Gastrointestinal smooth muscle spasm

Acute or episodic spasmodic abdominal pain in functional disorders (IBS), intestinal infections, biliary or renal colic. NICE NG61 (2017) and WGO 2023 set spasmolytics (hyoscine butylbromide, otilonium bromide, mebeverine) as first-line for functional spasmodic pain in short courses. With severe acute pain suggestive of surgical pathology (appendicitis, perforation), spasmolytics are withheld until the diagnosis is ruled out.

ICD-10 R10.42 drugs

Also known as: Intestinal colic, Abdominal cramping

Drugs used for this condition

BHyoscine butylbromideFirst line · Antispasmodic, quaternary ammonium belladonna alkaloidFirst-line for acute functional spasmodic abdominal pain per NICE NG61 (2017) and WGO 2023. Dose 10–20 mg 3–4 times daily orally or 20 mg IM/IV in severe colic. Annaházi 2014 meta-analysis showed moderate efficacy over placebo with low certainty. Short course – usually 1–3 days; persistent pain needs evaluation.

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

DDomperidoneNot recommended · Prokinetic, peripheral dopamine D2 receptor antagonistOff-label use of domperidone as a galactagogue (10–20 mg three times daily) is widespread in breastfeeding forums. Evidence is weak (Asztalos 2017 meta-analysis showed modest milk volume effect without improving feeding outcomes), and maternal QT-prolongation and arrhythmia risk plus potential milk excretion make this use problematic. FDA in 2004 issued a warning against lactation use. In Spain and other EU countries galactagogue is not a registered indication; for insufficient lactation, first-line is latch optimization and lactation-consultant support.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit