What is the dosage and administration of Mebeverine Hydrochloride (Colofac) 135mg tablets for managing irritable bowel syndrome?

Mebeverine Hydrochloride (Colofac) 135mg Dosage and Administration for IBS

The standard dosage of Mebeverine Hydrochloride (Colofac) 135mg for managing irritable bowel syndrome is one tablet three times daily, taken before meals. 1

Mechanism of Action and Efficacy

• Mebeverine is an antispasmodic that has a direct inhibitory effect on intestinal smooth muscle, helping to relieve abdominal pain and spasms associated with IBS 2
• Unlike anticholinergic antispasmodics (such as dicyclomine), mebeverine has fewer systemic side effects like dry mouth 2
• Meta-analyses show that mebeverine demonstrates global benefit in IBS treatment, although its specific effect on pain reduction may be less pronounced compared to anticholinergic agents 2

Evidence for Efficacy

• Systematic reviews indicate that mebeverine is generally well-tolerated with minimal adverse effects 3
• Some studies have shown significant decreases in abdominal pain after mebeverine treatment, though the overall efficacy for global improvement of IBS symptoms is not consistently statistically significant 4
• A 2019 study of controlled-release mebeverine showed modest but statistically significant improvement in bowel movements, abdominal cramps, and quality of life compared to baseline, though the difference versus placebo was not statistically significant 5

Dosage Forms and Administration

• Standard immediate-release tablets: 135mg taken three times daily before meals 1
• Controlled-release tablets: 200mg taken twice daily (though this formulation may not be available in all markets) 5
• Treatment duration is typically 8 weeks in clinical trials, but may be adjusted based on clinical response 5, 4

Place in Treatment Algorithm

• Antispasmodics like mebeverine are considered first-line pharmacological treatments for IBS, particularly for pain-predominant symptoms 2
• The British Society of Gastroenterology guidelines note that certain antispasmodics may be effective for global symptoms and abdominal pain in IBS, though the quality of evidence is rated as very low 2
• Mebeverine can be used alongside dietary modifications, such as increased soluble fiber intake for appropriate IBS subtypes 1

Safety Considerations

• Mebeverine is generally well-tolerated with few adverse effects reported in clinical trials 4, 3
• It has a better side effect profile than anticholinergic antispasmodics, which commonly cause dry mouth, visual disturbances, and dizziness 2
• Mebeverine is rapidly metabolized in the body to mebeverine-alcohol and veratric acid, which should be considered when interpreting laboratory results 6

Practical Considerations

• If using mebeverine as part of a comprehensive IBS management approach, it can be combined with:

  • Regular exercise, which is strongly recommended for all IBS patients 2
  • Dietary modifications appropriate to the IBS subtype 2
  • Soluble fiber supplements for constipation-predominant IBS 2
  • Loperamide for diarrhea-predominant IBS if needed 2

• For patients who do not respond adequately to mebeverine, second-line treatments may include:

  • Tricyclic antidepressants for global symptoms and abdominal pain 2
  • Selective serotonin reuptake inhibitors for global symptoms 2
  • More targeted therapies based on the predominant IBS subtype 2