UK Clinical Pharmacy Association


Issues for surgery

For irritable bowel syndrome, smooth muscle spasm, dysmenorrhoea – loss of symptomatic relief if omitted.

Advice in the perioperative period

Elective and emergency surgery 


Post-operative advice

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

Review alverine citrate if patient develops reduced gastrointestinal motility (e.g. ileus) post-operatively.

Interactions with common anaesthetic agents


Interactions with other common medicines used in the perioperative period


Further information

Uncontrolled reflux

Peppermint oil may exacerbate heartburn and reflux, potentially by reducing the tone of the lower oesophageal sphincter. Peppermint has a local rather than systemic action so use of enteric coated formulations should minimise this effect as release will be delayed until later in the gastro-intestinal tract.

Administration advice

Peppermint oil capsules should not be chewed or broken since this would release the peppermint oil prematurely, possibly causing local irritation of the mouth and oesophagus.


Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press.

Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. [Accessed on 7th March 2021]

Summary of Product Characteristics – Spasmonal® (alverine citrate) 60mg Hard Capsules. Mylan. Accessed via 07/03/2021 [date of revision of the text February 2018]