Mefenamic acid is a non-steroidal anti-inflammatory agent with analgesic properties, and a demonstrable antipyretic effect. It has been shown to inhibit prostaglandin activity. Indications 1. As an anti-inflammatory analgesic for the symptomatic relief of rheumatoid arthritis (including Still's Disease), osteoarthritis, and pain including muscular, traumatic and dental pain, headaches of most aetiology, post-operative and post-partum pain. 2. Primary dysmenorrhoea. 3. Menorrhagia due to dysfunctional causes and presence of an IUD when other pelvic pathology has been ruled out.

Nospasm 10 mg Tablets are for oral administration only. Nospasm 10 mg Tablets should be swallowed whole with adequate water. Adults: 2 tablets four times daily. For the symptomatic relief of Irritable Bowel Syndrome, the recommended starting dose is 1 tablet three times daily, this can be increased up to 2 tablets four times daily if necessary. Children 6 - 12 years: 1 tablet three times daily. No specific information on the use of this product in the elderly is available. Clinical trials have included patients over 65 years and no adverse reactions specific to this age group have been reported. Nospasm 10 mg Tablets should not be taken on a continuous daily basis or for extended periods without investigating the cause of abdominal pain.

In case severe, unexplained abdominal pain persists or worsens, or occurs together with symptoms like fever, nausea, vomiting, changes in bowel movements, abdominal tenderness, decreased blood pressure, fainting, or blood in stool, medical advice should immediately be sought. Nospasm 10 mg Tablets should be used with caution in conditions characterised by tachycardia such as thyrotoxicosis, cardiac insufficiency or failure and in cardiac surgery where it may further accelerate the heart rate. Due to the risk of anticholinergic complications, caution should be used in patients susceptible to intestinal or urinary outlet obstructions. Because of the possibility that anticholinergics may reduce sweating, Nospasm should be administered with caution to patients with pyrexia. Elevation of intraocular pressure may be produced by the administration of anticholinergic agents such as Nospasm in patients with undiagnosed and therefore untreated narrow angle glaucoma. Therefore, patients should seek urgent ophthalmological advice in case they should develop a painful, red eye with loss of vision whilst or after taking Nospasm. As the tablet coat contains sucrose (41.2 mg), patients with rare hereditary problems of fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency should not take Nospasm Tablets.

The anticholinergic effect of drugs such as tri- and tetracyclic antidepressants, antihistamines, quinidine, amantadine, antipsychotics (e.g. butyrophenones, phenothiazines), disopyramide and other anticholinergics (e.g. tiotropium, ipratropium, atropine-like compounds) may be intensified by Nospasm. Concomitant treatment with dopamine antagonists such as metoclopramide may result in diminution of the effects of both drugs on the gastrointestinal tract. The tachycardic effects of beta-adrenergic agents may be enhanced by Nospasm

Pregnancy There are limited data from the use of Hyoscine-N-Butylbromide in pregnant women. Animal studies are insufficient with respect to reproductive toxicity (see section 5.3). As a precautionary measure Nospasm is not recommended during pregnancy. Lactation There is insufficient information on the excretion of Hyoscine-N-Butylbromide and its metabolites in human milk. A risk to the breastfeeding child cannot be excluded. Use of Nospasm during breastfeeding is not recommended.Fertility No studies on the effects on human fertility have been conducted

No studies on the effects on the ability to drive and use machines have been performed. Because of possible visual accommodation disturbances patients should not drive or operate machinery if affected.

Many of the listed undesirable effects can be assigned to the anticholinergic properties of NOSPASM. Adverse events have been ranked under headings of frequency using the following convention: Very common (≥ 1/10); common (≥ 1/100, < 1/10); uncommon (≥ 1/1000, <1/100); rare (≥ 1/10000, <1/1000); very rare (<1/10000); not known – cannot be estimated from the available data. Immune system disorders Uncommon: skin reactions (e.g. urticaria, pruritus) Not known*: anaphylactic shock , anaphylactic reactions, dyspnoea, rash, erythema, other hypersensitivity Cardiac disorders Uncommon: tachycardia Gastrointestinal disorders: Uncommon: dry mouth Skin and subcutaneous tissue disorders Uncommon: dyshidrosis Renal and urinary disorders Rare: urinary retention * This adverse reaction has been observed in post-marketing experience. With 95% certainty, the frequency category is not greater than uncommon (3/1,368), but might be lower. A precise frequency estimation is not possible as the adverse drug reaction did not occur in a clinical trial database of 1,368 patients 

Symptoms: Serious signs of poisoning following acute overdosage have not been observed in man. In the case of overdosage, anticholinergic effects such as urinary retention, dry mouth, reddening of the skin, tachycardia, inhibition of gastrointestinal motility and transient visual disturbances may occur, and Cheynes-Stokes respiration has been reported. Therapy: In the case of oral poisoning, gastric lavage with medicinal charcoal should be followed by magnesium sulfate (15%). Symptoms of Nospasm overdosage respond to parasympathomimetics. For patients with glaucoma, pilocarpine should be given locally. Cardiovascular complications should be treated according to usual therapeutic principles. In case of respiratory paralysis, intubation and artificial respiration. Catheterisation may be required for urinary retention. In addition, appropriate supportive measures should be administered as required.

ATC code: A03BB01 Nospasm exerts a spasmolytic action on the smooth muscle of the gastrointestinal, biliary and genito-urinary tracts. As a quaternary ammonium derivative, Hyoscine-N-Butylbromide does not enter the central nervous system. Therefore, anticholinergic side effects at the central nervous system do not occur. Peripheral anticholinergic action results from a ganglionblocking action within the visceral wall as well as from an anti-muscarinic activity.

Absorption As a quaternary ammonium compound, Hyoscine-N-Butylbromide is highly polar and hence only partially absorbed following oral (8%) or rectal (3%) administration. After oral administration of single doses of Hyoscine-N-Butylbromide in the range of 20 to 400 mg, mean peak plasma concentrations between 0.11 ng/mL and 2.04 ng/mL were found at approximately 2 hours. In the same dose range, the observed mean AUC0-tz-values varied from 0.37 to 10.7 ng h/mL. The median absolute bioavailabilities of different dosage forms, i.e. Film-Coated Tablets, suppositories and oral solution, containing 100 mg of Hyoscine-NButylbromide each were found to be less than 1%. Distribution Because of its high affinity for muscarinic receptors and nicotinic receptors, Hyoscine-NButylbromide is mainly distributed on muscle cells of the abdominal and pelvic area as well as in the intramural ganglia of the abdominal organs. Plasma protein binding (albumin) of Hyoscine-N-Butylbromide is approximately 4.4%. Animal studies demonstrate that HyoscineN-Butylbromide does not pass the blood-brain barrier, but no clinical data to this effect is available. Hyoscine-N-Butylbromide (1 mM) has been observed to interact with the choline transport (1.4 nM) in epithelial cells of human placenta in vitro. Metabolism and elimination Following oral administration of single doses in the range of 100 to 400 mg, the terminal elimination half-lives ranged from 6.2 to 10.6 hours. The main metabolic pathway is the hydrolytic cleavage of the ester bond. Orally administered Hyoscine-N-Butylbromide is excreted in the faeces and in the urine. Studies in man show that 2 to 5% of radioactive doses is eliminated renally after oral, and 0.7 to 1.6% after rectal administration. Approximately 90% of recovered radioactivity can be found in the faeces after oral administration. The urinary excretion of Hyoscine-N-Butylbromide is less than 0.1% of the dose. The mean apparent oral clearances after oral doses of 100 to 400 mg range from 881 to 1420 L/min, whereas the corresponding volumes of distribution for the same range vary from 6.13 to 11.3 x 105 L, probably due to very low systemic availability. The metabolites excreted via the renal route bind poorly to the muscarinic receptors and are therefore not considered to contribute to the effect of the Hyoscine-N-Butylbromide.

In limited reproductive toxicity studies Hyoscine-N-Butylbromide showed no evidence of teratogenicity in rats at 200 mg/kg in the diet or in rabbits at 200 mg/kg by oral gavage or 50 mg/kg by subcutaneous injection. Fertility in the rat was not impaired at doses of up to 200 mg/kg in the diet.

Lactose BP 200, Maize Starch, Sodium Lauryl Sulphate, Magnesium Stearate, Purified Talc, Colloidal Silicon Dioxide, Polysorbate 80, Titanium Dioxide, Polyethylene Glycol MW 6000, Purified Talc, Hydroxypropyl Methycellulose, Purified Water.

None stated

Nospasm 10mg Tablets should be protected from light and stored in a dry place. Store below 30ºC

Transparent thermoformed PVC/PVDC 250 micron. Hard tempered aluminium foil 20 micron.Nospasm tablets are in blister packs of 30 & 100. Not all pack sizes may be marketed

None stated.