Meftal%252525252525252525252525252525252525252525252525252525252525252525252525252525252525252520spas

# Meftal spas ## Overview Meftal spas is a combination product containing mefenamic acid, a nonsteroidal anti-inflammatory drug (NSAID), and dicyclomine hydrochloride, an anticholinergic antispasmodic. Mefenamic acid works by inhibiting prostaglandin synthesis, reducing inflammation, pain, and fever. Dicyclomine reduces smooth muscle spasm by blocking muscarinic receptors. ## Primary Indications * Symptomatic relief of mild to moderate pain associated with: * Gastrointestinal spasms * Dysmenorrhea * Headaches * Dental pain * Post-operative pain ## Adult Dosing * **Mefenamic acid component:** 250 mg to 500 mg orally every 6 to 8 hours as needed. * **Dicyclomine hydrochloride component:** 10 mg to 20 mg orally every 6 to 8 hours as needed. * **Meftal spas tablet:** Typically contains 250 mg mefenamic acid and 20 mg dicyclomine hydrochloride. The usual dose is one tablet orally every 6 to 8 hours as needed. * **Maximum dose:** Mefenamic acid: 1500 mg/day. Dicyclomine: 80 mg/day. ## Pediatric Dosing Specific dosing for meftal spas in pediatrics is not well-established. Dosing for individual components may be considered under strict medical supervision: * **Mefenamic acid:** * Children 6 months to 12 years: 6.5 mg/kg orally every 6 hours. Do not exceed 500 mg/day. * **Dicyclomine hydrochloride:** * Generally not recommended in infants under 6 months due to potential for serious adverse effects, including respiratory depression and coma. * For children over 6 months, dosing is highly variable and depends on indication and local protocol. ## Dose Adjustments * **Renal impairment:** Use with caution. Dose reduction may be necessary. Mefenamic acid is renally excreted. * **Hepatic impairment:** Use with caution. Dose reduction may be necessary. * **Elderly:** Increased risk of adverse effects, particularly gastrointestinal bleeding and renal toxicity. Use the lowest effective dose. ## Contraindications * Known hypersensitivity to mefenamic acid, dicyclomine, or other NSAIDs. * History of asthma, urticaria, or allergic-type reactions after aspirin or other NSAIDs. * Inflammatory bowel disease (e.g., Crohn's disease, ulcerative colitis). * Gastrointestinal bleeding or perforation. * Severe renal or hepatic impairment. * Severe heart failure. * Obstructive uropathy or gastrointestinal obstruction. * Glaucoma (relative contraindication for dicyclomine). * Myasthenia gravis (relative contraindication for dicyclomine). * Infants under 6 months of age (for dicyclomine component). ## Adverse Effects **Common:** * **Gastrointestinal:** Nausea, vomiting, diarrhea, abdominal pain, dyspepsia, constipation. * **Central Nervous System (CNS):** Drowsiness, dizziness, headache, nervousness. * **Anticholinergic (dicyclomine):** Dry mouth, blurred vision, urinary retention, constipation, confusion. **Serious:** * **Gastrointestinal:** Serious bleeding, ulceration, perforation. * **Cardiovascular:** Increased risk of myocardial infarction, stroke, and heart failure. * **Renal:** Renal papillary necrosis, interstitial nephritis, renal failure. * **Hepatic:** Hepatotoxicity. * **Hematologic:** Anemia, agranulocytosis, aplastic anemia. * **Hypersensitivity:** Severe allergic reactions, Stevens-Johnson syndrome, toxic epidermal necrolysis. * **CNS (dicyclomine):** Hallucinations, confusion, seizures, coma, especially in children. ## Key Drug Interactions * **Anticoagulants (e.g., warfarin):** Increased risk of bleeding. * **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding. * **Other NSAIDs and Aspirin:** Increased risk of gastrointestinal adverse effects and reduced efficacy of low-dose aspirin. * **SSRIs and SNRIs:** Increased risk of gastrointestinal bleeding. * **Diuretics and ACE inhibitors:** Reduced antihypertensive effect and increased risk of renal impairment. * **Lithium:** Increased serum lithium levels. * **Methotrexate:** Increased risk of methotrexate toxicity. * **Anticholinergics:** Additive anticholinergic effects with dicyclomine. * **Proton Pump Inhibitors (PPIs):** May increase the risk of fracture associated with NSAID use. ## Monitoring * **Renal function:** Baseline and periodic assessment of serum creatinine and BUN, especially in patients with pre-existing renal disease or those on long-term therapy. * **Hepatic function:** Baseline and periodic assessment of liver enzymes, especially in patients with liver disease. * **Gastrointestinal symptoms:** Monitor for signs of bleeding or ulceration (e.g., melena, hematemesis). * **Blood pressure:** Monitor for potential increases in blood pressure. * **Signs of anticholinergic toxicity:** Monitor for dry mouth, blurred vision, urinary retention, confusion, especially in the elderly or those with impaired cognition. ## Clinical Pearls * Meftal spas should be used at the lowest effective dose for the shortest duration necessary to minimize the risk of serious adverse events. * Due to the anticholinergic effects of dicyclomine, caution is advised in the elderly and in patients with conditions such as glaucoma, prostatic hypertrophy, or cardiac disease. * Mefenamic acid is generally not recommended for long-term use. * Concomitant use with alcohol should be avoided due to increased risk of gastrointestinal irritation. * Patients should be advised to report any signs of gastrointestinal bleeding, cardiovascular events, or severe allergic reactions immediately. *** **Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information, product monographs, and clinical guidelines before making any treatment decisions. Local protocols may vary.