Warfarin
Severe
Database
Mefenamic acid increases bleeding risk via antiplatelet effect and protein binding displacement
Monitor INR; consider alternative analgesic
Source: Kimi deep-research + Cla
Drug reference
Drotaverine + Mefenamic Acid
Antispasmodic (PDE-4 inhibitor) + NSAID (non-selective COX inhibitor) · Antispasmodic and Analgesic
Also known as Doverin M, Drotin M, Meftal Spas, Cyclopam MF, Spasmonil Plus
START
1 tablet TDS after food for 2-3 days (short-term use)
TYPICAL MAX
3 tablets/day maximum; limit duration to 5-7 days
STOP IF
GI bleeding, severe abdominal pain not relieved, jaundice
WATCH
GI symptoms, renal function, duration of use
CDSCO approvedSchedule HATC A03A + M01AG01
KDIGO 2024 + manufacturer label
- ONSET
- 45min · Combined onset
- PEAK
- 1.5h · Peak combined effect
- t½
- 9h · Average of components
- DURATION
- 6h · Duration of effect
EXCRETION
Renal (both components)
route + CYP
INTERACTIONS
1 major
SEVERE in our sources
PREGNANCY
Avoid in third trimester; use only if clearly needed in earlier trimesters
FDA category + note
Top interactionssee all 5 →
- WarfarinSevereDatabaseKimi deep-research + Cla
Available in India
0 branded formulations and 790 fixed-dose combinations. Look up specific brands in the Drugs workspace.
Mechanism
Drotaverine: PDE-4 inhibitor causing smooth muscle relaxation. Mefenamic acid: Non-selective COX inhibitor reducing prostaglandin synthesis. Combined for synergistic relief of spasmodic pain.
Indications
DysmenorrheaRenal colicBiliary colicGI spasmodic painPost-operative pain with spasm
Dosing
- Adult
- Drotaverine 80 mg + Mefenamic acid 250 mg: 1 tablet TDS after food
- Pediatric
- Not recommended in children
- Renal adjustment
- Avoid if eGFR <30 mL/min
- Hepatic adjustment
- Avoid in severe hepatic impairment
- Geriatric
- Use lowest effective dose; monitor renal function
- Max dose
- Drotaverine 240 mg/day + Mefenamic acid 750 mg/day
Pharmacokinetics
Onset
30-60 minutes
Peak effect
1-2 hours
Duration
6-8 hours
Half-life
Drotaverine: 7-12 hours; Mefenamic acid: 2-4 hours
Bioavailability
Drotaverine: ~60%; Mefenamic acid: ~90%
Protein binding
Drotaverine: ~95%; Mefenamic acid: ~90%
Metabolism
Drotaverine: Hepatic; Mefenamic acid: Hepatic CYP2C9
Excretion
Both primarily renal
Contraindications
- Active peptic ulcer disease
- Severe renal or hepatic impairment
- Third trimester pregnancy
- Inflammatory bowel disease
- Hypersensitivity to either component
Side effects
Common
DrowsinessDizzinessNauseaDyspepsiaDiarrheaDry mouth
Serious
- GI bleeding or perforation
- Hepatotoxicity
- Nephrotoxicity
- Severe hypersensitivity reactions
Pregnancy & lactation
Pregnancy
Avoid in third trimester; use only if clearly needed in earlier trimesters
Lactation
Both components excreted in breast milk; use with caution during breastfeeding
Drug interactions
Antihypertensives
Moderate
Database
Reduced antihypertensive effect; risk of renal impairment
Monitor BP and renal function
Source: Kimi deep-research + Cla
Aspirin
Moderate
Database
Reduced aspirin cardioprotection; increased GI bleeding risk
Avoid concurrent use
Source: Kimi deep-research + Cla
Lithium
Moderate
Database
Reduced lithium renal clearance
Monitor lithium levels
Source: Kimi deep-research + Cla
Other Cns Depressants
Mild
Database
Additive sedation with drotaverine
Caution with alcohol, benzodiazepines, opioids
Source: Kimi deep-research + Cla
Related guidelines
Coronary angiography with renal dysfunction
CSI · Cardiology · 2020
Preoperative cardiac evaluation for non-cardiac surgery
AHA · Cardiology · 2025
Heart failure in diabetes
RSSDI · Cardiology · 2023
Acute kidney injury
KDIGO · Nephrology · 2012
Chronic kidney disease — assessment and management
KDIGO · Nephrology · 2024
Ask House about Drotaverine + Mefenamic Acid
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