (135mg three times daily)
- Peppermint oil capsules (0.2-0.4ml three times daily)
- Calcium channel blockers:
- Pinaverium (50-100mg three times daily)
- Otilonium bromide (40mg three times daily) For patients with IBS-predominant symptoms, antidepressants including low-dose tricyclics (amitriptyline 10-25mg at bedtime) or SSRIs (citalopram 10-20mg daily) can help by modulating pain perception and gut motility through central and peripheral mechanisms, as noted in a study published in 2021 1. Non-pharmacological approaches like heat therapy, dietary modifications (avoiding trigger foods), stress reduction techniques, and regular physical activity can complement medication therapy. Treatment selection should consider the underlying cause of spasms, symptom severity, and individual tolerance to side effects, with anticholinergic alternatives being particularly important for patients with glaucoma, urinary retention, or cognitive sensitivity, as discussed in a guideline published in 2021 1 and another in 2021 1.
From the Research
Alternatives to Hyoscyamine for Managing Abdominal Spasms
Alternatives to hyoscyamine, an anticholinergic agent, for managing abdominal spasms include:
- Dicyclomine, another anticholinergic agent, which has been shown to be effective in reducing abdominal pain in patients with irritable bowel syndrome (IBS) 2, 3
- Mebeverine, an antispasmodic agent, which has been found to be effective in reducing abdominal pain and improving bowel habits in patients with IBS 4
- Peppermint oil, which has been suggested to be effective in reducing abdominal pain in patients with IBS, although the evidence is debated 5
- Peripherally acting opiates, which have been suggested to be effective in reducing abdominal pain in patients with IBS 5
Pharmacologic Agents for IBS-Associated Pain
Pharmacologic agents used to treat IBS-associated pain include:
- Myorelaxants, such as dicyclomine and hyoscyamine, although their effectiveness has not been proven in reducing abdominal pain in patients with IBS 5
- Antidiarrheal agents, such as loperamide, which can be effective in reducing diarrhea in patients with IBS, but not abdominal pain 2, 5
- 5-HT(4) agonists, such as tegaserod, which have been shown to be effective in improving bowel frequency and stool consistency, and alleviating abdominal pain and bloating in women with constipation-predominant IBS 5
- Tricyclic antidepressants, which have been found to be effective in reducing chronic visceral pain in patients with IBS 2
Non-Pharmacologic Interventions
Non-pharmacologic interventions, such as:
- Dietary modifications, which can help alleviate symptoms of IBS 2
- Behavioral strategies, such as relaxation techniques and hypnosis, which can help reduce stress and alleviate symptoms of IBS 2
- Alternative therapies, such as biofeedback and acupuncture, which may be beneficial for patients who do not respond to conventional treatments 2