1. Hyoscine butylbromide:
60mg–120mg/24hr (higher doses have been used up to 300mg).
Or
2. Octreotide 2nd line (if hyoscine butylbromide ineffective with specialist advice):
250 microgram / 24hr initially, can be increased to 750 micrograms/24hrs if necessary.
If ineffective stop after 48 hours.
If octreotide is effective titrate to lowest effective dose.
Can add:
3. A three day trial of 5HT3 – receptor antagonists:
e.g. Ondansetron or granisetron.