Usage
- This combination medication is prescribed for the relief of abdominal pain and cramping associated with conditions like irritable bowel syndrome (IBS), menstrual cramps (dysmenorrhea), and intestinal gas. It is also used to alleviate bloating and gaseous distension.
- Pharmacological classification: This is a combination product containing an antispasmodic (dicyclomine), a non-steroidal anti-inflammatory drug (NSAID) (mefenamic acid), and an anti-foaming agent (simethicone).
Alternate Names
While “Dicyclomine + Mefenamic Acid + Simethicone” accurately represents the drug’s composition, there can be regional or international variations. Some brand names this combination is marketed under include Colispas, Meftal-Spas, and Emispas. There may be other brand names depending on the manufacturer and location.
How It Works
Dicyclomine:
- Pharmacodynamics: Dicyclomine acts as an antispasmodic, relaxing smooth muscle in the gastrointestinal tract by blocking the action of acetylcholine at muscarinic receptors (M1, M2, and M3), thereby reducing spasms and cramps. It also antagonizes bradykinin and histamine.
- Pharmacokinetics: Dicyclomine is well-absorbed orally. It is primarily metabolized in the liver and excreted in the urine.
Mefenamic Acid:
- Pharmacodynamics: Mefenamic acid is an NSAID that works by inhibiting cyclooxygenase (COX) enzymes, which are responsible for producing prostaglandins. Prostaglandins are chemical messengers that mediate pain and inflammation. By reducing prostaglandin production, mefenamic acid decreases pain and inflammation.
- Pharmacokinetics: It is absorbed following oral administration, metabolized in the liver and mostly excreted in urine.
Simethicone:
- Pharmacodynamics: Simethicone is an anti-foaming agent that works by reducing the surface tension of gas bubbles in the gastrointestinal tract, allowing them to coalesce into larger bubbles that can be passed more easily. This alleviates bloating, pressure, and discomfort.
- Pharmacokinetics: Simethicone is not absorbed systemically and is eliminated unchanged in the feces.
Dosage
Standard Dosage
Adults: One tablet three to four times a day. The maximum recommended daily dose is 480 mg of dicyclomine and 1500 mg of mefenamic acid.
Special Cases:
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Elderly Patients: Due to potential increased sensitivity to anticholinergic effects of dicyclomine, dose adjustments may be necessary. Start with a lower dose and titrate upwards based on the patient’s tolerance and response.
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Patients with Renal Impairment: Dicyclomine is mainly excreted by the kidneys. Dose reduction is necessary for patients with severe renal impairment.
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Patients with Hepatic Dysfunction: Exercise caution in patients with hepatic dysfunction. Consider dose reductions.
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Patients with Comorbid Conditions: Patients with glaucoma, myasthenia gravis, urinary retention, obstructive gastrointestinal disorders, severe heart disease, or uncontrolled hypertension should use this medication with caution. The presence of these conditions may warrant a lower dose or alternative treatments.
Clinical Use Cases
The use of this combination in specific clinical settings such as intubation, surgical procedures, mechanical ventilation, and ICU use is not explicitly supported by the current literature. Its primary use revolves around relieving pain and discomfort caused by IBS, menstrual cramps, and intestinal gas.
Dosage Adjustments
Dose modifications may be necessary based on patient-specific factors. For example, renal/hepatic dysfunction, metabolic disorders, or genetic polymorphisms may affect drug metabolism. This should be done under strict medical supervision.
Side Effects
Common Side Effects
Dry mouth, blurred vision, dizziness, drowsiness, nausea, constipation, weakness, nervousness, headache.
Rare but Serious Side Effects
Allergic reactions (angioedema, urticaria), difficulty breathing (apnea), confusion, palpitations, jaundice, gastritis, severe gastrointestinal issues.
Long-Term Effects
Chronic use of mefenamic acid, an NSAID, may lead to gastrointestinal ulcers, bleeding, or kidney problems. Long-term use of dicyclomine, an anticholinergic, can potentially lead to cognitive impairment in elderly patients.
Adverse Drug Reactions (ADR)
Any severe side effects, such as difficulty breathing, severe allergic reactions, or signs of gastrointestinal bleeding, require immediate medical attention.
Contraindications
- Hypersensitivity to any of the active ingredients.
- Myasthenia gravis, glaucoma, obstructive uropathy, obstructive gastrointestinal diseases, severe ulcerative colitis, paralytic ileus, toxic megacolon.
- Use in infants under 6 months of age.
Drug Interactions
- Other anticholinergics (atropine, hyoscyamine): Additive anticholinergic effects.
- NSAIDs (aspirin, ibuprofen): Increased risk of gastrointestinal side effects.
- Antidepressants (amitriptyline, imipramine): Additive anticholinergic effects.
- Antipsychotics (haloperidol, thioridazine): Additive anticholinergic effects.
- Opioid pain medications (codeine): Additive anticholinergic effects.
- Antihistamines (diphenhydramine): Additive anticholinergic effects.
- Medications for Parkinson’s disease (levodopa): Reduced effectiveness of levodopa.
- Potassium chloride: Increased risk of gastrointestinal ulcers or bleeding, especially in patients with chronic kidney disease.
- Digoxin, warfarin, methotrexate, some antibiotics and antidiabetic medications: Increased drug levels and risk of toxicity.
- Alcohol: Increased drowsiness and dizziness.
Pregnancy and Breastfeeding
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Pregnancy: Mefenamic acid is contraindicated in the third trimester of pregnancy due to the risk of premature closure of the ductus arteriosus in the fetus. Use in the first and second trimester is not recommended unless benefits clearly outweigh risks. Dicyclomine’s safety in pregnancy has not been fully established. Use only if clearly needed and under medical supervision.
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Breastfeeding: Mefenamic acid is excreted in breast milk and dicyclomine is contraindicated during breastfeeding. Breastfeeding should be discontinued during treatment.
Drug Profile Summary
- Mechanism of Action: Dicyclomine relaxes smooth muscle; mefenamic acid reduces pain and inflammation; simethicone relieves bloating and gas.
- Side Effects: Dry mouth, blurred vision, dizziness, drowsiness, nausea, constipation. Serious side effects include allergic reactions and breathing difficulties.
- Contraindications: Hypersensitivity, myasthenia gravis, glaucoma, bowel obstruction, third trimester of pregnancy, breastfeeding.
- Drug Interactions: Other anticholinergics, NSAIDs, certain antidepressants, and others. Consult the detailed list above.
- Pregnancy & Breastfeeding: Contraindicated in the third trimester of pregnancy and during breastfeeding. Use with caution in other stages of pregnancy.
- Dosage: Adults: One tablet three to four times daily. Not recommended for children under 12.
- Monitoring Parameters: Monitor for adverse effects, particularly in elderly patients and those with renal or hepatic impairment.
Popular Combinations
A combination of dicyclomine, mefenamic acid, and simethicone addresses both the spasmodic and inflammatory components of abdominal pain, as well as gas-related discomfort.
Precautions
- General Precautions: Pre-screening for allergies, metabolic disorders, organ dysfunction is crucial.
- Specific Populations: Use with caution in elderly patients and those with renal or hepatic impairment.
- Pregnant Women: Use with caution in the first and second trimester, contraindicated in the third trimester.
- Breastfeeding Mothers: Contraindicated.
- Children & Elderly: Not recommended for children under 12 years of age. Lower doses may be necessary for elderly patients.
- Lifestyle Considerations: Avoid alcohol. Caution advised when driving or operating machinery due to potential drowsiness and dizziness.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Dicyclomine + Mefenamic Acid + Simethicone?
A: The typical adult dosage is one tablet three to four times daily, not exceeding 480 mg of dicyclomine and 1500 mg of mefenamic acid per day. Not recommended for children under 12 years.
Q2: What are the common side effects?
A: Common side effects include dry mouth, blurred vision, dizziness, drowsiness, nausea, and constipation.
Q3: Is this combination safe during pregnancy?
A: Mefenamic acid is contraindicated in the third trimester and not typically recommended in the first and second trimesters. Dicyclomine use should be limited to when clearly needed, and under direct medical supervision.
Q4: Can I breastfeed while taking this medication?
A: No, this medication is contraindicated during breastfeeding.
Q5: How does this drug interact with alcohol?
A: Alcohol may increase drowsiness and dizziness. Concomitant use should be avoided.
Q6: What are the serious side effects I should watch out for?
A: Serious side effects include allergic reactions (angioedema, urticaria), difficulty breathing (apnea), confusion, palpitations, jaundice, and severe gastrointestinal issues. Seek immediate medical attention if any of these occur.
Q7: Are there any contraindications to using this drug?
A: Contraindications include hypersensitivity to the components, myasthenia gravis, glaucoma, urinary retention, obstructive GI diseases, paralytic ileus, toxic megacolon, and use in infants under 6 months.
Q8: Can I take this medicine if I have kidney disease?
A: Use with caution and under medical supervision. Dose adjustments may be required depending on the severity of renal impairment.
Q9: How does each component of this combination work?
A: Dicyclomine is an antispasmodic, relaxing the smooth muscle of the GI tract. Mefenamic acid is an NSAID, reducing pain and inflammation. Simethicone reduces gas bubbles.
Q10: What conditions is this medicine typically prescribed for?
A: It is primarily used for irritable bowel syndrome (IBS), menstrual cramps (dysmenorrhea), and intestinal gas.
