ANTISPASMOTICS - Bowel spasm / cramping / IBS / Hypermotility

Dicyclomine (Bentyl ®)	Donnatal Extentabs®
Propantheline (Pro-Banthine ®)	Simethicone (Mylicon ®)
hyoscyamine (Levsin ®)	Librax (clininium 2.5 mg + chlordiazepoxide 5 mg):
tegaserod (Zelnorm ®)	Bellergal-S

Dicyclomine (Bentyl ®)

Mechanism of Action
Blocks the action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands and the CNS

Use
Treatment of functional disturbances of GI motility such as irritable bowel syndrome

Dosing (Adult): Usual: 10-20 mg orally or IM four times daily (up to 40 mg orally four times daily).
[DO NOT GIVE IV]

Supplied
Capsule, as hydrochloride: 10 mg
Injection, solution, as hydrochloride: 10 mg/mL (2 mL)
Syrup, as hydrochloride: 10 mg/5 mL (480 mL)
Tablet, as hydrochloride: 20 mg

Donnatal Extentabs®

INDICATIONS: Based on a review of this drug by the National Academy of Sciences - National Research Council and/or other information, FDA has classified the following indications as "possibly" effective: For use as adjunctive therapy in the treatment of irritable bowel syndrome (irritable colon, spastic colon, mucous colitis) and acute enterocolitis. May also be useful as adjunctive therapy in the treatment of duodenal ulcer. IT HAS NOT BEEN SHOWN CONCLUSIVELY WHETHER ANTICHOLINERGIC /ANTISPASMODIC DRUGS AID IN THE HEALING OF A DUODENAL ULCER, DECREASE THE RATE OF RECURRENCES OR PREVENT COMPLICATIONS.

Dosing (Adult): Usual: The dosage of Donnatal Extentabs® should be adjusted to the needs of the individual patient to assure symptomatic control with a minimum of adverse reactions. The usual dose is one tablet every twelve (12) hours. If indicated, one tablet every eight (8) hours may be given.

Supplied:
Donnatal Extentabs® Tablets:
Each Donnatal Extentabs® tablet contains:
Phenobarbital, USP (3/4 gr.)..................48.6 mg
Hyoscyamine Sulfate, USP.....................0.3111 mg
Atropine Sulfate, USP.........................0.0582 mg
Scopolamine Hydrobromide, USP..................0.0195 mg

Propantheline (Pro-Banthine ®)

Dosing (Adult): Usual: 7.5 to 15 mg orally 30 minutes before meals and at bedtime.

Supplied: [7.5, 15mg tablets]

Simethicone (Mylicon ®)

Brand Names: Mylanta Gas, Gas Relief, Gas-X, Major-Con, Phazyme, Flatulex, Mylicon, Maalox Anti-Gas.
INDICATIONS: used to relieve symptoms of extra gas such as belching, bloating, and feelings of pressure/discomfort in the stomach/gut.

Mechanism of Action: Decreases the surface tension of gas bubbles thereby disperses and prevents gas pockets in the GI system

Dosage - Oral:
Infants: 20 mg 4 times/day
Children <12 years: 40 mg 4 times/day
Children >12 years and Adults: 40-120 mg after meals and at bedtime as needed, not to exceed 500 mg/day

Supplied
Softgels:
Alka-Seltzer® Gas Relief, Gas-X® Extra Strength, Mylanta® Gas Maximum Strength: 125 mg
Phazyme® Ultra Strength: 180 mg

Suspension, oral drops: 40 mg/0.6 mL (30 mL)
Drops: Mylicon® Infants: 40 mg/0.6 mL (30 mL) [alcohol free; contains sodium benzoate; available in a non-staining formula]

Tablet, chewable: 80 mg, 125 mg
Mylanta® Gas Extra Strength: 125 mg [cherry and mint flavors]
Phazyme® Quick Dissolve: 125 mg [contains 0.4 mg phenylalanine (as aspartame)/tablet; mint flavor]

hyoscyamine (Levsin ®)

Conventional hyoscyamine tablets may be administered orally or sublingually.
Dosing (Adult): The usual dose is 1 to 2 tablets (0.125 to 0.25 milligram) every 4 hours or as needed. No more than 12 tablets should be ingested per 24 hours.

(Sustained-release): 1 to 2 capsules or tablets (0.375 to 0.75 milligram) every 12 hours; the dose may be adjusted to 1 capsule every 8 hours if needed. The tablets are scored so that they may be broken to allow for easier titration of dose. Do not exceed 4 sustained-released capsules or tablets per 24 hours.

(Hyoscyamine Drops): 1 to 2 milliliters (0.125 to 0.25 milligram) every 4 hours or as needed; do not exceed 12 milliliters/24 hours.

(Hyoscyamine Elixir): 5 to 10 milliliters (0.125 to 0.25 milligram) every 4 hours or as needed - do not exceed 60 ml/24 hours. Hypermotility of the lower urinary tract: 1 to 2 tablets (0.15 to 0.3 mg) 4 times daily or fewer if possible.

[Supplied: 0.125 mg/5 ml elixir; 0.375 mg extended release cap/Tablet; 0.5 mg/ml solution for injection; 0.125 mg SL Tab]

Librax (clininium 2.5 mg + chlordiazepoxide 5 mg):

Librax (clininium 2.5 mg + chlordiazepoxide 5 mg):
Adults:
Adjunct treatment of peptic ulcer; treatment of IBS:
1-2 capsules 3-4 times/day (before meals and at bedtime).

tegaserod (Zelnorm ®)

INDICATIONS
IBS with Constipation: Zelnorm® (tegaserod maleate) is indicated for the short-term treatment of women with irritable bowel syndrome (IBS) whose primary bowel symptom is constipation. The safety and effectiveness of Zelnorm in men with IBS with constipation have not been established.

Chronic Idiopathic Constipation: Zelnorm® (tegaserod maleate) is indicated for the treatment of patients less than 65 years of age with chronic idiopathic constipation. The effectiveness of Zelnorm in patients 65 years or older with chronic idiopathic constipation has not been established (see Geriatric Use). The efficacy of Zelnorm for the treatment of IBS with constipation or chronic idiopathic constipation has not been studied beyond 12 weeks.

DOSAGE AND ADMINISTRATION:
IBS with Constipation: The recommended dosage of Zelnorm® (tegaserod maleate) is 6 mg taken twice daily orally before meals for 4 to 6 weeks. For those women who respond to therapy at 4-6 weeks, an additional 4-6 week course can be considered.

Chronic Idiopathic Constipation: The recommended dosage of Zelnorm is 6 mg taken twice daily orally before meals. Physicians and patients should periodically assess the need for continued therapy.

Supplied: [2, 6mg tablets]

OTHER

Bellergal-S

(phenobarbitol 40 mg + belladonna 0.2mg +ergotamine 0.6mg)

Adults:
Menopausal disorders, recurrent headaches, other: 1 tablet twice daily (in the morning and at bedtime).

Disclaimer

Listed dosages are for - Adult patients ONLY. PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon.

David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc.

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