• drug administration
• hospital care
• pharmacology
• symptoms and symptom management

I wrote recently to describe the case of a woman with motor neuron disease for whom we used propantheline to reduce her respiratory secretion burden. I am now writing to describe two further cases in which we used oral propantheline successfully to treat different symptoms: bowel/bladder spasm and increased stoma output.

Propantheline is a quaternary ammonium compound that is a non-specific acetylcholine antagonist at muscarinic M1–M3 receptors. Receptors are present in the bladder, salivary glands, the gastrointestinal (GI) tract and central nervous system to name but a few. As discussed, the potential benefits of propantheline versus other available anticholinergics are increased oral bioavailability, less sedation and the ability to administer the medication via parenteral feeding tubes.

It can be seen that propantheline has the potential to be used for many systemic symptoms including salivary secretions (see my previous letter, Mar 2023, 13 (1) 63-64; DOI:10.1136/spcare-2022-004109), GI secretions, GI motility and bladder spasms. This then leads me to my two cases.

The first is a 77-year-old woman with metastatic pancreatic cancer, diverticular disease and a colovesical fistula. She was admitted to the hospital following several …