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# Meftal spas
## Overview
Meftal spas is a combination product containing mefenamic acid (a nonsteroidal anti-inflammatory drug, NSAID) and dicyclomine hydrochloride (an anticholinergic antispasmodic).
## Primary Indications
* Symptomatic relief of mild to moderate pain associated with smooth muscle spasms, such as in dysmenorrhea, abdominal pain, and gastrointestinal spasms.
## Adult Dosing
* **Meftal spas tablet:** 1 tablet (250 mg mefenamic acid / 20 mg dicyclomine HCl) orally every 8 hours as needed.
* **Maximum dose:** Not explicitly defined, but prolonged use and higher doses of NSAIDs increase the risk of adverse effects. Limit duration of use to the period of symptomatic relief.
## Pediatric Dosing
* Dosing for pediatric patients is not established or recommended for this combination product.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Mefenamic acid is primarily eliminated by the kidneys; dose reduction may be necessary in severe impairment, though specific guidelines are lacking.
* **Hepatic Impairment:** Use with caution. Mefenamic acid is metabolized in the liver; dose reduction may be necessary in severe impairment, though specific guidelines are lacking.
* **Elderly:** Increased risk of adverse effects, particularly gastrointestinal bleeding and renal events. Use with caution and at the lowest effective dose.
## Contraindications
* Hypersensitivity to mefenamic acid, dicyclomine, or any component of the formulation.
* Patients with a history of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Severe renal impairment.
* Severe hepatic impairment.
* Intestinal obstruction or paralytic ileus.
* Glaucoma (especially narrow-angle).
* Myasthenia gravis.
* Severe ulcerative colitis.
* Prostatic hypertrophy.
* Cardiomyopathy.
* Acute hemorrhage.
## Adverse Effects
* **Common (mefenamic acid):** Nausea, vomiting, diarrhea, abdominal pain, constipation, dyspepsia, dizziness, headache.
* **Common (dicyclomine):** Dry mouth, blurred vision, dilated pupils, photophobia, urinary retention, constipation, drowsiness, confusion (especially in elderly).
* **Serious (mefenamic acid):** Gastrointestinal bleeding, ulceration, perforation; renal failure; hepatotoxicity; cardiovascular thrombotic events; hypersensitivity reactions (including anaphylaxis).
* **Serious (dicyclomine):** Severe anticholinergic toxicity, heat prostration.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding with mefenamic acid.
* **Other NSAIDs, corticosteroids, SSRIs:** Increased risk of gastrointestinal bleeding with mefenamic acid.
* **Diuretics, ACE inhibitors, ARBs:** Reduced antihypertensive effect and increased risk of renal impairment with mefenamic acid.
* **Lithium:** Increased lithium levels with mefenamic acid.
* **Methotrexate:** Increased methotrexate toxicity with mefenamic acid.
* **Anticholinergic agents:** Additive anticholinergic effects with dicyclomine.
* **MAO inhibitors:** May potentiate anticholinergic effects.
* **Antacids:** May reduce absorption of dicyclomine.
## Monitoring
* **Renal function:** Monitor creatinine and BUN, especially in patients with pre-existing renal disease or those at risk.
* **Hepatic function:** Monitor LFTs periodically, especially with long-term use.
* **Gastrointestinal symptoms:** Assess for signs of bleeding or ulceration (e.g., melena, hematemesis).
* **Signs of anticholinergic effects:** Monitor for dry mouth, blurred vision, urinary retention, and cognitive changes.
## Clinical Pearls
* Meftal spas should be used for the shortest duration necessary to control symptoms.
* The risk of gastrointestinal bleeding and renal toxicity increases with higher doses and longer duration of NSAID use.
* Dicyclomine can cause significant anticholinergic side effects, particularly in the elderly. Patients should be advised about potential side effects like dry mouth, blurred vision, and difficulty urinating.
* Patients with a history of asthma, especially those with aspirin sensitivity, should be cautioned due to the NSAID component.
* Combination products may not allow for individual dose titration of each component, which can be a disadvantage.
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**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant clinical guidelines for complete details before making any treatment decisions.
