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# Meftal Spas
## Overview
Meftal Spas is a combination medication containing mefenamic acid, a nonsteroidal anti-inflammatory drug (NSAID), and dicyclomine hydrochloride, an anticholinergic antispasmodic. Mefenamic acid reduces inflammation and pain by inhibiting prostaglandin synthesis. Dicyclomine reduces gastrointestinal spasms by blocking muscarinic receptors.
## Primary Indications
* Abdominal pain associated with gastrointestinal spasms.
* Dysmenorrhea (menstrual cramps).
## Adult Dosing
* **Abdominal Pain/Spasms:** 1 tablet (250 mg mefenamic acid / 20 mg dicyclomine) orally every 8 hours as needed.
* **Dysmenorrhea:** 1 tablet (250 mg mefenamic acid / 20 mg dicyclomine) orally every 8 hours as needed, typically starting with the onset of pain.
* Maximum dose: Local protocols should be consulted; however, generally avoid exceeding 1500 mg mefenamic acid per day. Dicyclomine maximum is typically 40 mg per day.
## Pediatric Dosing
Dosing for children is not well-established and requires careful consideration of weight and age. Consult specific pediatric guidelines or a pediatrician. Mefenamic acid doses in children can range from 5-7 mg/kg/dose every 6-8 hours. Dicyclomine is generally not recommended for infants under 6 months due to potential anticholinergic adverse effects.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Mefenamic acid is primarily renally excreted. Dose reduction may be necessary in severe impairment.
* **Hepatic Impairment:** Use with caution. Mefenamic acid can exacerbate liver dysfunction.
* **Elderly:** Increased risk of gastrointestinal bleeding, renal, and hepatic adverse effects. Use the lowest effective dose.
## Contraindications
* Hypersensitivity to mefenamic acid, dicyclomine, or other NSAIDs/anticholinergics.
* Active gastrointestinal ulceration or bleeding.
* Severe renal or hepatic impairment.
* Inflammatory bowel disease.
* Glaucoma (especially angle-closure).
* Myasthenia gravis.
* Obstructive uropathy.
* Uncontrolled heart failure.
* Late pregnancy (third trimester).
## Adverse Effects
* **Mefenamic Acid:** Gastrointestinal upset (nausea, vomiting, diarrhea, constipation, abdominal pain), dyspepsia, heartburn, occult blood loss, potentially serious gastrointestinal bleeding or perforation. Renal toxicity, fluid retention, edema, hypertension, headache, dizziness, rash, photosensitivity.
* **Dicyclomine:** Anticholinergic effects: dry mouth, blurred vision, urinary retention, constipation, drowsiness, confusion, dizziness.
## Key Drug Interactions
* **Other NSAIDs/Aspirin:** Increased risk of gastrointestinal bleeding.
* **Anticoagulants (e.g., Warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding.
* **Diuretics/ACE Inhibitors/ARBs:** Reduced antihypertensive effect, increased risk of renal dysfunction.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
* **Anticholinergics (e.g., some antihistamines, tricyclic antidepressants):** Additive anticholinergic effects.
* **CNS Depressants (e.g., sedatives, alcohol):** Increased sedation.
## Monitoring
* **Renal Function:** Baseline and periodic monitoring of serum creatinine and BUN, especially in patients with pre-existing renal disease or those on long-term therapy.
* **Hepatic Function:** Baseline and periodic monitoring of liver enzymes, especially in patients with hepatic impairment.
* **Gastrointestinal Symptoms:** Monitor for signs and symptoms of bleeding (e.g., melena, hematemesis) or ulceration.
* **Blood Pressure:** Monitor for potential increases.
* **Signs of Anticholinergic Overuse:** Monitor for dry mouth, blurred vision, urinary retention, constipation.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Administer with food or milk to reduce gastrointestinal upset.
* Caution patients about activities requiring mental alertness due to potential CNS effects of dicyclomine.
* Advise patients to report any signs of bleeding, severe abdominal pain, or persistent side effects.
* The combination should be used cautiously, as the risks of both agents are present.
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**Disclaimer:** This information is intended for healthcare professionals and does not substitute for professional medical judgment. Always verify current prescribing information and consult official drug compendia for the most up-to-date and complete details before making any treatment decisions.
