Meftal%25252525252525252525252525252525252525252525252525252525252525252525252525252525252520spas

# Meftal spas ## Overview Meftal spas is a brand name for a combination product containing **mefenamic acid** (a nonsteroidal anti-inflammatory drug - NSAID) and **dicyclomine hydrochloride** (an anticholinergic antispasmodic). ## Primary Indications * Symptomatic relief of abdominal pain and cramps associated with irritable bowel syndrome (IBS) and other gastrointestinal disorders. * Relief of primary dysmenorrhea. ## Adult Dosing * **Gastrointestinal Spasms/IBS:** 1 tablet (mefenamic acid 250 mg / dicyclomine HCl 10 mg) every 8 hours as needed. Do not exceed 4 doses in 24 hours. * **Primary Dysmenorrhea:** 1 tablet (mefenamic acid 250 mg / dicyclomine HCl 10 mg) every 8 hours as needed. Treatment should not exceed 3 days. * **Maximum Daily Dose:** Mefenamic acid: 1500 mg/day. Dicyclomine HCl: 40 mg/day. ## Pediatric Dosing * **There is no established pediatric dosing for Meftal spas.** Use in children is generally not recommended due to lack of specific data and potential risks associated with NSAIDs and anticholinergics in this population. ## Dose Adjustments * **Renal Impairment:** Caution advised. Mefenamic acid is renally excreted. Dose reduction may be necessary based on severity of impairment and patient response. * **Hepatic Impairment:** Caution advised. Mefenamic acid is metabolized by the liver. Dose reduction may be necessary. * **Elderly:** Use with caution. Increased risk of gastrointestinal bleeding, renal, and hepatic adverse effects. ## Contraindications * Hypersensitivity to mefenamic acid, dicyclomine, or other NSAIDs. * 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. * Inflammatory bowel disease (e.g., ulcerative colitis, Crohn's disease) due to potential for GI perforation. * Gastrointestinal obstruction, paralytic ileus, severe constipation, glaucoma, or myasthenia gravis (due to dicyclomine component). * Pyloric or duodenal obstruction, achalasia, or cardiospasm. * In children under 6 months of age or under 20 lbs (9 kg). ## Adverse Effects * **Common:** Nausea, vomiting, diarrhea, constipation, abdominal pain, dizziness, headache, nervousness, dry mouth, blurred vision, urinary retention. * **Serious:** * **Gastrointestinal:** Severe bleeding, ulceration, perforation. * **Cardiovascular:** Hypertension, edema, thrombosis. * **Renal:** Renal failure, interstitial nephritis. * **Hepatic:** Hepatotoxicity. * **Hematologic:** Anemia, leukopenia, thrombocytopenia. * **Dicyclomine-related:** Anticholinergic effects (e.g., confusion, delirium, especially in the elderly), heat prostration. ## Key Drug Interactions * **Anticoagulants (e.g., warfarin):** Increased risk of bleeding. * **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding. * **SSRIs/SNRIs:** Increased risk of gastrointestinal bleeding. * **Other NSAIDs/Aspirin:** Increased risk of gastrointestinal side effects and bleeding. * **ACE inhibitors, ARBs, diuretics:** NSAIDs can diminish their antihypertensive effect and increase risk of renal impairment. * **Lithium:** NSAIDs can increase lithium levels. * **Methotrexate:** NSAIDs can increase methotrexate toxicity. * **Anticholinergics:** Additive anticholinergic effects. * **Antacids/Cholestyramine:** May decrease absorption of mefenamic acid. ## Monitoring * **Renal function:** Baseline and periodic monitoring, especially in patients with pre-existing renal disease. * **Hepatic function:** Baseline and periodic monitoring. * **Gastrointestinal symptoms:** Monitor for signs and symptoms of bleeding (e.g., melena, hematemesis). * **Blood pressure:** Especially in patients with hypertension. * **Dicyclomine side effects:** Monitor for anticholinergic effects, particularly in the elderly. ## Clinical Pearls * Meftal spas is a combination product; consider the individual risks and benefits of both mefenamic acid and dicyclomine. * Due to the anticholinergic component (dicyclomine), it is generally **not recommended for use in very young children or the elderly** due to the risk of serious adverse effects. * The maximum duration of use for dysmenorrhea is typically 3 days. * Always advise patients to take with food or milk to minimize gastrointestinal upset. * Discontinue use if severe allergic reactions, severe gastrointestinal bleeding, or cardiovascular events occur. *** ***Disclaimer:** This information is intended for healthcare professionals and does not replace the need to consult the official prescribing information and any local guidelines. Always verify current drug information and specific dosing recommendations before prescribing or dispensing medication. Availability of specific brand names and formulations may vary by region.