Dicyclomine + Furazolidone + Metronidazole

Usage

This combination medication is primarily prescribed for the treatment of diarrhea and dysentery, particularly those caused by bacterial or protozoal infections. It addresses both the infection and the associated symptoms like abdominal cramps and pain.

• Pharmacological Classification: This is a combination product containing an anticholinergic (dicyclomine), an antibiotic (furazolidone), and an antibiotic/antiprotozoal (metronidazole).

• Mechanism of Action: Furazolidone and metronidazole exert antibacterial and antiprotozoal activity by disrupting the growth and survival of the causative organisms. Dicyclomine is an antispasmodic that relaxes the smooth muscles of the gastrointestinal tract, reducing cramps and pain.

Alternate Names

There isn’t one single international non-proprietary name (INN) for this specific combination. It is recognized by the combination of its individual components. Several brand names exist depending on the manufacturer, such as “Mefudic,” “LOMOCIN-D,” “EROMID MDF,” and “Religyl-F”. “MFD Care”, “Dim Kid” and “Diastop MF” are some other brand names this combination drug is marketed under. Other brand names might be available regionally.

How It Works

• Pharmacodynamics: Furazolidone disrupts bacterial enzymes and protein synthesis. Metronidazole damages microbial DNA. Dicyclomine acts as an anticholinergic, inhibiting acetylcholine’s action at muscarinic receptors in the GI tract, leading to smooth muscle relaxation.

• Pharmacokinetics: All three drugs are absorbed orally. Metronidazole is metabolized in the liver, while furazolidone’s metabolism is not fully elucidated. Dicyclomine is also metabolized in the liver and excreted mainly through the kidneys. Elimination pathways for furazolidone include renal and hepatic routes. Metronidazole is mainly excreted in the urine, some in feces.

• Mode of Action: Furazolidone interferes with bacterial cell wall formation. Metronidazole forms free radicals that damage DNA. Dicyclomine blocks acetylcholine’s binding to muscarinic receptors, inhibiting smooth muscle contraction.

• Receptor Binding/Enzyme Inhibition: Dicyclomine is a muscarinic receptor antagonist. Furazolidone inhibits several bacterial enzymes. Metronidazole’s interaction is through free radical formation with microbial DNA.

• Elimination Pathways: Dicyclomine is primarily excreted renally. Metronidazole is primarily eliminated in the urine as metabolites and unchanged drug. Furazolidone is excreted both renally and through the biliary system.

Dosage

Dosage is determined by a physician based on the individual patient’s condition and factors like age and weight.

Standard Dosage

Adults:

The dosage varies depending on the brand and the specific formulation. Refer to individual product literature. A typical regimen might include furazolidone 50mg, metronidazole 200mg, and dicyclomine 10mg, taken multiple times a day.

Children:

Dosages need to be adjusted based on the child’s weight and age. Specific pediatric formulations may exist. Consult specialist guidelines and product literature for detailed recommendations. Pediatric use should be carefully monitored by a physician.

Special Cases:

• Elderly Patients: Use with caution due to potential for increased sensitivity to anticholinergic side effects. Dose adjustment may be needed.

• Patients with Renal Impairment: Caution is advised, and dose adjustments may be required based on the degree of impairment.

• Patients with Hepatic Dysfunction: Use with caution as metabolism may be affected. Dosage adjustments might be necessary.

• Patients with Comorbid Conditions: Consider comorbid conditions carefully, particularly in patients with glaucoma, urinary retention, or cardiovascular disease, as these can influence drug tolerance and potential for adverse effects.

Clinical Use Cases

This drug combination is not typically used in specific clinical settings like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations. Its primary indication is the management of diarrhea and dysentery.

Dosage Adjustments

Dosage adjustments should be based on individual patient factors, including renal and hepatic function, other medical conditions, and potential drug interactions.

Side Effects

Common Side Effects

Nausea, metallic taste, dry mouth, dizziness, headache, blurred vision, and dark-colored urine are commonly reported side effects.

Rare but Serious Side Effects

Peripheral neuropathy (with prolonged furazolidone use), allergic reactions, and severe gastrointestinal disturbances.

Long-Term Effects

Long-term use, especially of furazolidone, can lead to rare cases of peripheral neuropathy.

Adverse Drug Reactions (ADR)

Hypersensitivity reactions, neurological side effects (e.g., seizures), blood dyscrasias, and hepatic dysfunction.

Contraindications

Hypersensitivity to any component, glaucoma, myasthenia gravis, GI obstruction, severe ulcerative colitis, infants under 6 months, and breastfeeding.

Drug Interactions

• Monoamine Oxidase Inhibitors (MAOIs): Concomitant use with furazolidone is contraindicated due to the risk of hypertensive crisis.
• Alcohol: Avoid alcohol during treatment with metronidazole and furazolidone (disulfiram-like reaction).
• Anticoagulants (e.g., warfarin): Furazolidone may enhance the effects of anticoagulants.
• Other CNS depressants: Dicyclomine may enhance the sedative effects of other CNS depressants.

Pregnancy and Breastfeeding

• Pregnancy: This combination should generally be avoided during pregnancy, especially in the first trimester, as it may pose risks to the developing fetus. Consult specialist guidelines for potential use in later stages of pregnancy when benefits may outweigh risks.
• Breastfeeding: The combination is contraindicated during breastfeeding due to potential infant exposure. Safer alternatives should be considered.

Drug Profile Summary

• Mechanism of Action: Antibacterial, antiprotozoal, and antispasmodic.
• Side Effects: Nausea, dry mouth, dizziness, headache, metallic taste, dark urine.
• Contraindications: Hypersensitivity, glaucoma, myasthenia gravis, GI obstruction, infants under 6 months.
• Drug Interactions: MAOIs, alcohol, anticoagulants, CNS depressants.
• Pregnancy & Breastfeeding: Generally contraindicated.
• Dosage: Varies; consult individual product literature.
• Monitoring Parameters: Observe for GI effects, neurological symptoms, and signs of infection resolution.

Popular Combinations

This specific combination is itself a popular combination used in clinical practice for the indications mentioned. Combining it with other drugs would need careful consideration due to the potential for interactions.

Precautions

Pre-existing medical conditions, especially involving the liver, kidneys, or cardiovascular system, should be considered carefully. Close monitoring is recommended, especially in the elderly and patients with comorbid conditions. Alcohol should be strictly avoided.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Dicyclomine + Furazolidone + Metronidazole?

A: Dosage varies based on individual patient factors and brand. Please refer to individual product literature and consult specialist guidelines.

Q2: What are the primary uses of this drug combination?

A: Diarrhea and dysentery, primarily those caused by bacterial or protozoal infections.

Q3: What are the common side effects?

A: Nausea, dry mouth, dizziness, headache, metallic taste, dark urine, and blurred vision.

Q4: Are there any serious side effects?

A: Yes, though rare. Peripheral neuropathy (with prolonged furazolidone use), allergic reactions, and severe gastrointestinal disturbances are possible.

Q5: Can this medication be taken during pregnancy?

A: Generally contraindicated, especially in the first trimester. Consult specialist guidelines.

Q6: Is it safe to take this medication while breastfeeding?

A: No, it is contraindicated during breastfeeding.

Q7: What are the key drug interactions to be aware of?

A: MAOIs, alcohol, anticoagulants, and other CNS depressants.

Q8: What precautions should be taken when prescribing this combination?

A: Consider pre-existing medical conditions, monitor closely, and avoid alcohol.

Q9: What are the contraindications for this combination?

A: Hypersensitivity, glaucoma, myasthenia gravis, GI obstruction, severe ulcerative colitis, infants under 6 months, breastfeeding.