A fixed-dose combination (FDC) analgesic-antispasmodic medication primarily indicated for the symptomatic relief of moderate to severe pain associated with smooth muscle spasm, such as in dysmenorrhea, renal colic, and intestinal colic. Dicyclomine is an anticholinergic antispasmodic, Paracetamol is a centrally-acting analgesic and antipyretic, and Mefenamic Acid is a peripherally-acting NSAID with analgesic, anti-inflammatory, and antipyretic properties. This combination provides a multi-modal approach to pain relief by targeting both visceral spasm and pain pathways.
Adult: One tablet three times a day (TDS) or as directed by the physician. The total daily dose of mefenamic acid should not exceed 1500mg (i.e., 6 tablets of this FDC).
Note: Take with or after food to minimize gastrointestinal irritation. Swallow whole with a full glass of water. Do not crush or chew. Should be used for the shortest duration necessary to control symptoms.
The combination exerts a synergistic effect. Dicyclomine acts as a competitive muscarinic acetylcholine receptor antagonist, reducing smooth muscle tone and motility in the gastrointestinal and genitourinary tracts. Paracetamol's exact mechanism is not fully elucidated but is believed to involve central inhibition of prostaglandin synthesis (COX-2 and COX-3 inhibition) and modulation of serotonergic and cannabinoid pathways. Mefenamic Acid is a reversible, competitive inhibitor of both cyclooxygenase (COX-1 and COX-2) enzymes, reducing the synthesis of prostaglandins, thromboxanes, and prostacyclins at the site of inflammation, thereby providing peripheral analgesic and anti-inflammatory effects.
Pregnancy: Pregnancy Category C (US FDA). Avoid, especially in the first and third trimesters. First trimester: NSAID use associated with risk of miscarriage and congenital malformations. Third trimester: Risk of premature closure of ductus arteriosus, oligohydramnios, and prolonged labor. Paracetamol is preferred if an analgesic is needed. Dicyclomine may cause fetal tachycardia. Use only if potential benefit justifies potential fetal risk.
Driving: May cause dizziness, drowsiness, or blurred vision. Patients should be cautioned about operating machinery or driving until they know how the medication affects them.
| Other Anticholinergics (e.g., Atropine, Trihexyphenidyl) | Additive anticholinergic side effects (dry mouth, constipation, urinary retention, confusion). | Major |
| Oral Anticoagulants (Warfarin, Acenocoumarol) | Mefenamic Acid displaces warfarin from protein binding and inhibits platelet function, increasing risk of bleeding. | Major |
| Other NSAIDs (including Aspirin) | Increased risk of GI ulceration and bleeding. Reduced antiplatelet effect of aspirin. | Major |
| Lithium | Mefenamic Acid can decrease renal clearance of lithium, leading to toxicity. | Major |
| Methotrexate | NSAIDs can reduce renal clearance of methotrexate, increasing risk of bone marrow suppression. | Major |
| Diuretics (Furosemide, Thiazides) | NSAIDs may reduce the diuretic and antihypertensive effect and increase risk of renal impairment. | Moderate |
| Antihypertensives (ACE inhibitors, ARBs, Beta-blockers) | NSAIDs can attenuate the blood pressure lowering effect. | Moderate |
| Selective Serotonin Reuptake Inhibitors (SSRIs) | Increased risk of upper GI bleeding. | Moderate |
| Cholinesterase Inhibitors (Donepezil, Rivastigmine) | Dicyclomine antagonizes their effect. | Moderate |
| Alcohol | Chronic excessive use increases risk of paracetamol hepatotoxicity and GI bleeding with mefenamic acid. | Moderate |
| Antidiabetic Drugs (Sulfonylureas) | Mefenamic Acid may potentiate hypoglycemic effect. | Moderate |
Same composition (Dicyclomine (20mg) + Paracetamol (500mg) + Mefenamic Acid (250mg)), different brands: