Cambridgeshire and Peterborough Joint Prescribing Group MEDICINE REVIEW
Name of Medicine / Dicycloverine Class (generic and brand) Licensed indication(s) Smooth muscle antispasmodic primarily indicated for treatment of functional conditions involving smooth muscle spasm of the gastrointestinal tract.
Licensed dose(s) Adults: 10-20mg three times daily before or after meals. Children (2-12 years): 10mg three times daily.
Purpose of Document To review information currently available on this class of medicines, give guidance on potential use and assign a prescribing classification http://www.cambsphn.nhs.uk/CJPG/CurrentDrugClassificationTable.aspx
Annual cost (FP10) (July 2017 Drug Tariff) Antispasmodic Annual Cost in Primary Care
Mebeverine (135mg tds) £57 Mebeverine MR (200mg bd) £89 Peppermint Oil (Colpermin®) (1cap tds) £133 Hyoscine Butylbromide (20mg qds) £156 Propantheline (15mg tds) £202 Alverine (60mg tds) £212 Dicycloverine (10mg tds) £2,017 Dicycloverine (20mg tds) £2,563 Dicycloverine 2mg/ml (10mg tds) £8,157
Recommendation It is recommended to Cambridgeshire and Peterborough CCG JPG members and through them to local NHS organisations that the arrangements for use of dicycloverine are in line with restrictions agreed locally for drugs designated as NOT RECOMMENDED:. DO NOT PRESCRIBE DICYCLOVERINE ON THE NHS IN CAMBRIDGESHIRE & PETERBOROUGH Antispasmodics include direct-acting smooth muscle relaxants such as mebeverine, alverine, and peppermint oil, and antimuscarinics such as hyoscine butylbromide, propantheline and dicycloverine. There is insufficient evidence to demonstrate a significant difference in effectiveness between hyoscine, mebeverine, peppermint oil and dicycloverine. Evidence from generally small, heterogeneous studies suggests that antispasmodics improve symptoms of pain, bloating, and bowel habits compared with placebo. There does not appear to be a difference in efficacy between antimuscarinics and smooth muscle relaxants. [CKS 2013] NICE Clinical Guideline (CG61) updated 2017, Irritable bowel syndrome in adults: diagnosis and management ,stated the following interventions were treated as a class of interventions with the same clinical effectiveness as there was insufficient evidence to demonstrate a significant difference in effectiveness between them; hyoscine, mebeverine (standard and slow
release), peppermint oil, dicycloverine and alverine. Antimuscarinics are more likely to cause adverse effects than direct-acting smooth muscle relaxants. Mebeverine and alverine have some selectivity for smooth intestinal muscle and have relatively few adverse effects. However, antimuscarinics such as hyoscine butylbromide and dicycloverine are poorly selective and are likely to cause antimuscarinic adverse effects. Across C&PCCG over £127K is spent on dicycloverine annually. Alternative cost effective pharmacological treatments are available. Cambridgeshire & Peterborough CCG Formulary currently recommends mebeverine (1st line) and hyoscine butylbromide (2nd line). Local Hospital NWAFT: Formulary (including hyoscine butylbromide, mebeverine and pepper Formulary Status mint oil) CUHFT: Non-formulary Papworth: Non-formulary CPFT: Not applicable Status Presented to CPJPG July 2017 Prepared by Cambridgeshire & Peterborough Medicines Optimisation Team [email protected] July 2017