Gastrointestinal smooth muscle spasm
Muscle spasm involving smooth muscle of the gastrointestinal tract can occur in patients with palliative care needs. This may be associated with functional changes (eg constipation) and lead to pain. Treat the underlying condition, if possible.
To manage pain associated with smooth muscle spasm of the gastrointestinal tract in palliative care, consider combination therapy with an opioid and hyoscine butylbromide. Suitable regimens for a trial of hyoscine butylbromide are:
1hyoscine butylbromide 10 to 20 mg orally, 3 or 4 times daily. If response is inadequate after 3 doses, seek expert advice hyoscine butylbromide
OR
1hyoscine butylbromide 10 to 20 mg subcutaneously, 4-hourly. If response is inadequate after 3 doses, seek expert advice hyoscine butylbromide
OR
1hyoscine butylbromide 60 to 80 mg/24 hours by continuous subcutaneous infusion, adjust to effective dose. If response is inadequate, seek expert advice. Maximum dose 120 mg/24 hours. hyoscine butylbromide
Review therapy and reduce dose to stop when hyoscine butylbromide is no longer needed. If hyoscine butylbromide is ineffective, stop therapy.
If bowel obstruction or constipation is a suspected cause of smooth muscle spasm of the gastrointestinal tract, use caution because hyoscine may worsen pain.