Indications: symptomatic relief of gastro-intestinal disorders characterised by smooth muscle spasm.

Cautions: Antimuscarinics should be used with caution in Down's syndrome, in children and in the elderly; they should also be used with caution in gastro-oesophageal reflux disease, diarrhoea, ulcerative colitis, autonomic neuropathy, acute myocardial infarction, hypertension, conditions characterised by tachycardia (including hyperthyroidism, cardiac insufficiency, cardiac surgery), pyrexia, and in individuals susceptible to angle-closure glaucoma.

Contra-indications: in myasthenia gravis (but may be used to decrease muscarinic Side Effects: of anticholinesterases—paralytic ileus, pyloric stenosis, toxic megacolon, and prostatic enlargement. also infants under 6 months.

Side Effects: constipation, transient bradycardia (followed by tachycardia, palpitation and arrhythmias), reduced bronchial secretions, urinary urgency and retention, dilatation of the pupils with loss of accommodation, photophobia, dry mouth, flushing and dryness of the skin. Side Effects: that occur occasionally include confusion (particularly in the elderly), nausea, vomiting, and giddiness; very rarely, angle-closure glaucoma may occur.

Pregnancy: not known to be harmful; manufacturer advises use only if essential

Breast-feeding: avoid—present in milk; apnoea reported in infant

Dose: 10–20 mg 3 times daily; INFANT 6–24 months 5–10 mg 3–4 times daily, 15 minutes before feeds; CHILD 2–12 years 10 mg 3 times daily.