Meftal%252525252525252525252525252525252525252525252525252520spas

### Meftal Spas **Overview** Meftal Spas is a combination product containing mefenamic acid, a nonsteroidal anti-inflammatory drug (NSAID), and hyoscine butylbromide, an anticholinergic antispasmodic. **Primary Indications** * Painful menstruation (dysmenorrhea) * Abdominal cramps and pain associated with gastrointestinal disorders. **Adult Dosing** * **Dysmenorrhea:** 250-500 mg mefenamic acid (equivalent to 1-2 tablets) every 4-6 hours as needed, not to exceed 1500 mg per day. Hyoscine butylbromide is typically co-administered at 10-20 mg every 4-6 hours as needed. * **Gastrointestinal pain:** Dosing is variable and depends on the severity of pain and local protocols. Generally, 250-500 mg mefenamic acid with 10-20 mg hyoscine butylbromide every 4-6 hours as needed. **Pediatric Dosing** Mefenamic acid dosing in children is typically weight-based. Hyoscine butylbromide dosing in pediatrics is not well-established and should be approached with caution and at the discretion of the prescriber. * **Mefenamic acid:** 5-7 mg/kg/dose orally every 6-8 hours. Maximum daily dose is 500 mg for children under 12 years and 1000 mg for children 12 years and older. * **Hyoscine butylbromide:** Due to limited data, specific pediatric doses are not routinely recommended. Use should be based on clinical judgment and individual patient response. **Dose Adjustments** * **Renal Impairment:** Mefenamic acid should be used with caution and at reduced doses in patients with moderate to severe renal impairment. The drug is contraindicated in severe renal impairment. * **Hepatic Impairment:** Mefenamic acid should be used with caution in patients with hepatic impairment. The drug is contraindicated in severe hepatic impairment. **Contraindications** * Known hypersensitivity to mefenamic acid, hyoscine butylbromide, or other NSAIDs. * Active gastrointestinal bleeding or ulceration. * Severe renal or hepatic impairment. * Myasthenia gravis. * Tachyarrhythmias. * Angle-closure glaucoma. * Ileus, paralytic ileus, intestinal atony, megacolon. * Prostatic hypertrophy with urinary retention. **Adverse Effects** * **Mefenamic Acid:** Gastrointestinal upset (nausea, vomiting, diarrhea, constipation, abdominal pain), headache, dizziness, rash, peptic ulceration, bleeding, renal toxicity, hepatic dysfunction. * **Hyoscine Butylbromide:** Dry mouth, blurred vision, dilated pupils, photophobia, urinary retention, constipation, tachycardia, drowsiness. **Key Drug Interactions** * **Warfarin and other anticoagulants:** Increased risk of bleeding. * **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding. * **ACE inhibitors, ARBs, diuretics:** Reduced antihypertensive effect and increased risk of renal impairment. * **Lithium:** Increased serum lithium levels. * **Methotrexate:** Increased risk of methotrexate toxicity. * **Anticholinergic agents:** Additive anticholinergic effects. * **Antacids:** May decrease absorption of mefenamic acid. **Monitoring** * Monitor for signs and symptoms of gastrointestinal bleeding or perforation. * Monitor renal function (BUN, creatinine) and liver function tests (AST, ALT). * Monitor for signs of hypersensitivity reactions. * Monitor for adverse effects related to anticholinergic activity. **Clinical Pearls** * Meftal Spas should be taken with food or milk to minimize gastrointestinal upset. * Shortest duration of therapy is recommended due to the risk of gastrointestinal and cardiovascular events associated with NSAIDs. * Due to the anticholinergic effects of hyoscine butylbromide, caution should be exercised in the elderly and in patients with conditions that may be exacerbated by anticholinergics. * Combination products limit dose titration of individual components; consider separate agents if precise dosing is required. *** **Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant literature before making clinical decisions. Local guidelines and protocols may influence drug use and dosing.