Synopsis
Choose common gastrointestinal medicines by mechanism and diagnosis, prescribe a defined course, and prevent QT, neurological, anticholinergic, electrolyte, interaction, obstruction and masking harms.
- Treat the cause and dangerous alternatives before suppressing a symptom: antiemetics, antidiarrhoeals, antispasmodics and laxatives can obscure obstruction, sepsis, bleeding or inflammatory disease.
- For every GI drug, write the indication, intended duration, review or stop point, renal and hepatic considerations, pregnancy context, interactions and what response would justify continuation.
- Proton-pump inhibitors are effective for acid-mediated disease and gastroprotection when risk warrants it, but lowest effective intensity and review reduce unnecessary long-term exposure and rebound-driven continuation.
Key red flags
Persistent vomiting with distension, severe pain, absent stool or flatus, dehydration or peritonism requires urgent obstruction or acute-abdomen assessment before prokinetics, laxatives or oral medicines.
Investigation priorities
Identify active indications, duplicate mechanisms, interactions, self-medication and prescriptions that have outlived their purpose.
Management branches
A patient requests treatment for pain, nausea, reflux, constipation or diarrhoea.
- Define symptom chronology, likely mechanism, red flags, comorbidity, pregnancy possibility and current prescription or non-prescription exposure.
- Examine and investigate enough to exclude an acute abdomen, bleeding, severe infection or metabolic emergency before suppressing the signal.
Key medicines
Proton-pump inhibitorUse the BNF regimen matching the licensed indication, then step down to the lowest effective intensity or stop after the planned course.
MetoclopramideFor adults, do not exceed 10 mg up to three times daily or 30 mg daily, and usually limit treatment to five days.