Usage
Camylofin + Nimesulide is prescribed for the symptomatic relief of abdominal pain and cramps associated with various gastrointestinal conditions. These include:
- Intestinal colic (blockage in the intestine)
- Biliary colic (gallstones)
- Renal colic (kidney stones)
- Dysmenorrhea (menstrual cramps)
- Irritable bowel syndrome
- Diverticulitis
- Dyspepsia
Pharmacological Classification:
- Analgesic
- Antispasmodic
- Anti-inflammatory
Mechanism of Action: This combination drug works through two distinct mechanisms:
-
Nimesulide, a non-steroidal anti-inflammatory drug (NSAID), inhibits cyclooxygenase (COX) enzymes, primarily COX-2, reducing the production of prostaglandins, which are chemical messengers responsible for pain, fever, and inflammation.
-
Camylofin, an antispasmodic, acts as a smooth muscle relaxant by inhibiting muscarinic receptors and phosphodiesterase type IV. These actions reduce smooth muscle contractions (spasms) in the gastrointestinal tract.
Alternate Names
This combination drug is known by several brand names, including Anafortan N and Sumo Spas. There doesn’t seem to be any established international non-proprietary name (INN) for this specific combination product.
How It Works
Pharmacodynamics:
- Nimesulide: Exerts its analgesic and anti-inflammatory effects by reducing prostaglandin synthesis through COX inhibition. This reduces pain signaling and inflammation at the affected site.
- Camylofin: Relaxes the smooth muscles of the gastrointestinal tract by acting as an anticholinergic agent (blocking acetylcholine) and inhibiting phosphodiesterase type IV, leading to increased cyclic AMP and reduced intracellular calcium, both of which contribute to smooth muscle relaxation.
Pharmacokinetics:
- Nimesulide:
- Absorption: Well-absorbed orally.
- Metabolism: Extensively metabolized in the liver.
- Elimination: Primarily eliminated through the kidneys.
- Camylofin:
- Absorption: Limited information available.
- Metabolism: Limited information available.
- Elimination: Limited information available.
Mode of Action:
- Nimesulide: Inhibits COX-2 enzyme, reducing prostaglandin synthesis.
- Camylofin: Dual mechanism: Anticholinergic action by blocking muscarinic receptors and direct smooth muscle relaxation by inhibiting phosphodiesterase type IV, leading to increased cAMP and reduced intracellular calcium.
Elimination Pathways:
- Nimesulide: Primarily renal excretion.
- Camylofin: Limited information available. It is likely to be metabolized in the liver and eliminated through the kidneys and/or bile.
Dosage
The following represents collated information about dosage and may not fully reflect current clinical practice. Always consult up-to-date resources.
Standard Dosage
Adults: The typical dose is one tablet of Camylofin 50 mg + Nimesulide 100 mg twice daily, orally, after meals.
Children: This combination is generally not recommended for children under 12 years of age.
Special Cases:
- Elderly Patients: Use with caution. Dosage adjustments may be necessary.
- Patients with Renal Impairment: Use with caution in patients with mild to moderate renal impairment. Contraindicated in severe renal impairment. Dose adjustment is necessary depending upon creatinine clearance.
- Patients with Hepatic Dysfunction: Contraindicated in patients with hepatic impairment.
- Patients with Comorbid Conditions: Caution is advised in patients with cardiovascular disease, history of gastrointestinal ulcers, or bleeding disorders.
Clinical Use Cases
The dosage in specialized clinical situations like intubation, surgical procedures, mechanical ventilation, ICU use, and emergencies should be determined on a case-by-case basis by the attending physician. These situations often present with other conditions requiring specialized medications and dose modifications.
Dosage Adjustments
Dosage adjustments may be required based on patient-specific factors, including renal or hepatic dysfunction and other comorbid conditions. Close monitoring for adverse events is recommended, especially in elderly patients.
Side Effects
Common Side Effects:
- Nausea
- Vomiting
- Constipation
- Dry mouth
- Diarrhea
- Dizziness
- Headache
- Blurred vision
- Palpitations
Rare but Serious Side Effects:
- Liver damage (hepatotoxicity)
- Gastrointestinal bleeding
- Allergic reactions (rash, itching, shortness of breath, swelling)
- Stevens-Johnson Syndrome (rare and serious skin reaction)
Long-Term Effects:
Potential long-term effects of nimesulide, especially with prolonged use, include renal damage, cardiovascular complications, and gastrointestinal problems.
Adverse Drug Reactions (ADR):
Clinically significant ADRs requiring immediate intervention include signs of liver damage (jaundice, dark urine, abdominal pain), allergic reactions, severe gastrointestinal bleeding, or signs of Stevens-Johnson Syndrome.
Contraindications
- Hypersensitivity to camylofin or nimesulide.
- Active peptic ulcer or gastrointestinal bleeding.
- Severe hepatic or renal impairment.
- Heart failure.
- Severe bleeding disorders.
- Pregnancy and breastfeeding.
- Children under 12 years of age.
Drug Interactions
- Other NSAIDs: Increased risk of gastrointestinal side effects.
- Anticoagulants (e.g., warfarin): Increased risk of bleeding.
- Antihypertensives: May reduce the effectiveness of these medications.
- Alcohol: Increased risk of gastrointestinal side effects and liver damage.
- Methotrexate: Increased risk of methotrexate toxicity.
- Lithium: May increase lithium levels.
- CYP450 interactions: Nimesulide is primarily metabolized by CYP2C9. Concomitant use with CYP2C9 inhibitors may increase the risk of nimesulide-related adverse effects.
Pregnancy and Breastfeeding
Camylofin + Nimesulide is contraindicated during pregnancy and breastfeeding due to potential risks to the fetus and neonate. Nimesulide may cause premature closure of the ductus arteriosus in the fetus, particularly when used in the third trimester.
Drug Profile Summary
- Mechanism of Action: Nimesulide: COX-2 inhibitor, reducing prostaglandins. Camylofin: Anticholinergic, phosphodiesterase-4 inhibitor, relaxing smooth muscles.
- Side Effects: Nausea, vomiting, constipation, dizziness, headache, liver damage (rare).
- Contraindications: Hypersensitivity, peptic ulcer, hepatic/renal impairment, pregnancy, breastfeeding.
- Drug Interactions: Other NSAIDs, anticoagulants, antihypertensives, alcohol.
- Pregnancy & Breastfeeding: Contraindicated.
- Dosage: Adults: One tablet twice daily after meals.
- Monitoring Parameters: Liver function tests, renal function tests.
Popular Combinations
While Camylofin + Nimesulide itself is a combination product, camylofin is often combined with other analgesics or NSAIDs like paracetamol and diclofenac. These combinations aim to provide broader pain relief by addressing different pain pathways.
Precautions
- Evaluate liver and kidney function before starting treatment.
- Monitor for signs of gastrointestinal bleeding and liver toxicity.
- Avoid alcohol during treatment.
- Use cautiously in elderly patients and those with cardiovascular disease.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Camylofin + Nimesulide?
A: The standard adult dosage is one tablet (camylofin 50 mg + nimesulide 100 mg) twice daily after meals. Dosages must be adjusted according to hepatic or renal function.
Q2: What are the common side effects?
A: Common side effects include nausea, vomiting, constipation, dry mouth, dizziness, and headache.
Q3: Is this medication safe during pregnancy or breastfeeding?
A: No, it’s contraindicated during pregnancy and breastfeeding.
Q4: How does this combination relieve abdominal pain?
A: Nimesulide reduces inflammation and pain, while camylofin relaxes smooth muscle spasms.
Q5: What are the serious side effects I should watch out for?
A: Serious side effects include liver damage, gastrointestinal bleeding, and allergic reactions. Immediately discontinue use and contact a medical professional if observed.
Q6: Can I take this medication with other painkillers?
A: It’s best to avoid taking this combination with other NSAIDs due to the increased risk of side effects. Consult your doctor before combining with any other painkillers.
Q7: What should I do if I miss a dose?
A: If you miss a dose, take it as soon as you remember unless it’s nearly time for your next dose. Do not double the dose.
Q8: Are there any dietary restrictions while taking this medication?
A: Limit alcohol consumption, as it may increase the risk of gastrointestinal side effects and liver damage.
Q9: Can patients with kidney problems take this medication?
A: It should be used cautiously in patients with mild to moderate renal impairment and is contraindicated in those with severe renal impairment. Dosage adjustments may be necessary.
Q10: What is the maximum duration I can take Camylofin + Nimesulide?
A: It’s generally recommended to use this medication for the shortest duration necessary to control symptoms, typically not exceeding 15 days, unless otherwise directed by a physician.
