Antispasmodics (myotropic)
ATC code: A03AA04 (Mebeverine)
Brand names
Colofac, Duspatalin
Direct myotropic antispasmodic on GI smooth muscle. Blocks sodium channels, reduces muscle tone, and suppresses spastic contractions without affecting normal peristalsis. Unlike atropinic antispasmodics, mebeverine has no anticholinergic effects — no dry mouth, accommodation disturbance, or urinary retention.
Individual decision
In functional abdominal pain and non-IBS spasms, mebeverine produces modest pain reduction. In organic disease (peptic ulcer, cholecystitis, appendicitis), mebeverine masks symptoms and delays diagnosis – primary workup is required.
Individual decision
Per 2021 and Rome IV, myotropic antispasmodics are first-line pharmacotherapy for abdominal pain in irritable bowel syndrome. Mebeverine dose 200 mg twice daily 20 minutes before meals. Effect on abdominal pain is moderate (NNT 7), on overall QoL – small. 2021 grades antispasmodic recommendations as 'conditional, low-quality evidence'. If no benefit after 4 weeks, reassess diagnosis and switch to peppermint oil, eluxadoline, rifaximin, or psychotropic agents.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Mebeverine is an antispasmodic that relaxes the smooth muscle of the gut, and it's sometimes prescribed for biliary dyskinesia too. Convincing benefit for this particular condition hasn't been shown, and there's no solid evidence base for the use. Gallbladder and sphincter dysfunction usually calls for clarifying the diagnosis, adjusting diet, and follow-up with a gastroenterologist who can match the approach to the actual cause of symptoms.
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Manufacturer label contraindicates first-trimester use. Data on second/third-trimester risk are limited. In pregnant IBS patients, non-pharmacological measures and the FODMAP diet are preferred.
Data on breast milk transfer are limited. Manufacturer label advises against breastfeeding.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Mebeverine is evaluated for the following indications with varying evidence strength: Abdominal smooth muscle spasm (evidence tier B), Irritable bowel syndrome (evidence tier B), Biliary dyskinesia (evidence tier D). See the full indication matrix with dosing and citations above on this page.
Common side effects of Mebeverine (≥ 1 in 100): Allergic skin reactions, Dizziness (rare), Dyspepsia. See the Safety section for uncommon and serious reactions.
FDA category C. Manufacturer label contraindicates first-trimester use. Data on second/third-trimester risk are limited. In pregnant IBS patients, non-pharmacological measures and the FODMAP diet are preferred.
Data on breast milk transfer are limited. Manufacturer label advises against breastfeeding.
Mebeverine is contraindicated in: Hypersensitivity; Age under 18 (extended-release forms); Pregnancy (per manufacturer). Full list in the Safety section.