Issues for surgery
For irritable bowel syndrome, smooth muscle spasm, adult enuresis or hyperhidrosis – loss of symptomatic relief if omitted.
Advice in the perioperative period
Elective surgery
Continue.
Except:
- Kolanticon® (dicycloverine + aluminium hydroxide + magnesium oxide + simeticone) – see Antacids drug records.
Post-operative advice
Resume post-operatively, if needed, once enteral intake resumed.
Review if patient develops reduced gastrointestinal motility (e.g. ileus) post-operatively.
Review appropriateness of continuing treatment if patient develops post-operative delirium.
Interactions with common anaesthetic agents
Antimuscarinic action
Antimuscarinic action may be additive with agents that also have antimuscarinic effects such as atropine and glycopyrronium.
Interactions with other common medicines used in the perioperative period
Delayed gastric emptying
Antimuscarinics delay gastric emptying which may alter the absorption of concomitantly administered medication.
Paracetamol
Propantheline reduces the rate, but not the extent, of paracetamol absorption; other antimuscarinic drugs would be expected to interact similarly. The clinical relevance of this interaction is not known but is likely that a delay in absorption may reduce the rapid pain relief from a single dose of paracetamol but have little impact on repeated dosing.
Prokinetics
Due to the effect of antimuscarinics on gastro-intestinal motility the effectiveness of prokinetic agents, e.g. metoclopramide may be reduced.
Antimuscarinic action
Antiemetics
Antimuscarinic action may be additive with antiemetics that also have antimuscarinic effects such as cyclizine, haloperidol, levomepromazine or prochlorperazine.
Nefopam
Antimuscarinic action may be additive with nefopam which also has antimuscarinic effects.
Further information
None relevant.
References
Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. https://about.medicinescomplete.com/ [Accessed on 14th March 2021]
Summary of Product Characteristics – Pro-Banthine® (propantheline) tablets. Kyowa Kirin Ltd. Accessed via www.medicines.org.uk 14/03/2021 [date of revision of the text October 2018]
Summary of Product Characteristics – Buscopan® (hyoscine butylbromide) 10mg Tablets. SANOFI. Accessed via www.medicines.org.uk 14/03/2021 [date of revision of the text April 2020]
Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. https://about.medicinescomplete.com/ [Accessed on 14th March 2021]