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Mebeverine
Mebeverine is a first-line option for IBS and GI spasms due to its targeted action and favorable safety profile. Clinicians should adhere to BNF dosing guidelines, monitor for rare hypersensitivity, and avoid use in paralytic ileus. Its minimal drug interactions make it suitable for polypharmacy patients.
Mebeverine is a musculotropic antispasmodic that directly targets smooth muscle cells in the gastrointestinal (GI) tract. Its mechanism involves:
- Inhibition of Phosphodiesterase: Increases intracellular cyclic adenosine monophosphate (cAMP), promoting muscle relaxation.
- Calcium Channel Blockade: Reduces calcium influx into smooth muscle cells, preventing excessive contractions.
- Sodium Channel Modulation: Stabilizes membrane potential, further decreasing spasms.
Unlike anticholinergics, mebeverine selectively relaxes hyperactive GI muscles without affecting normal motility, minimizing systemic side effects (Lippincott).
Mebeverine is primarily indicated for:
- Irritable Bowel Syndrome (IBS): Alleviates abdominal pain, cramps, and bloating.
- Functional Gastrointestinal Disorders:
- Non-ulcer dyspepsia.
- Diverticular disease-associated spasms.
- Symptomatic Relief: Reduces colicky pain in chronic conditions (BNF).
Adults:
- Oral: 135 mg three times daily, taken 20 minutes before meals (BNF).
- Maximum Daily Dose: 405 mg.
Children (≥12 years):
- Use adult dosing under medical supervision.
Special Populations:
- Renal/Hepatic Impairment: No specific adjustment required, but use with caution (BNF).
- Elderly: No dose alteration needed.
Mebeverine is generally well-tolerated, with rare adverse effects:
- Common: Nausea, constipation, dizziness.
- Serious (Rare):
- Hypersensitivity reactions (rash, angioedema).
- Hepatitis (isolated reports).
- Pregnancy: Limited data; avoid unless benefits outweigh risks.
- Lactation: Excretion in breast milk unknown; avoid (BNF).
- Chronic Use: Typically prescribed for short-term relief; long-term use requires medical supervision.
Mebeverine has low systemic absorption, leading to minimal interactions:
- Antispasmodics/Anticholinergics: Potential additive effects (monitor for excessive relaxation).
- Prokinetic Agents: Theoretical antagonism (e.g., metoclopramide), but clinical significance is low (Lange).
- Generic: Mebeverine Hydrochloride.
- Brand Names: Colofac (UK), Duspatal (international), Colospa (India).
