Mebeverine (Triptomer) Dosing for IBS
For IBS management, mebeverine should be dosed at either 135 mg three times daily before meals OR 200 mg twice daily (controlled-release formulation), as both regimens are therapeutically equivalent and effective for abdominal pain and global IBS symptoms. 1
Standard Dosing Regimens
Immediate-Release Formulation
- 135 mg three times daily before meals is the traditional dosing schedule 2, 1
- This formulation has demonstrated significant improvement in abdominal pain severity and frequency in multiple trials 2, 3
Controlled-Release Formulation
- 200 mg twice daily (controlled-release) is therapeutically equivalent to the three-times-daily regimen 1
- Approximately 70% of patients achieve ≥50% improvement in abdominal pain with this dosing 1
- This formulation offers improved convenience without compromising efficacy 1
Clinical Context and Positioning
First-Line Antispasmodic Option
Mebeverine functions as a first-line antispasmodic for IBS, though current guidelines classify antispasmodics as a group with weak recommendations due to very low quality evidence 4. The British Society of Gastroenterology notes that certain antispasmodics may effectively treat global symptoms and abdominal pain, though common side effects include dry mouth, visual disturbance, and dizziness 4, 5.
Evidence for Efficacy
- Six studies in a systematic review demonstrated significant decreases in abdominal pain (p-values <0.05 to <0.001) 3
- Improvements extend beyond pain to include abnormal bowel habits, abdominal distension, and stool frequency/consistency 3
- However, one controlled trial showed only modest effects in IBS-D, suggesting it may not be optimal for severe symptoms 6
Treatment Duration and Monitoring
- Standard treatment course: 8 weeks based on clinical trial data 6, 2, 1
- Assess response at 4 weeks and 8 weeks 1
- Response is defined as ≥50% improvement in abdominal pain on visual analogue scale 1
Safety Profile
Mebeverine has an excellent safety profile with rare adverse events, primarily related to underlying IBS symptoms rather than the medication itself 3. No significant safety concerns have been identified in clinical trials 1.
Critical Positioning Relative to Other Therapies
When Mebeverine Is Insufficient
If patients do not achieve adequate symptom control with mebeverine after 8 weeks, escalate to tricyclic antidepressants (TCAs) as second-line therapy 4:
- Start amitriptyline 10 mg once daily at bedtime
- Titrate slowly to 30-50 mg once daily
- TCAs have strong recommendation with moderate quality evidence, making them more robustly supported than antispasmodics 4
Combination Therapy Considerations
Fixed combination of mebeverine with ispaghula (soluble fiber) offers no advantage over mebeverine plus dietary fiber advice, and up to 28% of patients find the fixed combination unpalatable 2. Use mebeverine alone with separate dietary fiber recommendations rather than fixed combinations 2.
Common Pitfalls to Avoid
- Do not use mebeverine as monotherapy for severe IBS symptoms - the controlled-release formulation showed only modest effects in severe IBS-D 6
- Do not expect significant improvement in constipation-predominant IBS - mebeverine primarily addresses pain and spasm, not motility disorders requiring secretagogues 4
- Do not continue beyond 8 weeks without reassessment - if no response by 8 weeks, transition to evidence-based second-line agents like TCAs 4, 1