Otilonium Bromide for Irritable Bowel Syndrome

Introduction to Otilonium Bromide

Otilonium bromide is an effective first-line antispasmodic for IBS, dosed at 40 mg three times daily, with proven superiority over placebo in reducing abdominal pain frequency and bloating severity, particularly when treatment extends beyond 10 weeks 1

Otilonium bromide functions as an L-type calcium channel antagonist in intestinal smooth muscle cells, classified as an antimuscarinic antispasmodic rather than a direct smooth muscle relaxant, as recommended by the British Society of Gastroenterology 1

The British Society of Gastroenterology guidelines position antispasmodics like otilonium bromide as first-line pharmacological therapy after dietary modifications and lifestyle interventions 3, 1, 2
The treatment sequence includes first-line dietary advice and soluble fiber, followed by antispasmodics (including otilonium bromide) for global symptoms and abdominal pain, and tricyclic antidepressants as second-line therapy if antispasmodics fail after 3 months 2, 1, 2, 4

Review efficacy after 3 months and discontinue otilonium bromide if no symptomatic improvement, as recommended by the British Society of Gastroenterology 2

The British Society of Gastroenterology advises against using otilonium bromide as monotherapy in IBS-C patients without concurrent laxative therapy, as antimuscarinic antispasmodics reduce intestinal motility and can worsen constipation 1