Usage
Chlordiazepoxide + Mebeverine is prescribed for the relief of irritable bowel syndrome (IBS) symptoms, including abdominal cramps, pain, bloating, and flatulence. It is also used to manage the anxiety and tension often associated with IBS.
It combines a benzodiazepine (chlordiazepoxide) and an antispasmodic (mebeverine). Chlordiazepoxide belongs to the anxiolytic and sedative classes, while mebeverine is classified as an antispasmodic and musculotropic agent.
Chlordiazepoxide enhances the effect of GABA, a neurotransmitter that reduces brain activity, leading to a calming effect. Mebeverine directly relaxes the smooth muscles of the gastrointestinal tract, relieving spasms and pain.
Alternate Names
While no specific alternate generic names exist, numerous brand names market this combination, including “Matiz Plus,” “Emoxide-M,” and “Coloverin A.”
How It Works
Pharmacodynamics: Mebeverine acts directly on the smooth muscle of the gut, reducing spasms without affecting normal intestinal motility. Chlordiazepoxide enhances the effect of GABA, leading to a calming effect on the central nervous system. This dual action addresses both the physical and psychological symptoms of IBS.
Pharmacokinetics: Mebeverine is rapidly absorbed after oral administration. Its metabolism is primarily through ester hydrolysis, and the metabolites are excreted mainly in the urine. Chlordiazepoxide is also well-absorbed orally and undergoes extensive liver metabolism, with its metabolites excreted in the urine. Both drugs can potentially interact with other medications metabolized by the same hepatic enzymes (e.g., CYP450 enzymes).
Mode of Action: Mebeverine’s exact mechanism is unclear but involves inhibiting calcium influx into smooth muscle cells, thus reducing contractility. Chlordiazepoxide binds to benzodiazepine receptors in the central nervous system, potentiating GABA’s inhibitory effects. No specific receptor binding or enzyme inhibition has been identified for mebeverine beyond its calcium channel effects.
Elimination Pathways: Both drugs are primarily eliminated through hepatic metabolism and renal excretion.
Dosage
Standard Dosage
Adults:
A typical dosage is one tablet or capsule containing 135mg of mebeverine and 5mg or 10mg of chlordiazepoxide, taken three times a day, approximately 20 minutes before meals. Some formulations with sustained-release mebeverine may be taken twice daily. The dosage may be adjusted according to the patient’s response and tolerance.
Children:
This combination is generally not recommended for children under 18 years of age due to limited safety and efficacy data.
Special Cases:
- Elderly Patients: Start with a lower dose (e.g., one tablet twice a day) and increase cautiously as needed.
- Patients with Renal Impairment: Dosage adjustments may be necessary; consult specialist guidance.
- Patients with Hepatic Dysfunction: Use cautiously and with dosage adjustments as the liver metabolizes both drugs.
- Patients with Comorbid Conditions: Consider potential drug interactions and adjust accordingly.
Clinical Use Cases
The combination is specifically indicated for IBS and is not typically used in settings like intubation, surgical procedures, mechanical ventilation, ICU, or emergency situations. Benzodiazepines like chlordiazepoxide might be used independently in some of these contexts, but not in this fixed combination.
Dosage Adjustments
Dose adjustments may be needed for elderly patients, individuals with renal or hepatic impairment, and those with certain comorbid conditions. Close monitoring and individualization of therapy are crucial.
Side Effects
Common Side Effects:
Drowsiness, dizziness, dry mouth, nausea, constipation, blurred vision, difficulty concentrating, and confusion.
Rare but Serious Side Effects:
Allergic reactions (rash, itching, swelling), paradoxical reactions (increased anxiety, agitation), jaundice, difficulty breathing, and dependency with prolonged use.
Long-Term Effects:
Potential for dependence and withdrawal symptoms with long-term chlordiazepoxide use. Tolerance may also develop, requiring higher doses for the same effect.
Adverse Drug Reactions (ADR):
Severe allergic reactions, paradoxical reactions (increased anxiety, agitation), dependence and withdrawal symptoms.
Contraindications
Glaucoma, prostatic hypertrophy, paralytic ileus, myasthenia gravis, porphyria, hypersensitivity to either drug, and severe liver or kidney disease. Use with extreme caution in pregnancy and breastfeeding. Not recommended for children under 18.
Drug Interactions
Alcohol, other CNS depressants (e.g., opioids, barbiturates, antihistamines), some antidepressants (e.g., MAOIs, SSRIs), muscle relaxants, certain antifungal and HIV medications. Discuss all medications and supplements with a doctor.
Pregnancy and Breastfeeding
This combination is generally not recommended during pregnancy, especially in the first trimester, due to the risk of congenital disabilities. It is also not recommended while breastfeeding as chlordiazepoxide is excreted in breast milk.
Drug Profile Summary
- Mechanism of Action: Mebeverine: Direct smooth muscle relaxation in the gut; Chlordiazepoxide: Enhances GABA activity, leading to CNS depression.
- Side Effects: Drowsiness, dizziness, dry mouth, nausea, constipation, blurred vision, dependence.
- Contraindications: Glaucoma, prostatic hypertrophy, paralytic ileus, myasthenia gravis, porphyria, hypersensitivity, severe liver/kidney disease, pregnancy, breastfeeding, children <18 years.
- Drug Interactions: Alcohol, CNS depressants, some antidepressants, muscle relaxants, antifungal & HIV medications.
- Pregnancy & Breastfeeding: Not recommended.
- Dosage: Adults: 1 tablet (135mg mebeverine/5-10mg chlordiazepoxide) TID before meals. Adjustments necessary for elderly and those with hepatic/renal impairment.
- Monitoring Parameters: Liver function tests, renal function tests, monitor for signs of dependence.
Popular Combinations
This combination is itself a common pairing. No other fixed combinations involving both these agents are widely used.
Precautions
- General Precautions: Assess for allergies, liver/kidney function, and other medical conditions.
- Specific Populations: See “Special Cases” under “Dosage.”
- Lifestyle Considerations: Avoid alcohol; caution with driving or operating machinery.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Chlordiazepoxide + Mebeverine?
A: The usual adult dose is 1 tablet (135mg mebeverine/5-10mg chlordiazepoxide) three times a day, 20 minutes before meals. Dosage adjustments are often necessary for the elderly, patients with renal/hepatic impairment, and those with other medical conditions.
Q2: Is this combination safe during pregnancy or breastfeeding?
A: No. It’s generally contraindicated in pregnancy and breastfeeding due to potential risks to the fetus or infant.
Q3: What are the common side effects?
A: Common side effects include drowsiness, dizziness, dry mouth, nausea, constipation, blurred vision, difficulty concentrating, and confusion.
Q4: How does this combination work in IBS?
A: It combines the antispasmodic action of mebeverine, which relaxes gut muscles, with the anxiolytic effect of chlordiazepoxide, which reduces anxiety and tension associated with IBS.
Q5: What are the serious side effects I should watch out for?
A: Serious side effects include allergic reactions, paradoxical reactions (increased anxiety/agitation), jaundice, breathing difficulties, and dependence.
Q6: Can I drink alcohol while taking this medication?
A: No. Alcohol can potentiate the sedative effects of chlordiazepoxide, leading to increased drowsiness and other adverse effects.
Q7: Are there any specific contraindications?
A: Yes. Contraindications include glaucoma, prostatic hypertrophy, paralytic ileus, myasthenia gravis, porphyria, severe liver/kidney disease, and hypersensitivity to the drugs.
Q8: What should I do if I miss a dose?
A: Take the missed dose as soon as you remember, unless it is close to the next scheduled dose. Do not double the dose.
Q9: Can this medication be used long-term?
A: Long-term use should be carefully considered due to the potential for dependence and tolerance with chlordiazepoxide.
Q10: What are the key drug interactions I should be aware of?
A: This medication can interact with other CNS depressants (e.g., opioids, alcohol), some antidepressants, muscle relaxants, and certain antifungal/HIV medications. A doctor should be consulted about all concomitant medications.
