Usage
This combination medication is primarily prescribed to alleviate abdominal pain and cramping associated with conditions like irritable bowel syndrome (IBS) and dysmenorrhea (menstrual cramps). It may also be used for other gastrointestinal disorders involving spasms and pain.
Pharmacological Classifications:
- Dicyclomine: Anticholinergic, Antispasmodic
- Famotidine: H2 Receptor Antagonist (Antacid)
- Mefenamic Acid: Nonsteroidal Anti-inflammatory Drug (NSAID)
Mechanism of Action: This combination offers a three-pronged approach:
- Dicyclomine relaxes the smooth muscles in the gastrointestinal tract, reducing spasms and cramping.
- Mefenamic Acid reduces pain and inflammation.
- Famotidine decreases stomach acid production, addressing heartburn and acid indigestion that may accompany abdominal pain.
Alternate Names
- Dicycloverine + Mefenamic Acid + Famotidine (Dicycloverine is another name for Dicyclomine)
How It Works
Pharmacodynamics:
- Dicyclomine: Blocks acetylcholine at muscarinic receptors on smooth muscle cells in the GI tract, leading to muscle relaxation and reduced spasms.
- Mefenamic Acid: Inhibits cyclooxygenase (COX) enzymes, decreasing prostaglandin synthesis and thus reducing inflammation and pain.
- Famotidine: Blocks histamine H2 receptors in the parietal cells of the stomach, reducing gastric acid secretion.
Pharmacokinetics:
- Dicyclomine: Rapidly absorbed after oral administration, primarily excreted via the kidneys.
- Mefenamic Acid: Well-absorbed orally, extensively metabolized in the liver, primarily excreted via the kidneys.
- Famotidine: Good oral bioavailability, partly metabolized in the liver, primarily excreted via the kidneys.
Dosage
Standard Dosage
Adults:
One tablet containing Dicyclomine 10mg, Mefenamic Acid 250mg, and Famotidine 10-20mg, taken orally three to four times a day. The maximum daily dose is generally not recommended to exceed 40mg of Dicyclomine and 1000mg of Mefenamic Acid. Famotidine maximum dose depends on the indication.
Children: This combination is generally not recommended for children due to the lack of established safety and efficacy data.
Special Cases:
- Elderly Patients: Initiate therapy with the lowest effective dose.
- Patients with Renal Impairment: Dose adjustment may be necessary.
- Patients with Hepatic Dysfunction: Dose adjustment may be necessary.
Clinical Use Cases The combination is not typically used in these settings. Individual components might be utilized separately.
Dosage Adjustments Adjustments may be required based on patient-specific factors, including renal or hepatic dysfunction. Close monitoring is essential.
Side Effects
Common Side Effects
- Nausea, vomiting, diarrhea, constipation
- Dry mouth, blurred vision
- Dizziness, drowsiness, headache
- Nervousness, weakness
Rare but Serious Side Effects
- Allergic reactions (rash, itching, swelling, difficulty breathing)
- Gastrointestinal bleeding
- Cardiac arrhythmias
- Stevens-Johnson syndrome
Long-Term Effects Long-term use of NSAIDs like Mefenamic Acid carries risks of cardiovascular complications, renal impairment, and gastrointestinal issues. Long-term anticholinergic use can lead to cognitive impairment.
Contraindications
- Hypersensitivity to any component of the drug
- Glaucoma, myasthenia gravis, urinary retention, gastrointestinal obstruction
- Severe ulcerative colitis, paralytic ileus, toxic megacolon
- Pregnancy (especially third trimester) and breastfeeding
- Infants under 6 months of age
Drug Interactions
- Anticholinergic drugs (additive effects)
- Antacids (reduced absorption of Dicyclomine)
- Anticoagulants (increased bleeding risk with Mefenamic Acid)
- CYP450 inhibitors/inducers (potential interaction with Famotidine)
- Alcohol (increased drowsiness with Dicyclomine and Mefenamic acid, and increased bleeding risk with Mefenamic Acid)
Pregnancy and Breastfeeding
Contraindicated during pregnancy, especially in the third trimester, and during breastfeeding.
Drug Profile Summary
- Mechanism of Action: Antispasmodic, anti-inflammatory, and antacid effects.
- Side Effects: Nausea, dry mouth, blurred vision, dizziness, drowsiness, constipation. Serious side effects include GI bleeding and allergic reactions.
- Contraindications: Glaucoma, GI obstruction, urinary retention, pregnancy (third trimester), breastfeeding.
- Drug Interactions: Other anticholinergics, antacids, anticoagulants, CYP450 inhibitors/inducers.
- Pregnancy & Breastfeeding: Contraindicated.
- Dosage: Adult: 1 tablet (Dicyclomine 10mg, Mefenamic Acid 250mg, Famotidine 10-20mg) TID-QID. Pediatric: Not recommended.
- Monitoring Parameters: Renal function, liver function, cardiovascular status, and eye pressure.
Popular Combinations
This triple combination itself is available in some formulations.
Precautions
- Pre-existing medical conditions should be evaluated before prescribing.
- Pregnant and breastfeeding women should not use this medication.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Dicyclomine + Famotidine + Mefenamic Acid?
A: Adults: One tablet (Dicyclomine 10mg, Mefenamic Acid 250mg, Famotidine 10-20mg) three to four times daily. Not recommended for children.
Q2: What are the primary uses of this combination?
A: Primarily for abdominal pain and cramping associated with IBS and dysmenorrhea.
Q3: Is this combination safe during pregnancy?
A: No, it is contraindicated, especially in the third trimester.
Q4: Are there any specific monitoring parameters for patients on this medication?
A: Yes, monitor renal function, liver function, cardiovascular status, and eye pressure.
Q5: What are the common side effects?
A: Nausea, dry mouth, blurred vision, dizziness, drowsiness, constipation.
Q6: Can this combination be used in children?
A: Generally not recommended due to lack of safety and efficacy data.
Q7: What are the serious side effects to watch out for?
A: Allergic reactions, gastrointestinal bleeding, and cardiovascular issues.
Q8: Does this drug interact with alcohol?
A: Yes, alcohol can increase drowsiness and bleeding risk.
Q9: Can patients with glaucoma take this medication?
A: No, it is contraindicated in patients with glaucoma.
