Overview
Mebeverine is a direct-acting smooth muscle relaxant used primarily in the management of irritable bowel syndrome (IBS) and other gastrointestinal motility disorders. Unlike anticholinergic antispasmodics, mebeverine acts directly on the intestinal smooth muscle without systemic antimuscarinic effects. This makes it suitable for long-term use in patients with abdominal pain, cramps, and altered bowel habits, particularly where anticholinergic side effects (dry mouth, blurred vision, urinary retention) are undesirable.
Pharmacological Class and Formulations
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Class: Antispasmodic (smooth muscle relaxant, non-anticholinergic)
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ATC Code: A03AA04
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Formulations:
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Tablets (135 mg)
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Modified-release capsules (200 mg)
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Oral suspension (rare, region-specific)
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Mechanism of Action
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Mebeverine acts directly on smooth muscle cells in the gastrointestinal tract.
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It inhibits sodium and potassium channels, reducing excitability of smooth muscle membranes.
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The result is reduction of intestinal hypermotility and spasms without impairing normal gut motility.
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No significant systemic anticholinergic activity → minimal risk of common side effects associated with antimuscarinic drugs.
Pharmacokinetics
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Absorption: Rapid after oral administration.
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Metabolism: Extensively metabolized in the liver to inactive metabolites.
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Elimination: Primarily renal excretion of metabolites.
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Half-life: Short; modified-release formulations prolong therapeutic effect.
Clinical Indications
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Irritable Bowel Syndrome (IBS)
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Relief of abdominal pain, cramps, bloating, and altered bowel habits.
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Other gastrointestinal spasm disorders
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Secondary to organic disease (e.g., diverticular disease, chronic colitis).
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Biliary spasm (occasionally used, off-label).
Contraindications
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Hypersensitivity to mebeverine or excipients.
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Paralytic ileus.
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Children under 10 years (safety not established).
Precautions
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Use with caution in hepatic or renal impairment (though no dose adjustment usually needed).
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Not recommended in porphyria.
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Pregnancy: Limited data, generally avoided unless necessary.
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Lactation: Small amounts may pass into breast milk; use with caution.
Adverse Effects
Common (generally rare overall)
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Gastrointestinal: nausea, dyspepsia, constipation, diarrhea
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Neurological: headache, dizziness
Rare
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Hypersensitivity reactions: rash, urticaria, angioedema
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Anaphylaxis (extremely rare)
Mebeverine is generally well tolerated, with fewer adverse effects than anticholinergic alternatives.
Drug Interactions
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No significant interactions reported with commonly used drugs.
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Can be co-administered safely with most IBS therapies (e.g., fiber supplements, laxatives, antidiarrheals).
Dosage
Adults
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Tablets (135 mg):
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One tablet three times daily, 20 minutes before meals.
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May be reduced to twice daily if symptoms controlled.
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Modified-release capsules (200 mg):
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One capsule twice daily (morning and evening).
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Children
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Safety not established for <10 years.
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For adolescents (>10 years), use may be considered under specialist advice.
Duration
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Treatment duration should be guided by symptom control.
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Patients should be reassessed regularly, and drug holidays can be attempted to confirm continuing need.
Monitoring
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No routine laboratory monitoring required.
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Clinical monitoring focuses on symptom relief and tolerability.
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Reassess diagnosis if symptoms persist despite adequate treatment.
Patient Counseling Points
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Take tablets/capsules 20 minutes before meals.
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Swallow capsules whole; do not chew or crush modified-release forms.
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Inform healthcare provider if experiencing allergic reactions such as swelling of lips, face, or throat.
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IBS symptoms often fluctuate — therapy may reduce intensity and frequency but may not completely eliminate symptoms.
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Lifestyle changes (dietary fiber adjustment, reduced caffeine/fat intake, stress management) can improve outcomes when combined with mebeverine.
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