Role of antispasmodics in the treatment of irritable bowel syndrome

World J Gastroenterol. 2014 May 28;20(20):6031-43. doi: 10.3748/wjg.v20.i20.6031.


Irritable bowel syndrome (IBS) is a long-lasting, relapsing disorder characterized by abdominal pain/discomfort and altered bowel habits. Intestinal motility impairment and visceral hypersensitivity are the key factors among its multifactorial pathogenesis, both of which require effective treatment. Voltage-gated calcium channels mediate smooth muscle contraction and endocrine secretion and play important roles in neuronal transmission. Antispasmodics are a group of drugs that have been used in the treatment of IBS for decades. Alverine citrate, a spasmolytic, decreases the sensitivity of smooth muscle contractile proteins to calcium, and it is a selective 5-HT1A receptor antagonist. Alverine, in combination with simethicone, has been demonstrated to effectively reduce abdominal pain and discomfort in a large placebo-controlled trial. Mebeverine is a musculotropic agent that potently blocks intestinal peristalsis. Non-placebo-controlled trials have shown positive effects of mebeverine in IBS regarding symptom control; nevertheless, in recent placebo-controlled studies, mebeverine did not exhibit superiority over placebo. Otilonium bromide is poorly absorbed from the GI tract, where it acts locally as an L-type calcium channel blocker, an antimuscarinic and a tachykinin NK2 receptor antagonist. Otilonium has effectively reduced pain and improved defecation alterations in placebo-controlled trials in IBS patients. Pinaverium bromide is also an L-type calcium channel blocker that acts locally in the GI tract. Pinaverium improves motility disorders and consequently reduces stool problems in IBS patients. Phloroglucinol and trimethylphloroglucinol are non-specific antispasmodics that reduced pain in IBS patients in a placebo-controlled trial. Antispasmodics have excellent safety profiles. T-type calcium channel blockers can abolish visceral hypersensitivity in animal models, which makes them potential candidates for the development of novel therapeutic agents in the treatment of IBS.

Keywords: Calcium channel blockers; Irritable bowel syndrome; Motility; Spasmolytics; Treatment.

Publication types

  • Review

MeSH terms

  • Abdominal Pain / drug therapy
  • Animals
  • Calcium / chemistry
  • Calcium Channel Blockers / therapeutic use
  • Calcium Channels / metabolism
  • Disease Models, Animal
  • Humans
  • Irritable Bowel Syndrome / drug therapy*
  • Morpholines / therapeutic use
  • Parasympatholytics / therapeutic use*
  • Phenethylamines / therapeutic use
  • Quaternary Ammonium Compounds / chemistry
  • Randomized Controlled Trials as Topic
  • Treatment Outcome


  • Calcium Channel Blockers
  • Calcium Channels
  • Morpholines
  • Parasympatholytics
  • Phenethylamines
  • Quaternary Ammonium Compounds
  • octylonium
  • mebeverine
  • Calcium
  • pinaverium