A fixed-dose combination analgesic-antispasmodic agent primarily indicated for the symptomatic relief of pain and discomfort associated with primary dysmenorrhea (menstrual cramps) and premenstrual syndrome (PMS). Paracetamol provides central analgesic and antipyretic effects, Pamabrom acts as a mild diuretic to reduce water retention and bloating, and Dicyclomine is an antispasmodic that relieves smooth muscle spasms in the uterus and gastrointestinal tract.
Adult: One tablet every 6-8 hours as needed for pain and cramps. Do not exceed 3 tablets in 24 hours. Should be taken with or after food.
Note: Take with a full glass of water, preferably with or after meals to minimize gastric upset. Do not crush or chew. The tablet can be taken at the first sign of menstrual cramps and continued for 2-3 days as needed.
The combination works synergistically: Paracetamol inhibits central cyclooxygenase (COX), particularly the COX-2 variant, and modulates the endogenous cannabinoid system, reducing prostaglandin synthesis in the CNS to elevate pain threshold. Dicyclomine is a competitive muscarinic acetylcholine receptor antagonist, directly relaxing smooth muscle in the uterus and GI tract via anticholinergic action, relieving spasm. Pamabrom is a xanthine derivative with mild diuretic properties, promoting renal excretion of sodium and water, thereby reducing premenstrual fluid retention, bloating, and breast tenderness.
Pregnancy: Category C (US FDA). Animal reproduction studies not conducted. Use during pregnancy only if the potential benefit justifies the potential risk to the fetus, especially in the first trimester. Paracetamol is generally considered safe in pregnancy, but the combination with dicyclomine (anticholinergic) is best avoided unless specifically indicated.
Driving: May cause dizziness, drowsiness, and blurred vision. Patients should be cautioned against driving or operating machinery until they know how the medication affects them.
| Alcohol (Chronic/heavy use) | Increased risk of paracetamol-induced hepatotoxicity due to CYP2E1 induction. | Major |
| Anticholinergics (e.g., Atropine, Trihexyphenidyl, TCAs, Antihistamines) | Additive anticholinergic side effects (dry mouth, constipation, urinary retention, confusion). | Major |
| Warfarin and other Coumarin Anticoagulants | Paracetamol may potentiate anticoagulant effect, increasing INR and bleeding risk, especially with doses >1.3g/day for >1 week. | Moderate |
| Metoclopramide, Domperidone | Dicyclomine may antagonize the prokinetic effect in the gut. | Moderate |
| Levodopa | Dicyclomine may reduce gastric emptying and absorption of levodopa. | Moderate |
| Digoxin | Anticholinergics may increase serum digoxin levels by decreasing gut motility. | Moderate |
| Other Hepatotoxic drugs (e.g., Isoniazid, Phenytoin, Carbamazepine, Rifampicin) | Increased risk of liver damage with paracetamol. | Major |
| Diuretics (e.g., Furosemide, Hydrochlorothiazide) | Additive diuretic effect with Pamabrom, increasing risk of dehydration and electrolyte imbalance. | Moderate |
Same composition (Paracetamol (325mg) + Pamabrom (25mg) + Dicyclomine (10mg)), different brands: