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Palliative cancer care - pain - Management
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How should I manage intestinal colic?

  • Consider whether there is a treatable underlying cause:
    • It may be possible to treat certain causes of colicky pain (for example, bowel colic due to constipation) in primary care — see the CKS topic on Palliative cancer care - constipation.
    • However, some causes (for example, bowel obstruction) need specialist management and possibly surgical intervention, provided the person is fit enough for surgery and wants to be admitted.
  • If symptomatic management is appropriate, consider hyoscine butylbromide (an antispasmodic).
  • There is no agreement among experts in terms of dose or route of administration. Suggested doses are:
    • 10–20 mg as a subcutaneous dose as required, repeated 2-hourly, or
    • 40–300 mg as a subcutaneous infusion over 24 hours via a syringe driver.
  • If the oral route is preferred, consider mebeverine 135 mg three times a day.

In depth

Prescriptions

Antimuscarinic: hyoscine butylbromide or mebeverine

Age from 16 years onwards
Hyoscine butylbromide sc inj: 10-20mg when required
Hyoscine butylbromide 20mg/1ml solution for injection ampoules
FOR SUBCUTANEOUS INJECTION. Give 0.5ml (10mg) to 1ml (20mg) as a subcutaneous dose, repeated after 2 hours if required for colic.
Supply 10 1ml ampoules.
Age: from 16 years onwards
NHS cost: £2.03
Licensed use: no
Hyoscine butylbromide sc infusion: 40-300mg over 24 hours
Hyoscine butylbromide 20mg/1ml solution for injection ampoules
FOR CONTINUOUS SUBCUTANEOUS INFUSION. Give 2ml (40mg) to 15ml (300mg) over 24 hours via a syringe driver when required to reduce gastric secretions.
Supply 10 1ml ampoules.
Age: from 16 years onwards
NHS cost: £2.03
Licensed use: no
Mebeverine tablets: 135mg three times a day
Mebeverine 135mg tablets
Take one tablet three times a day, preferably 20 minutes before meals.
Supply 84 tablets.
Age: from 16 years onwards
NHS cost: £10.52
OTC cost: £4.99
Licensed use: yes

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