Antispasmodics (Antimuscarinics)


Dicycloverine, Hyoscine butylbromide, Propantheline


  Issues for Surgery


For irritable bowel syndrome, smooth muscle spasm, adult enuresis or hyperhidrosis – loss of symptomatic relief if omitted.


  Advice in the Perioperative period


Elective Surgery

Continue.

EXCEPT: -


Post-operative Advice

Resume post-operatively, if needed, once enteral intake resumed.

Review if patient develops reduced gastrointestinal motility (e.g. ileus) post-operatively1, 2, 3.

Review appropriateness of continuing treatment if patient develops post-operative delirium1.


  Interaction(s) with Common Anaesthetic Agents


Antimuscarinic action

Antimuscarinic action may be additive with agents that also have antimuscarinic effects such as atropine and glycopyrronium1, 2, 3.


  Interaction(s) with other Common Medicines used in the Perioperative Period


Delayed Gastric Emptying

Antimuscarinics delay gastric emptying which may alter the absorption of concomitantly administered medication2.

Paracetamol
Propantheline reduces the rate, but not the extent, of paracetamol absorption2, 4; other antimuscarinic drugs would be expected to interact similarly4. The clinical relevance of this interaction is not known but is likely that a delay in absorption may reduce the rapid pain relief from a single dose of paracetamol but have little impact on repeated dosing4.

Prokinetics
Due to the effect of antimuscarinics on gastro-intestinal motility the effectiveness of prokinetic agents e.g. metoclopramide may be reduced2, 3.

 Antimuscarinic action
Antiemetics 
Antimuscarinic action may be additive with antiemetics that also have antimuscarinic effects such as cyclizine, haloperidol, levomepromazine or prochlorperazine1, 2, 3.

Nefopam
Antimuscarinic action may be additive with nefopam which also has antimuscarinic effects1.


  Further Information


Nil relevant.

 

  References


  1. Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. https://about.medicinescomplete.com/ [Accessed on 14th March 2021]
  2. Summary of Product Characteristics – Pro-Banthine® (propantheline) tablets. Kyowa Kirin Ltd. Accessed via www.medicines.org.uk 14/03/2021 [date of revision of the text October 2018]
  3. Summary of Product Characteristics – Buscopan® (hyoscine butylbromide) 10mg Tablets. SANOFI. Accessed via www.medicines.org.uk 14/03/2021 [date of revision of the text April 2020]
  4. Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. https://about.medicinescomplete.com/ [Accessed on 14th March 2021]