Usage
This combination medication is primarily prescribed for the relief of abdominal pain and cramping associated with conditions like irritable bowel syndrome (IBS) and menstrual cramps (dysmenorrhea). It also helps alleviate intestinal gas. Pharmacologically, this is classified as a gastrointestinal medication with antispasmodic, anti-inflammatory, analgesic, and anti-foaming properties.
The mechanism of action involves multiple pathways: Dicyclomine, an antispasmodic, relaxes smooth muscles in the gastrointestinal tract by blocking acetylcholine. Mefenamic acid, an NSAID, reduces pain and inflammation by inhibiting prostaglandin synthesis. Simethicone, an anti-foaming agent, reduces bloating and gas by altering the surface tension of gas bubbles.
Alternate Names
While there isn’t a universally recognized alternate name for this specific triple combination, the individual components have various synonyms. Dicyclomine is sometimes referred to as dicycloverine. Mefenamic acid is occasionally listed as mefenamate. Dimethicone is also known as polydimethylsiloxane. Brand names for this combination, or combinations containing two of the three drugs, include Remigan D, Mefag Spas, Spasrine, and Colpep.
How It Works
Pharmacodynamics: Dicyclomine exerts its antispasmodic effect by competitively blocking muscarinic receptors, specifically M1, M2, and M3 subtypes, located on smooth muscle cells within the GI tract. This inhibits acetylcholine-mediated muscle contractions, leading to relaxation. Mefenamic acid inhibits cyclooxygenase (COX) enzymes, primarily COX-1 and to a lesser extent COX-2, which decreases prostaglandin synthesis, reducing inflammation and pain. Simethicone acts as an anti-foaming agent by reducing the surface tension of gas bubbles in the GI tract, allowing them to coalesce and be expelled more easily.
Pharmacokinetics: Dicyclomine is rapidly absorbed after oral administration. It is metabolized in the liver and excreted mainly in urine. Mefenamic acid is also well-absorbed orally, metabolized in the liver, and eliminated in urine and feces. Simethicone is not absorbed systemically; it passes through the GI tract unchanged and is excreted in feces.
Dosage
Standard Dosage
Adults:
The standard adult dosage for dicyclomine + mefenamic acid (without simethicone) is typically one tablet three to four times daily. Dicyclomine + mefenamic acid + simethicone combination dosage information is less readily available. For the triple drug combination, consult a healthcare professional for individualized recommendations.
Children:
The triple combination, as well as the dual combination of dicyclomine and mefenamic acid, is generally not recommended for children under 12 years of age. Pediatric dosing for individual components or other combinations needs to be determined by a doctor.
Special Cases:
- Elderly Patients: Exercise caution and consider dose reductions due to potential increased sensitivity to anticholinergic effects.
- Patients with Renal Impairment: Use with caution. Dose adjustments may be necessary for patients with moderate to severe renal dysfunction.
- Patients with Hepatic Dysfunction: Use with caution. Dose adjustments may be needed.
- Patients with Comorbid Conditions: Careful evaluation is needed for patients with glaucoma, myasthenia gravis, obstructive uropathy, cardiovascular disease, or other relevant conditions.
Clinical Use Cases
Dosage recommendations for specific clinical settings like intubation, surgical procedures, mechanical ventilation, or ICU use are not established for this combination. It’s primarily used for symptomatic relief of abdominal cramps and pain.
Dosage Adjustments
Dose modifications should be considered in elderly patients, individuals with renal or hepatic impairment, and those with specific comorbid conditions.
Side Effects
Common Side Effects
Dry mouth, nausea, dizziness, drowsiness, blurred vision, constipation, weakness, nervousness.
Rare but Serious Side Effects
Confusion, respiratory depression, seizures, coma, allergic reactions (skin rash, itching, swelling), gastrointestinal bleeding, cardiovascular events (in patients with risk factors).
Long-Term Effects
Long-term use of NSAIDs like mefenamic acid can increase the risk of gastrointestinal issues, including ulcers and bleeding, and potential cardiovascular problems.
Adverse Drug Reactions (ADR)
Clinically significant ADRs include severe anticholinergic effects, gastrointestinal bleeding, and hypersensitivity reactions. These warrant immediate medical attention.
Contraindications
Hypersensitivity to any of the components; Glaucoma; Myasthenia gravis; Obstructive uropathy; Obstructive diseases of the gastrointestinal tract; Severe renal or hepatic impairment; Third trimester of pregnancy.
Drug Interactions
Anticholinergics (atropine, scopolamine), antidepressants (tricyclic antidepressants, MAO inhibitors), antihistamines, opioid pain relievers, blood thinners (warfarin), diuretics (furosemide), lithium, methotrexate, alcohol, digoxin, oral hypoglycemics, antiplatelet drugs.
Pregnancy and Breastfeeding
This combination is generally not recommended during pregnancy, especially during the third trimester. Mefenamic acid is contraindicated in the third trimester. The safety of dicyclomine and dimethicone during pregnancy and breastfeeding is not well-established. Consult a physician before use.
Drug Profile Summary
- Mechanism of Action: Antispasmodic, analgesic, anti-inflammatory, anti-foaming.
- Side Effects: Dry mouth, nausea, dizziness, drowsiness, blurred vision, constipation. Serious side effects: Confusion, respiratory depression, seizures, coma, allergic reactions, GI bleeding.
- Contraindications: Hypersensitivity, glaucoma, myasthenia gravis, obstructive uropathies, severe renal/hepatic impairment.
- Drug Interactions: Anticholinergics, antidepressants, antihistamines, opioids, warfarin, diuretics, lithium, methotrexate, alcohol.
- Pregnancy & Breastfeeding: Not recommended.
- Dosage: Varies; consult a physician. Adult dosage for dicyclomine + mefenamic acid: one tablet three to four times daily. Not for children under 12.
- Monitoring Parameters: Monitor for adverse effects, especially anticholinergic symptoms, gastrointestinal issues, and renal/hepatic function.
Popular Combinations
Dicyclomine + mefenamic acid and dicyclomine + dimethicone.
Precautions
Evaluate patients with pre-existing kidney/liver disease, cardiovascular problems. Consult with pregnant/breastfeeding women. Use caution in elderly patients. Not recommended for children under 12. Avoid alcohol. Avoid driving if drowsy or experiencing blurred vision.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Dicyclomine + Dimethicone + Mefenamic Acid?
A: Standard dosage information for this triple combination is not readily available. Consult a doctor for specific recommendations. The dosage for dicyclomine + mefenamic acid in adults is typically one tablet three or four times a day.
Q2: What are the primary uses of this combination?
A: It is primarily used to relieve abdominal pain and cramps associated with IBS, menstrual cramps, and intestinal gas.
Q3: Is this medication safe during pregnancy?
A: It is generally not recommended during pregnancy, especially in the third trimester. Consult a doctor before use.
Q4: What are the common side effects?
A: Common side effects include dry mouth, nausea, dizziness, drowsiness, blurred vision, and constipation.
Q5: Are there any serious side effects I should be aware of?
A: Yes, rare but serious side effects can include confusion, respiratory depression, seizures, coma, allergic reactions, and gastrointestinal bleeding. Seek immediate medical attention if these occur.
Q6: Can I take this medication if I have glaucoma?
A: No, this medication is contraindicated in patients with glaucoma.
Q7: What should I do if I miss a dose?
A: Take the missed dose as soon as you remember, unless it’s almost time for your next dose. Do not double the dose.
Q8: Can this medication interact with other drugs I’m taking?
A: Yes, it can interact with various medications, including anticholinergics, antidepressants, antihistamines, opioids, blood thinners, and others. Inform your doctor about all medications you are taking.
Q9: Can I drink alcohol while taking this medication?
A: It’s advisable to avoid alcohol as it may worsen drowsiness and increase the risk of stomach problems.
Q10: Is this safe for children?
A: This combination is generally not recommended for children under 12.
