From the Guidelines
Antispasmodics should be used in patients with irritable bowel syndrome to reduce abdominal pain, as they have been shown to provide adequate global relief of IBS symptoms and improvement in abdominal pain compared to placebo 1. The use of antispasmodics in clinical practice is supported by a Cochrane Review that included 22 RCTs evaluating 2983 patients with IBS, which found that antispasmodics were effective in reducing abdominal pain and improving IBS symptoms 1. Some of the antispasmodics that can be used include:
- Hyoscine
- Dicyclomine
- Peppermint oil These medications work by reducing smooth muscle contraction and possibly visceral hypersensitivity, thereby relieving IBS symptoms 1. It is essential to note that the overall certainty in evidence is low due to the serious risk of bias and publication bias, and the effect of individual antispasmodics is difficult to interpret due to the small number of studies evaluated for each of the drugs 1. Common adverse events reported with antispasmodics include dry mouth, dizziness, and blurred vision, but no serious adverse events were reported 1. In clinical practice, antispasmodics can be used to reduce abdominal pain associated with IBS, and their use should be considered alongside dietary modifications and other treatment options 1.
From the FDA Drug Label
The data described below reflect exposure in controlled clinical trials involving over 100 patients treated for functional bowel/irritable bowel syndrome with dicyclomine hydrochloride at initial doses of 160 mg daily (40 mg four times a day).
Gastrointestinal Disorders: abdominal distension, abdominal pain, constipation, dry mouth, dyspepsia, nausea, vomiting
Dicyclomine is used to treat abdominal pain associated with irritable bowel syndrome. The drug has been shown to be effective in reducing symptoms of abdominal pain in clinical trials 2. However, it is essential to note that the medication can cause anticholinergic side effects, such as dry mouth, dizziness, and blurred vision.
- Key benefits: relief from abdominal pain and other symptoms of irritable bowel syndrome
- Key risks: anticholinergic side effects, such as dry mouth, dizziness, and blurred vision It is crucial to weigh the potential benefits and risks of using dicyclomine for abdominal pain and to consult a healthcare professional for proper evaluation and treatment 2.
From the Research
Antispasmodics for Abdominal Pain
- Antispasmodic agents are used to treat abdominal pain caused by intestinal smooth muscle spasms and intestinal functional disorders in the course of irritable bowel syndrome (IBS) 3, 4, 5.
- Mebeverine is an antispasmodic agent that has been shown to be effective in reducing abdominal pain in patients with IBS, with a good safety profile and low frequency of adverse effects 4.
- Other antispasmodic agents, such as hyoscyamine, have been found to have varying degrees of efficacy and safety in treating chronic abdominal pain 5, 6.
- Hyoscine butylbromide is an antispasmodic drug that has been used to treat abdominal cramping and pain, with a high affinity for muscarinic receptors located on the smooth-muscle cells of the GI tract 7.
Efficacy of Antispasmodics
- Studies have shown that mebeverine can significantly decrease abdominal pain in patients with IBS, with p-values ranging from <0.05 to <0.001 4.
- Hyoscine butylbromide has been found to be beneficial in treating abdominal pain caused by cramping, with a local spasmolytic effect 7.
- Antispasmodic agents, such as dicyclomine and hyoscyamine, have not been proven effective in reducing abdominal pain in patients with IBS 3.
Safety of Antispasmodics
- Mebeverine has been found to have a good safety profile, with rare adverse events associated mainly with IBS symptoms 4.
- Hyoscine butylbromide is generally well tolerated, with few adverse events reported, and no significant increases in the incidence of anticholinergic-related adverse effects 7.
- Other antispasmodic agents, such as hyoscyamine, have been found to have varying degrees of safety, with some studies reporting adverse events such as nausea and dry mouth 5, 6.