Meftal%252525252525252525252525252525252525252525252525252525252525252525252525252525252520spas

# Meftal spas ## Overview Meftal spas is a combination product containing mefenamic acid, a nonsteroidal anti-inflammatory drug (NSAID), and dicyclomine hydrochloride, an anticholinergic antispasmodic agent. Mefenamic acid provides analgesic and anti-inflammatory effects, while dicyclomine reduces smooth muscle spasms. ## Primary Indications * Pain associated with smooth muscle spasms, particularly in gynecological conditions (e.g., dysmenorrhea). * Abdominal pain related to gastrointestinal spasms. ## Adult Dosing * **Usual dose:** 1 tablet (mefenamic acid 250 mg, dicyclomine 20 mg) three times daily as needed for pain. * **Maximum dose:** Not explicitly defined for the combination, but for mefenamic acid, the maximum daily dose is typically 1500 mg, and for dicyclomine, it is 120 mg. Adhere to these individual component maximums. ## Pediatric Dosing Dosing for Meftal spas in pediatric patients has not been well established. Mefenamic acid pediatric dosing is typically 20-25 mg/kg/day divided into 3-4 doses, not to exceed 1500 mg/day. Dicyclomine pediatric dosing is generally 5-10 mg orally or intramuscularly every 4-6 hours, but caution is advised due to potential anticholinergic side effects in children. **Use in pediatric patients should be under strict medical supervision, and dosing should be individualized.** ## Dose Adjustments * **Renal impairment:** Use with caution. Mefenamic acid is renally excreted and can cause renal damage. Dose reduction may be necessary, especially in moderate to severe impairment. * **Hepatic impairment:** Use with caution. Mefenamic acid is metabolized by the liver. Dose reduction may be necessary in severe hepatic impairment. * **Elderly:** Increased risk of adverse effects, particularly gastrointestinal bleeding, renal dysfunction, and cardiovascular events. Use the lowest effective dose for the shortest duration. ## Contraindications * Hypersensitivity to mefenamic acid, dicyclomine, or other NSAIDs. * History of asthma, urticaria, or allergic-type reactions after aspirin or other NSAIDs. * Inflammatory bowel disease (Crohn's disease, ulcerative colitis). * Gastrointestinal bleeding or perforation. * Severe heart failure. * Severe renal or hepatic impairment. * Obstructive uropathy. * Myasthenia gravis. * Glaucoma (especially narrow-angle). * Gastrointestinal obstruction. * Ileus. * Lactation. ## Adverse Effects **Common:** * **Mefenamic acid:** Nausea, vomiting, diarrhea, abdominal pain, dyspepsia, dizziness, headache, rash. * **Dicyclomine:** Dry mouth, blurred vision, urinary retention, constipation, drowsiness, confusion. **Serious:** * **Mefenamic acid:** Gastrointestinal bleeding, ulceration, perforation; renal failure; cardiovascular thrombotic events (MI, stroke); hepatic failure; anaphylaxis; Stevens-Johnson syndrome/toxic epidermal necrolysis. * **Dicyclomine:** Severe anticholinergic effects (especially in elderly or those with underlying conditions), heat prostration. ## Key Drug Interactions * **Other NSAIDs, aspirin, corticosteroids, SSRIs, anticoagulants (e.g., warfarin):** Increased risk of gastrointestinal bleeding. * **Diuretics, ACE inhibitors, ARBs:** Reduced antihypertensive effect and increased risk of renal dysfunction. * **Lithium, Methotrexate:** Increased serum levels and potential for toxicity. * **Anticholinergic agents:** Additive anticholinergic effects. * **Probenecid:** May increase serum levels of mefenamic acid. ## Monitoring * **Gastrointestinal symptoms:** Monitor for signs and symptoms of bleeding (e.g., melena, hematemesis). * **Renal function:** Monitor BUN and creatinine, especially in patients with pre-existing renal disease or those at risk. * **Hepatic function:** Monitor LFTs, especially in patients with liver disease. * **Blood pressure:** NSAIDs can increase blood pressure. * **Signs of anticholinergic toxicity:** Monitor for confusion, drowsiness, urinary retention, dry mouth. ## Clinical Pearls * Use the lowest effective dose for the shortest duration necessary to minimize risks. * Administer with food or milk to reduce gastrointestinal upset. * Discontinue immediately if signs of serious gastrointestinal bleeding, renal impairment, or hypersensitivity occur. * Be cautious in elderly patients due to increased risk of adverse effects. * The anticholinergic effects of dicyclomine can be exacerbated by other medications with anticholinergic properties. --- **Disclaimer:** This information is intended for clinical professionals. It is essential to consult the most current prescribing information and relevant guidelines for complete and up-to-date details before making treatment decisions.