Please check your internet connection and try again.
# Meftal spas
## Overview
Meftal spas is a combination product containing mefenamic acid and dicyclomine. Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) used for mild to moderate pain. Dicyclomine is an anticholinergic and antispasmodic agent used to relieve smooth muscle spasms.
## Primary Indications
* Pain associated with intestinal colic
* Abdominal pain due to spasm
## Adult Dosing
* **Mefenamic acid:** 500 mg orally every 8 hours. Maximum 1500 mg/day.
* **Dicyclomine:** 20 mg orally every 8 hours. Maximum 80 mg/day.
* **Meftal spas (combination product):** Typically contains specific strengths of both mefenamic acid and dicyclomine. Dosing is usually one tablet orally every 8 hours as needed for pain.
## Pediatric Dosing
* Dosing for children is not well-established for this combination product. Use with caution and consider individual component dosing if appropriate and under expert guidance.
* **Mefenamic acid (pediatric):** Generally **not recommended** for children under 14 years for anti-inflammatory use. For symptomatic relief of mild to moderate pain, dosing can be: 6.5 mg/kg orally every 6 hours as needed. Maximum 4 doses in 24 hours.
* **Dicyclomine (pediatric):** Generally **not recommended** for infants under 6 months due to risk of serious side effects, including respiratory depression and death. For infants 6 months and older, dosing is highly variable and requires careful titration. For children: 10 mg orally 3 to 4 times daily.
## Dose Adjustments
* **Renal impairment:** Use with caution. Mefenamic acid is generally **contraindicated** in severe renal impairment. Dicyclomine is renally excreted; dose adjustment may be needed in significant renal impairment.
* **Hepatic impairment:** Use with caution. Mefenamic acid can exacerbate liver dysfunction.
## Contraindications
* Hypersensitivity to mefenamic acid, dicyclomine, or other NSAIDs/anticholinergics.
* History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Active gastrointestinal bleeding or ulceration.
* Inflammatory bowel disease.
* Glaucoma.
* Myasthenia gravis.
* Severe renal or hepatic impairment.
* Infants under 6 months of age (for dicyclomine component).
* Uncontrolled ulcerative colitis.
* Obstructive uropathy.
* Obstructive gastrointestinal conditions.
## Adverse Effects
* **Mefenamic acid:** Gastrointestinal upset (nausea, vomiting, diarrhea, abdominal pain), headache, dizziness, rash, fluid retention, increased risk of cardiovascular events and serious gastrointestinal bleeding, perforation, or ulceration.
* **Dicyclomine:** Dry mouth, blurred vision, dilated pupils, photophobia, urinary hesitancy, constipation, nausea, abdominal distension, drowsiness, weakness, dizziness, confusion, hallucinations (especially in the elderly).
## Key Drug Interactions
* **Mefenamic acid:**
* Anticoagulants (e.g., warfarin): Increased risk of bleeding.
* Corticosteroids: Increased risk of GI ulceration and bleeding.
* Other NSAIDs/Aspirin: Increased risk of GI side effects and toxicity.
* ACE inhibitors, ARBs, Diuretics: Decreased antihypertensive effect, increased risk of renal impairment.
* Lithium: Increased lithium levels.
* Methotrexate: Increased methotrexate toxicity.
* **Dicyclomine:**
* Other anticholinergics (e.g., antihistamines, tricyclic antidepressants): Additive anticholinergic effects.
* MAO inhibitors: May potentiate anticholinergic effects.
* Amantadine: Additive anticholinergic effects.
## Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Monitor renal and hepatic function, especially with prolonged use or in patients with pre-existing impairment.
* Monitor for signs of anticholinergic toxicity (dry mouth, blurred vision, urinary retention, constipation, confusion).
* Assess pain relief and side effects regularly.
## Clinical Pearls
* Due to the potential for serious gastrointestinal adverse effects with NSAIDs, use the lowest effective dose for the shortest duration necessary.
* Mefenamic acid should be taken with food or milk to minimize gastric irritation.
* Anticholinergic side effects of dicyclomine can be more pronounced in elderly patients.
* The combination product may not be suitable for all patients requiring either mefenamic acid or dicyclomine individually, especially if dose adjustments are needed for one component but not the other.
***
**Disclaimer:** This information is intended for clinical professionals and does not replace comprehensive drug information resources or professional judgment. Always consult the most current prescribing information and relevant guidelines before making treatment decisions.
