Mepenzolate (Cantil) - Uses, Dose, MOA, Brands, Side effects

Mepenzolate (Cantil) suppresses the secretion of pepsin and reduces colonic motility. It is used in the management of peptic ulcer disease in combination with other medications like proton pump inhibitors (omeprazole, pantoprazole, esomeprazole, lansoprazole, and dexlansoprazole)

Mepenzolate Uses:

  • It is indicated for the management of peptic ulcer disease along with other agents.
  • It does not have any major effect on healing of peptic ulcers, prevention of complications and avoiding recurrence.

Mepenzolate (Cantil) Dose in Adults:

Mepenzolate (Cantil) Dose in the treatment of Peptic ulcer disease:

  • Oral: 25-50 mg 4 times/day

Use in Children:

Not indicated.


Pregnancy Risk Factor B

  • No adverse effects reported in animal studies.

Use during breastfeeding:

  • Lactation can be inhibited due to anticholinergic effects.

Dose in Kidney Disease:

No dose adjustment required.

Dose in Liver disease:

No dose adjustment required.


Side effects of Mepenzolate (Cantil):

  • Cardiovascular:

    • Palpitations
    • Tachycardia
  • Central Nervous System:

    • Confusion
    • Dizziness
    • Drowsiness
    • Headache
    • Insomnia
    • Nervousness
  • Dermatologic:

    • Hypohidrosis
    • Urticaria
  • Gastrointestinal:

    • Ageusia
    • Bloating
    • Constipation
    • Delayed Gastric Emptying
    • Nausea
    • Vomiting
    • Xerostomia
  • Genitourinary:

    • Decreased Lactation
    • Impotence
    • Urinary Hesitancy
    • Urinary Retention
  • Hypersensitivity:

    • Anaphylaxis
  • Neuromuscular & Skeletal:

    • Weakness
  • Ophthalmic:

    • Blurred Vision
    • Cycloplegia
    • Increased Intraocular Pressure
    • Mydriasis

Contraindications to Mepenzolate (Cantil):

  • Mepenzolate hypersensitivity has been documented.
  • glaucoma
  • Obstructive Uropathy (i.e. bladder neck obstruction caused by prostatic hyperplasia).
  • Obstructive gastrointestinal Disease (e.g. pyloroduodenal, achalasia).
  • Paralytic ileus
  • Debilitated and elderly patients may experience a bowel atony.
  • Background of GI bleed and hemodynamic instability
  • Ulcerative colitis and toxic megacolon
  • Myasthenia gravis

Warnings and precautions

  • CNS effects

    • It can cause central nervous system depression, blurred vision, and drowsiness.
  • Diarrhea:

    • If diarrhea occurs, stop using the product as it could indicate partial intestinal obstruction.
  • Heat prostration:

    • High temperatures may cause severe reactions.
  • Psychosis:

    • Certain patients may be more susceptible to developing psychosis from the anticholinergic effect.
  • Cardiovascular disease

    • Before using, rule out tachycardia. Prevent cardiac failure, heart disease, hypertension, arrhythmias, or tachycardia.
  • Gastric ulcer treatment

    • Gastric emptying can be delayed when used to treat gastric ulcers.
  • Hepatic impairment

    • Take care when you have hepatic dysfunction.
  • Hiatal hernia

    • This can exacerbate the symptoms of hiatal hernia or reflux esophagitis.
  • Hyperthyroidism:

    • Prevent hyperthyroidism by taking care.
  • Neuropathy:

    • Prevent autonomic neuropathy by using caution.
  • Prostatic hyperplasia

    • Patients with BPH should be used with care
  • Renal impairment

    • Prevent renal dysfunction.
  • Ulcerative colitis

    • May cause toxic megacolon. In the presence of ulcerative collitis, be cautious.

Mepenzolate: Drug Interaction

Risk Factor C (Monitor therapy)

Acetylcholinesterase Inhibitors

May diminish the therapeutic effect of Anticholinergic Agents. Anticholinergic Agents may diminish the therapeutic effect of Acetylcholinesterase Inhibitors.

Amantadine

May enhance the anticholinergic effect of Anticholinergic Agents.

Anticholinergic Agents

May enhance the adverse/toxic effect of other Anticholinergic Agents.

Botulinum Toxin-Containing Products

May enhance the anticholinergic effect of Anticholinergic Agents.

Cannabinoid-Containing Products

Anticholinergic Agents may enhance the tachycardic effect of Cannabinoid-Containing Products. Exceptions: Cannabidiol.

Chloral Betaine

May enhance the adverse/toxic effect of Anticholinergic Agents.

Gastrointestinal Agents (Prokinetic)

Anticholinergic Agents may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic).

Glucagon

Anticholinergic Agents may enhance the adverse/toxic effect of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased.

Itopride

Anticholinergic Agents may diminish the therapeutic effect of Itopride.

Mianserin

May enhance the anticholinergic effect of Anticholinergic Agents.

Mirabegron

Anticholinergic Agents may enhance the adverse/toxic effect of Mirabegron.

Nitroglycerin

Anticholinergic Agents may decrease the absorption of Nitroglycerin. Specifically, anticholinergic agents may decrease the dissolution of sublingual nitroglycerin tablets, possibly impairing or slowing nitroglycerin absorption.

Opioid Agonists

Anticholinergic Agents may enhance the adverse/toxic effect of Opioid Agonists. Specifically, the risk for constipation and urinary retention may be increased with this combination.

Ramosetron

Anticholinergic Agents may enhance the constipating effect of Ramosetron.

Thiazide and Thiazide-Like Diuretics

Anticholinergic Agents may increase the serum concentration of Thiazide and Thiazide-Like Diuretics.

Topiramate

Anticholinergic Agents may enhance the adverse/toxic effect of Topiramate.

Risk Factor D (Consider therapy modification)

Pramlintide

May enhance the anticholinergic effect of Anticholinergic Agents. These effects are specific to the GI tract.

Secretin

Anticholinergic Agents may diminish the therapeutic effect of Secretin. Management: Avoid concomitant use of anticholinergic agents and secretin. Discontinue anticholinergic agents at least 5 half-lives prior to administration of secretin.

Risk Factor X (Avoid combination)

Aclidinium

May enhance the anticholinergic effect of Anticholinergic Agents.

Cimetropium

Anticholinergic Agents may enhance the anticholinergic effect of Cimetropium.

Eluxadoline

Anticholinergic Agents may enhance the constipating effect of Eluxadoline.

Glycopyrrolate (Oral Inhalation)

Anticholinergic Agents may enhance the anticholinergic effect of Glycopyrrolate (Oral Inhalation).

Glycopyrronium (Topical)

May enhance the anticholinergic effect of Anticholinergic Agents.

Ipratropium (Oral Inhalation)

May enhance the anticholinergic effect of Anticholinergic Agents.

Levosulpiride

Anticholinergic Agents may diminish the therapeutic effect of Levosulpiride.

Oxatomide

May enhance the anticholinergic effect of Anticholinergic Agents.

Potassium Chloride

Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride.

Potassium Citrate

Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Citrate.

Revefenacin

Anticholinergic Agents may enhance the anticholinergic effect of Revefenacin.

Tiotropium

Anticholinergic Agents may enhance the anticholinergic effect of Tiotropium.

Umeclidinium

May enhance the anticholinergic effect of Anticholinergic Agents.

 

Monitoring Parameters:

None mentioned.


How to administer Mepenzolate (Cantil)?

Take with food, preferably at night.


Mechanism of action of Mepenzolate (Cantil):

  • It causes decreased gastric acid production and increased pepsin secretion by blocking the postganglionic parasympathetic nerves. 
  • It also inhibits colonic movement.

Absorption when administered orally: Low

Excretion:

  • Urine (3% to 22%);
  • feces

International Brand Names of Mepenzolate:

  • Cantil
  • Colibantil
  • Eftoron
  • Mepenzol
  • Tralanta
  • Trancolon
  • Trancolon P

Mepenzolate Brand Names in Pakistan:

No Brands Available in Pakistan.

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