Usage
This combination medication is primarily prescribed for the symptomatic relief of dysmenorrhea (painful menstruation), including menstrual cramps, bloating, and abdominal discomfort. It is also used to treat other colicky pain, such as intestinal, biliary, and ureteric colic.
Pharmacological Classification:
- Dicyclomine: Anticholinergic, Antispasmodic
- Mefenamic Acid: Non-Steroidal Anti-Inflammatory Drug (NSAID), Analgesic
- Pamabrom: Diuretic
Mechanism of Action: This combination targets menstrual discomfort through multiple pathways. Dicyclomine relaxes the smooth muscles in the gastrointestinal tract, reducing spasms and cramps. Mefenamic acid inhibits prostaglandin synthesis, thereby decreasing pain and inflammation. Pamabrom, a mild diuretic, helps reduce water retention and bloating.
Alternate Names
Some alternate names for this combination include Pamaspas Plus, Mefbrom Spas, Twagic Spas, MEFTAL-SPAS, and MEFTAL-SPAS DS. Several brand names exist for this drug combination depending on the manufacturer and region.
How It Works
Pharmacodynamics:
- Dicyclomine: Acts as an anticholinergic agent, blocking the action of acetylcholine at muscarinic receptors in the smooth muscle of the gastrointestinal tract. This leads to relaxation of the muscles and reduced spasms.
- Mefenamic Acid: Inhibits cyclooxygenase (COX) enzymes, responsible for prostaglandin synthesis. Prostaglandins contribute to pain, inflammation, and fever. By reducing prostaglandin levels, mefenamic acid alleviates pain and inflammation.
- Pamabrom: Acts as a mild diuretic, increasing urine production and reducing water retention.
Pharmacokinetics:
- Dicyclomine: Well absorbed orally, metabolized in the liver, and excreted in the urine and feces.
- Mefenamic Acid: Rapidly absorbed after oral administration, reaching peak plasma concentrations in 2-4 hours. It is highly protein-bound and undergoes hepatic metabolism, with metabolites primarily excreted in the urine.
- Pamabrom: Absorbed from the gastrointestinal tract and excreted in the urine.
Mode of Action: The combined action of these drugs provides comprehensive relief from menstrual discomfort. Dicyclomine addresses muscle spasms, while mefenamic acid reduces pain and inflammation, and pamabrom alleviates bloating by reducing water retention.
Dosage
Standard Dosage
Adults:
One tablet three times a day, preferably with food. The total daily dose of mefenamic acid should not exceed 1500 mg.
Children:
This combination is not recommended for children under 12 years of age. For older children, dosing must be determined by a physician.
Special Cases:
- Elderly Patients: Use with caution, particularly in patients with renal or hepatic impairment. Dosage adjustments may be necessary.
- Patients with Renal Impairment: Use with caution. Dose adjustment may be required. The drug should be avoided in patients with end-stage renal disease.
- Patients with Hepatic Dysfunction: Use with caution. Dosage adjustments may be needed. Contraindicated in patients with severe liver disease.
- Patients with Comorbid Conditions: Exercise caution in patients with asthma, glaucoma, myasthenia gravis, hypertension, inflammatory bowel disease, paralytic ileus, intestinal atony, or cardiovascular disease.
Clinical Use Cases
The primary clinical use case for this combination is the management of dysmenorrhea. Its use in other clinical situations like intubation, surgical procedures, mechanical ventilation, ICU use, and emergency situations is not established.
Side Effects
Common Side Effects:
Dry mouth, dizziness, blurred vision, nausea, vomiting, heartburn, indigestion, diarrhea, headache, drowsiness, rash, weakness.
Rare but Serious Side Effects:
Confusion, hallucinations, rapid heartbeat, difficulty urinating, gastrointestinal bleeding (bloody stools, vomiting blood), severe allergic reactions (swelling, severe dizziness, trouble breathing), kidney problems (changes in urine output), liver problems (yellowing of skin/eyes, dark urine).
Adverse Drug Reactions (ADR):
Any of the rare/serious side effects mentioned above qualify as ADRs requiring immediate medical attention.
Contraindications
Hypersensitivity to any component of the drug, glaucoma, urinary retention, obstructive uropathy, obstructive diseases of the gastrointestinal tract, myasthenia gravis, severe ulcerative colitis, acute intermittent porphyria, severe liver or kidney disease, pregnancy (especially third trimester), breastfeeding.
Drug Interactions
Anticholinergics (atropine, ipratropium), monoamine oxidase inhibitors (MAOIs) (selegiline, phenelzine), other medications containing paracetamol/acetaminophen, antidepressants (tricyclic antidepressants), antihistamines, opioid pain relievers, anticoagulants (warfarin), diuretics, lithium, methotrexate, alcohol.
Pregnancy and Breastfeeding
Pregnancy: Contraindicated, especially in the third trimester. Mefenamic acid can delay labor and potentially cause harm to the fetus.
Breastfeeding: Contraindicated. Both dicyclomine and mefenamic acid are excreted in breast milk and may affect the nursing infant.
Drug Profile Summary
- Mechanism of Action: Dicyclomine: Antispasmodic; Mefenamic acid: NSAID; Pamabrom: Diuretic.
- Side Effects: Dry mouth, dizziness, blurred vision, nausea, drowsiness, gastrointestinal upset. Serious side effects: See “Rare but Serious Side Effects” above.
- Contraindications: See “Contraindications” above.
- Drug Interactions: See “Drug Interactions” above.
- Pregnancy & Breastfeeding: Contraindicated.
- Dosage: Adults: One tablet three times daily (max 1500 mg mefenamic acid/day). Children: Not recommended under 12 years.
- Monitoring Parameters: Monitor for signs of GI bleeding, allergic reactions, renal/hepatic dysfunction, and changes in urine output.
Popular Combinations
This drug itself is a combination product. No other specific drug combinations are routinely used alongside it.
Precautions
- Screen patients for allergies, metabolic disorders, and organ dysfunction.
- Advise on potential drug interactions, including those with OTC drugs, supplements, alcohol, and other medications.
- Caution is advised for elderly patients, especially those with renal or liver disease.
- Pregnant and breastfeeding women should not use this drug.
- Driving or operating machinery should be avoided due to potential dizziness and drowsiness.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Dicyclomine + Mefenamic Acid + Pamabrom?
A: The standard adult dosage is one tablet three times a day, with food. The maximum daily dose of mefenamic acid should not exceed 1500 mg. Dosage adjustments may be required for elderly patients or those with renal or liver disease. This medication is not recommended for children under 12.
Q2: What are the common side effects?
A: Common side effects include dry mouth, dizziness, blurred vision, nausea, drowsiness, and gastrointestinal upset.
Q3: Is this drug safe during pregnancy?
A: No, this drug is contraindicated during pregnancy, particularly in the third trimester. It may delay labor and cause fetal harm.
Q4: Can I take this medication while breastfeeding?
A: No, this drug is contraindicated while breastfeeding as the components are excreted in breast milk.
Q5: Can I drink alcohol while taking this medication?
A: No, alcohol should be avoided as it can worsen side effects like drowsiness and dizziness and increase the risk of stomach bleeding.
Q6: What should I do if I miss a dose?
A: Take the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and continue your regular dosing schedule. Do not double the dose to catch up.
Q7: How long can I take this medication?
A: Take this medication for the duration prescribed by your doctor. For dysmenorrhea, it’s typically used for 3-5 days during menstruation. Do not use for more than seven days without consulting your physician.
Q8: What should I do if I experience severe side effects?
A: Discontinue use immediately and seek medical attention if you experience any severe or unusual side effects such as confusion, hallucinations, rapid heartbeat, difficulty urinating, gastrointestinal bleeding, severe allergic reactions, or signs of kidney or liver problems.
Q9: Can this medication be used for other types of pain?
A: While it may provide some relief for other types of colicky pain such as intestinal, biliary, and ureteric colic, its primary indication is for menstrual pain. Consult with a physician for other pain management strategies.
Q10: Does this drug interact with other medications?
A: Yes, it can interact with several other medications. Always inform your doctor about all other prescription and over-the-counter medications, supplements, and herbal products you are taking to avoid potential interactions.
