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Mepenzolate Bromide

Pronouncation: (meh-PEN-zoe-late BROE-mide)
Class: Quarternary anticholinergic

Trade Names:
Cantil
- Tablets 25 mg

Pharmacology

Diminishes gastric acid and pepsin secretion; suppresses spontaneous contractions of the colon. It is a post-ganglionic parasympathetic inhibitor.

Pharmacokinetics

Absorption

Oral absorption is low.

Elimination

Over a 5-day period, 3% to 22% is excreted in the urine, with the majority appearing on day 1. The remainder appears in the feces and is presumed not to have been absorbed.

Indications and Usage

Adjunctive therapy in the treatment of peptic ulcer.

Contraindications

Glaucoma; obstructive uropathy (eg, bladder neck obstruction caused by prostatic hypertrophy); obstructive GI tract disease (eg, pyloric duodenal stenosis); paralytic ileus; intestinal atony of the elderly or debilitated patient; unstable CV status in acute GI hemorrhage; toxic megacolon complicating ulcerative colitis; myasthenia gravis; allergic or idiosyncratic reactions to any component of the product or related compounds.

Dosage and Administration

Adults

PO 25 or 50 mg 4 times daily, preferably with meals and at bedtime.

Storage/Stability

Store at controlled room temperature (59° to 86°F). Protect from excessive heat.

Drug Interactions

Agents used to treat achlorhydria

May antagonize the effect of mepenzolate.

Amantadine, antiarrhythmic agents of class I (eg, quinidine), antihistamines, antipsychotic agents (eg, phenothiazines), benzodiazepines, MAOIs, narcotic analgesics (eg, meperidine), nitrates, nitrites, sympathomimetic agents, tricyclic antidepressants, other drugs with anticholinergic activity

These agents may increase certain actions or adverse reactions of anticholinergic drugs.

Antacids

May interfere with mepenzolate absorption; avoid simultaneous administration.

Antiglaucoma agents

Action may be antagonized by mepenzolate.

Digoxin

Serum digoxin levels may be increased in patients taking slow-dissolving dosage forms.

Drugs that alter GI motility (eg, metoclopramide)

Action may be antagonized by mepenzolate.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Cardiovascular

Tachycardia; palpitations.

CNS

Mental confusion; dizziness; weakness; drowsiness; headache; nervousness; insomnia; psychosis (including signs and symptoms of confusion, disorientation, short-term memory loss, hallucinations, dysarthria, ataxia, coma, euphoria, decreased anxiety, fatigue, insomnia, agitation, inappropriate affect).

Dermatologic

Urticaria.

EENT

Increased ocular tension; cycloplegia; blurred vision; dilated pupil.

GI

Vomiting; nausea; constipation; loss of taste; bloated feeling; dry mouth.

Genitourinary

Urinary retention; urinary hesitancy; suppression of lactation; impotence.

Miscellaneous

Anaphylaxis; decreased sweating.

Precautions

Pregnancy

Category B .

Lactation

Undetermined.

Children

Safety and efficacy not established.

Special Risk Patients

Use with caution in the elderly and in patients with autonomic neuropathy, hepatic or renal disease, ulcerative colitis, coronary heart disease, CHF, cardiac arrhythmia, tachycardia, hypertension, prostatic hypertrophy, or hyperthyroidism.

Diarrhea

May be symptom of incomplete intestinal obstruction, especially in patients with ileostomy or colostomy. Treatment of diarrhea with drug is inappropriate and possibly harmful.

Heat prostration

Can occur in presence of high environmental temperature.

Overdosage

Symptoms

Headache, nausea, vomiting, blurred vision, dilated pupils, hot, dry skin, dizziness, dryness of the mouth, difficulty swallowing, CNS stimulation, curare-like action (neuromuscular blockade).

Patient Information

Advise patient to take prescribed dose with meals and at bedtime.
Advise patient that dose may be changed periodically to achieve max benefit.
Advise patient to avoid strenuous activity during periods of high temperature or humidity.
Advise patient to take sips of water, suck on ice chips or sugarless hard candy, or chew sugarless gum if dry mouth occurs.
Advise patient that drug may cause drowsiness or blurred vision and to use caution while driving or performing other tasks requiring mental alertness until tolerance is determined.
Advise patient to notify health care provider if symptoms do not improve or appear to be getting worse.
Advise patient to stop taking the drug and notify health care provider immediately if any of the following occur: rash, flushing, eye pain, inability to urinate.
Advise patient that medication may cause dry mouth, urination difficulties, or constipation and to notify health care provider if they occur and are bothersome.