Meftal%252525252525252525252525252525252525252525252525252525252525252525252520spas

# 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 Meftal spas is indicated for the symptomatic relief of mild to moderate pain and spasms associated with: * Dysmenorrhea * Gastrointestinal spasms (e.g., irritable bowel syndrome, diverticulitis) * Urogenital spasms ## Adult Dosing * **Typical Dose:** 1 tablet (mefenamic acid 250 mg / dicyclomine HCl 10 mg) taken orally 3 times daily. * **Maximum Dose:** Not to exceed 1 tablet 3 times daily. The duration of use should generally not exceed 7 days. ## Pediatric Dosing * Safety and efficacy in pediatric patients have not been established. Use is not recommended. ## Dose Adjustments * **Renal Impairment:** Mefenamic acid is renally eliminated. Use with caution in patients with pre-existing renal disease. Dose adjustments may be necessary; consult local protocols. * **Hepatic Impairment:** Mefenamic acid can cause hepatic impairment. Use with caution. * **Elderly:** Elderly patients may be more susceptible to adverse effects, particularly gastrointestinal bleeding and renal toxicity. ## 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. * Severe heart failure. * Intestinal obstruction, paralytic ileus, severe ulcerative colitis, toxic megacolon. * Myasthenia gravis. * Glaucoma. * Infants less than 6 months of age. ## Adverse Effects **Common:** * **Gastrointestinal:** Nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia. * **Central Nervous System:** Dizziness, drowsiness, headache. * **Anticholinergic (Dicyclomine):** Dry mouth, blurred vision, urinary retention, constipation, drowsiness, confusion. **Serious:** * **Gastrointestinal:** Serious gastrointestinal bleeding, ulceration, and perforation. * **Cardiovascular:** Increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke. * **Renal:** Renal papillary necrosis and other renal injury. * **Hepatic:** Liver enzyme elevations, hepatitis, jaundice. * **Hematologic:** Anemia, leukopenia, thrombocytopenia, aplastic anemia, agranulocytosis. * **Dermatologic:** Severe skin reactions (e.g., Stevens-Johnson syndrome, toxic epidermal necrolysis). * **Ophthalmologic (Dicyclomine):** Increased intraocular pressure. ## Key Drug Interactions * **Other NSAIDs, Aspirin:** Increased risk of gastrointestinal bleeding and other adverse effects. * **Anticoagulants (e.g., Warfarin):** Increased risk of bleeding. * **Corticosteroids:** Increased risk of gastrointestinal bleeding. * **Diuretics, ACE Inhibitors, ARBs:** Reduced antihypertensive effect and increased risk of renal impairment. * **Lithium:** Mefenamic acid can increase lithium levels. * **Methotrexate:** Mefenamic acid can decrease methotrexate clearance. * **Anticholinergics:** Additive anticholinergic effects with dicyclomine. * **Antacids:** May reduce absorption of mefenamic acid. * **MAO Inhibitors, Tricyclic Antidepressants:** May potentiate anticholinergic effects of dicyclomine. ## Monitoring * **Renal function:** Monitor serum creatinine and BUN, especially in patients with risk factors. * **Hepatic function:** Monitor liver enzymes. * **Gastrointestinal symptoms:** Assess for signs and symptoms of bleeding or ulceration. * **Blood pressure:** Monitor, especially with concurrent antihypertensive use. * **Signs of anticholinergic effects:** Monitor for dry mouth, blurred vision, urinary retention, constipation, and confusion. ## Clinical Pearls * Meftal spas should be used at the lowest effective dose for the shortest duration necessary to control symptoms. * It is generally recommended to take with food or milk to minimize gastrointestinal upset. * Caution patients about operating machinery or driving due to potential drowsiness and blurred vision. * Due to the potential for serious gastrointestinal and cardiovascular events, patients should be counseled on the risks associated with NSAID use. * The anticholinergic component of dicyclomine can exacerbate conditions such as glaucoma and myasthenia gravis. *** **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 local guidelines before making any treatment decisions. Drug information can change rapidly, and individual patient factors must be considered.