BNF for Children (BNFC) 2018-2019

of accidental exposure is recommended, such as food and
drinks to avoid, ensuring adequate nutritional intake, and
interpreting food labels. For children in whom elimination
diets might affect growth, a consultation with a nutritionist
is recommended to identify alternative dietary sources.h

Drug treatment

gThere is low quality evidence to support the use of
antihistamines to treat acute,non-life-threatening
symptoms (such asflushing and urticaria) if accidental
ingestion of allergenic food has occurred (seeAntihistamines,
under Antihistamines, allergen immunotherapy and allergic
emergencies p. 171 ). Chlorphenamine maleate p. 178 is
licensed for the symptomatic control of food allergy. In case
of food-induced anaphylaxis, adrenaline/epinephrine p. 136
is thefirst-line immediate treatment (see alsoAllergic
emergencies, under Antihistamines, allergen immunotherapy
and allergic emergencies p. 171 ). Carers and children (of an
appropriate age) who are at risk of anaphylaxis should be
trained to use self-injectable adrenaline/epinephrine.h

Cow’s milk allergy

gParents of infants with suspected allergy to cow’s milk
should be informed about the most appropriate
hypoallergenic formula or milk substitute. Cow’s milk
avoidance is recommended for the mothers of breast-fed
infants who have cow’s milk allergy. Children who are
allergic to milk should receive alternative dietary sources of
calcium and vitamin D.h

Useful Resources

Food allergy in under 19 s: assessment and diagnosis.
National Institute for Health and Care Excellence. Clinical
guideline 116. February 2011
http://www.nice.org.uk/guidance/cg 116

6 Gastro-intestinal smooth

muscle spasm

Antispasmodics

Antimuscarinics

The intestinal smooth muscle relaxant properties of
antimuscarinic and other antispasmodic drugs may be useful
inirritable bowel syndrome.
Antimuscarinics (formerly termed‘anticholinergics’)
reduce intestinal motility. They are occasionally used for the
management ofirritable bowel syndrome.
Antimuscarinics that are used for gastro-intestinal smooth
muscle spasm includes the tertiary amine dicycloverine
hydrochloride below and the quaternary ammonium
compounds propantheline bromide p. 63 and hyoscine
butylbromide p. 62. The quaternary ammonium compounds
are less lipid soluble than atropine and are less likely to cross
the blood-brain barrier; they are also less well absorbed from
the gastro-intestinal tract.
Dicycloverine hydrochloride, may also have some direct
action on smooth muscle. Hyoscine butylbromide is
advocated as a gastro-intestinal antispasmodic, but it is
poorly absorbed; the injection may be useful in endoscopy
and radiology.
Other indications for antimuscarinic drugs include asthma
and airways disease, motion sickness, urinary frequency and
enuresis, mydriasis and cycloplegia, premedication,
palliative care and as an antidote to organophosphorus
poisoning.

Other antispasmodics

Alverine citrate p. 63 , mebeverine hydrochloride p. 63 , and

peppermint oil p. 35 are believed to be direct relaxants of

intestinal smooth muscle and may relieve pain inirritable

bowel syndrome, andprimary dysmenorrhoea. They have no

serious adverse effects but, like all antispasmodics, should be

avoided in paralytic ileus.

Motility stimulants

Domperidone is a dopamine receptor antagonist which

stimulates gastric emptying and small intestinal transit, and

enhances the strength of oesophageal sphincter contraction.

The MHRA/CHM has issued restrictions on its use because

domperidone is associated with a small increased risk of

serious cardiac side effects.

A low dose of erythromycin p. 331 stimulates gastro-

intestinal motility and may be used on the advice of a

paediatric gastroenterologist to promote tolerance of enteral

feeds; erythromycin may be less effective as a prokinetic

drug in preterm neonates than in older children.

ANTIMUSCARINICS

eiiiiF 489

Dicycloverine hydrochloride

(Dicyclomine hydrochloride)

lINDICATIONS AND DOSE

Symptomatic relief of gastro-intestinal disorders

characterised by smooth muscle spasm

▶BY MOUTH

▶Child 6–23 months: 5 – 10 mg 3 – 4 times a day, dose to be

taken 15 minutes before feeds

▶Child 2–11 years: 10 mg 3 times a day

▶Child 12–17 years: 10 – 20 mg 3 times a day

lCONTRA-INDICATIONSChild under 6 months

lINTERACTIONS→Appendix 1 : dicycloverine

lSIDE-EFFECTSAppetite decreased.fatigue.sedation.

thirst

lPREGNANCYNot known to be harmful; manufacturer

advises use only if essential.

lBREAST FEEDINGAvoid—present in milk; apnoea reported

in infant.

lEXCEPTIONS TO LEGAL CATEGORYDicycloverine

hydrochloride can be sold to the public provided that max.

single dose is 10 mg and max. daily dose is 60 mg.

lMEDICINAL FORMS

There can be variation in the licensing of different medicines

containing the same drug.

Oral solution

▶Dicycloverine hydrochloride (Non-proprietary)

Dicycloverine hydrochloride 2 mg per 1 mlDicycloverine

10 mg/ 5 ml oral solution| 120 mlP£ 196. 36 DT = £ 179. 73

Tablet

▶Dicycloverine hydrochloride (Non-proprietary)

Dicycloverine hydrochloride 10 mgDicycloverine 10 mg tablets|

100 tabletP£ 201. 22 DT = £ 184. 25

Dicycloverine hydrochloride 20 mgDicycloverine 20 mg tablets|

84 tabletP£ 203. 42 DT = £ 196. 69

BNFC 2018 – 2019 Gastro-intestinal smooth muscle spasm 61

Gastro-intestinal system

1