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Irritable bowel syndrome - Management
Which antispasmodic should I prescribe?
- There is little difference in efficacy between different antispasmodics.
- Antimuscarinics more are likely to cause adverse effects than direct-acting smooth muscle relaxants or peppermint oil.
- Direct-acting smooth muscle relaxants, such as mebeverine and alverine, have some selectivity for smooth intestinal muscle and have relatively few adverse effects.
- Peppermint oil has antispasmodic properties and directly relaxes gastrointestinal smooth muscle.
- Antimuscarinics (anticholinergics) such as hyoscine butylbromide and dicycloverine are poorly selective and are likely to cause antimuscarinic adverse effects.
- There is good evidence that standard-release and modified-release mebeverine are equally effective.
- CKS recommends mebeverine, alverine citrate, and therapeutic peppermint oil.
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