|(mepenzolate bromide USP)
CANTIL tablets for oral administration contain 25 mg mepenzolate bromide USP.
The anticholinergic agent mepenzolate bromide USP chemically is 3-[(hydroxydiphenylacetyl)oxy]-1,1-dimethylpiperidinium
bromide and has the following structure:
Mepenzolate bromide occurs as a white or light cream-colored powder, which is freely soluble in methanol, slightly
soluble in water and chloroform, and practically insoluble in ether.
Each yellow tablet contains 25 mg mepenzolate bromide USP. This tablet also contains inactive ingredients: confectioners’
sugar, corn starch, corn syrup solids, FD&C Yellow No. 5 (tartrazine), (see PRECAUTIONS, General), lactose, magnesium
stearate and microcrystalline cellulose.
CANTIL diminishes gastric acid and pepsin secretion. CANTIL also suppresses spontaneous contractions of the colon.
Pharmacologically, it is a post-ganglionic parasympathetic inhibitor.
Radiotracer studies in which CANTIL-14C was used in animals and humans indicate the absorption following oral administration,
as with other quaternary ammonium compounds, is low. Between 3 and 22% of an orally administered dose is excreted in the urine
over a 5-day period, with the majority of the radioactivity appearing on Day 1. The remainder appears in the next 5 days in
the feces and presumably has not been absorbed.
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INDICATIONS AND USAGE
CANTIL is indicated for use as adjunctive therapy in the treatment of peptic ulcer.
It has not been shown to be effective in contributing to the healing of peptic ulcer, decreasing the rate of recurrence,
or preventing complications.
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||Obstructive uropathy (for example, bladder neck obstruction due to prostatic hypertrophy)
||Obstructive disease of the gastrointestinal tract (for example, pyloroduodenal stenosis, achalasia)
||Intestinal atony of the elderly or debilitated patient
(See PRECAUTIONS, Geriatric
||Unstable cardiovascular status in acute gastrointestinal hemorrhage
||Toxic megacolon complicating ulcerative colitis
||Allergic or idiosyncratic reactions to CANTIL or related compounds
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In the presence of high environmental temperature, heat prostration
(fever and heat stroke due to decreased sweating) can occur with use of CANTIL.
Diarrhea may be an early symptom of incomplete intestinal obstruction especially in patients with ileostomy or
colostomy. In this instance, treatment with this drug would be inappropriate and possibly harmful.
CANTIL may produce drowsiness or blurred vision. The patient should be cautioned regarding activities requiring
mental alertness such as operating a motor vehicle or other machinery or performing hazardous work while taking this drug.
With overdosage, a curare-like action may occur i.e., neuromuscular blockage leading to muscular weakness and possible paralysis.
It should be noted that the use of anticholinergic drugs in the treatment of gastric ulcer may produce a delay in
gastric emptying time and may complicate such therapy (antral stasis).
Psychosis has been reported in sensitive individuals given anticholinergic drugs. CNS signs and symptoms include
confusion, disorientation, short-term memory loss, hallucinations, dysarthria, ataxia, coma, euphoria, decreased
anxiety, fatigue, insomnia, agitation and mannerisms and inappropriate affect. These CNS signs and symptoms usually
resolve within 12 to 24 hours after discontinuation of the medication.
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Use CANTIL with caution in the elderly (see PRECAUTIONS, Geriatric Use)
and in all patients with:
||Hepatic or renal disease
||Ulcerative colitis. Large doses may suppress intestinal motility to the point of producing a paralytic ileus and for this reason precipitate or aggravate “toxic megacolon,” a serious complication of the disease.
||Hiatal hernia associated with reflux esophagitis, since anticholinergic drugs may aggravate this condition.
||Coronary heart disease
||Congestive heart failure
Investigate any tachycardia before giving anticholinergic (atropine-like) drugs since they may increase the heart rate.
This product contains FD&C Yellow No. 5 (tartrazine), which may cause allergic-type reactions (including bronchial asthma)
in certain susceptible individuals. Although the overall incidence of FD&C Yellow No. 5 (tartrazine) sensitivity in the
general population is low, it is frequently seen in patients who also have aspirin sensitivity.
Information for Patients
CANTIL may produce drowsiness or blurred vision. The patient should be cautioned regarding activities requiring mental
alertness, such as operating a motor vehicle or other machinery or performing hazardous work while taking this drug.
The following agents may increase certain actions or side effects of anticholinergic drugs: amantadine, antiarrhythmic
agents of class I (e.g., quinidine), antihistamines, antipsychotic agents (e.g., phenothiazines), benzodiazepines,
MAO inhibitors, narcotic analgesics (e.g., meperidine), nitrates and nitrites, sympathomimetic agents, tricyclic
antidepressants, and other drugs having anticholinergic activity.
Anticholinergics antagonize the effects of antiglaucoma agents. Anticholinergic drugs in the presence of increased
intraocular pressure may be hazardous when taken concurrently with agents such as corticosteroids. (See
Anticholinergic agents may affect gastrointestinal absorption of various drugs, such as slowly dissolving dosage forms
of digoxin; increased serum digoxin concentrations may result. Anticholinergic drugs may antagonize the effects of drugs
that alter gastrointestinal motility, such as metoclopramide. Because antacids may interfere with the absorption of
anticholinergic agents, simultaneous use of these drugs should be avoided.
The inhibiting effects of anticholinergic drugs on gastric hydrochloric acid secretion are antagonized by agents used
to treat achlorhydria and those used to test gastric secretion.
Carcinogenesis, Mutagenesis, Impairment of Fertility
No data are available on long-term potential for carcinogenicity, mutagenicity, or impairment of fertility in animals or humans.
Teratogenic Effects. Pregnancy Category B. Reproduction studies have been performed in rats and rabbits at doses up
to 30 times the human dose (based on 50 kg weight) and have shown no evidence of impaired fertility or harm to the
animal fetus. There are, however, no adequate and well-controlled studies with CANTIL in pregnant women. Because
animal reproduction studies are not always predictive of human response, CANTIL should be used during pregnancy
only if clearly needed.
Nonteratogenic Effects. No data are available on nonteratogenic effects in the fetus or newborn infant.
It is not known whether CANTIL is secreted in human milk. Because many drugs are excreted in human milk,
caution should be exercised when CANTIL is administered to a nursing woman.
Safety and effectiveness in pediatric patients have not been established. Studies in newborn animals (rats)
show that younger animals are more sensitive to the toxic effects of CANTIL than are older animals.
Clinical studies of CANTIL did not include sufficient numbers of subjects aged 65 and over to determine
whether they respond differently from younger subjects. Other reported clinical experience has not identified
differences in responses between the elderly and younger patients. In general, dose selection for an elderly
patient should be cautious, usually starting at the low end of the dosing range (see DOSAGE AND ADMINISTRATION),
reflecting the greater frequency of decreased hepatic, renal or cardiac function (see PRECAUTIONS, General),
and of concomitant disease or other drug therapy. (See
PRECAUTIONS, Drug Interactions.)
CANTIL is contraindicated in intestinal atony of the elderly. (See
CONTRAINDICATIONS.) CANTIL should be used
with caution in the elderly. (See PRECAUTIONS, General.)
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Precise frequency data from controlled clinical studies with CANTIL are not available.
Gastrointestinal System: vomiting, nausea, constipation, loss of taste, bloated feeling, dry mouth
Central Nervous System: mental confusion, dizziness, weakness, drowsiness, headache, nervousness
Ophthalmologic: increased ocular tension, cycloplegia, blurred vision, dilation of the pupil
Dermatologic-Hypersensitivity: anaphylaxis, urticaria
Cardiovascular: tachycardia, palpitations
Genitourinary: urinary retention, urinary hesitancy
Miscellaneous: decreased sweating, drowsiness, insomnia, impotence, suppression of lactation
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DRUG ABUSE AND DEPENDENCE
Tolerance, abuse, or dependence has not been reported with CANTIL.
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Signs and Symptoms
The signs and symptoms of overdosage are headache; nausea; vomiting; blurred vision; dilated pupils; hot,
dry skin; dizziness; dryness of the mouth; difficulty in swallowing; and CNS stimulation. A curare-like
action may occur (i.e., neuromuscular blockade leading to muscular weakness and possible paralysis).
The oral LD50 is greater than 750 mg/kg in mice and greater than 1000 mg/kg in rats.
Maximum Human Dose Recorded
The maximum human dose recorded is 375 to 500 mg in a 4-year-old child (no adverse effects reported)
and 500 to 750 mg in a 30-year-old adult (resulted in death).
It is not known if the drug is dialyzable.
Treatment should consist of gastric lavage, emetics, and activated charcoal. Sedatives (e.g., short-acting
barbiturates, benzodiazepines) may be used for management of overt signs of excitement. If indicated, an
appropriate parenteral cholinergic agent may be used as an antidote.
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DOSAGE AND ADMINISTRATION
The usual adult dose is 1 or 2 tablets (25 or 50 mg) 4 times a day preferably with meals and at bedtime. Begin
with the lower dosage when possible and adjust subsequently according to the patient’s response.
Safety and efficacy in pediatric patients have not been established.
In general, dose selection for an elderly patient should be cautious, usually starting at the low end
of the dosing range, reflecting the greater frequency of decreased hepatic, renal or cardiac function,
and of concomitant disease or other drug therapy. (See PRECAUTIONS, Geriatric Use.)
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25 mg mepenzolate bromide, compressed yellow tablets debossed MERRELL 37.
NDC 0068-0037-01: bottles of 100
Keep tightly closed. Store at room temperature, preferably below 86°F. Protect from excessive heat. Dispense
in tight containers with child-resistant closure.
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Rev. February 2006
sanofi-aventis U.S. LLC
Bridgewater, NJ 08807
©2006 sanofi-aventis U.S. LLC