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# Meftal spas
## Overview
Meftal spas is a combination medication containing mefenamic acid (a nonsteroidal anti-inflammatory drug, NSAID) and dicyclomine hydrochloride (an anticholinergic antispasmodic).
## Primary Indications
* Symptomatic relief of mild to moderate pain associated with smooth muscle spasms, particularly in gynecological conditions (e.g., dysmenorrhea) and gastrointestinal disorders.
## Adult Dosing
* **Usual Dose:** 1 tablet (mefenamic acid 250 mg, dicyclomine HCl 20 mg) three times daily.
* **Maximum Dose:** Consult product labeling. Mefenamic acid generally should not be used for more than 7 days continuously. Dicyclomine maximum dose is typically 160 mg daily.
## Pediatric Dosing
* Dosing in pediatric patients has not been established. Use is generally not recommended.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Mefenamic acid is renally excreted. Avoid in severe renal impairment.
* **Hepatic Impairment:** Use with caution. Mefenamic acid is metabolized by the liver. Avoid in severe hepatic impairment.
* **Elderly:** Use with caution, increased risk of adverse effects.
## Contraindications
* Hypersensitivity to mefenamic acid, dicyclomine, or other NSAIDs.
* History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Inflammatory bowel disease.
* Glaucoma (narrow-angle).
* Myasthenia gravis.
* Obstructive uropathy or gastrointestinal obstruction.
* Severe renal or hepatic impairment.
* Third trimester of pregnancy.
## Adverse Effects
* **Mefenamic Acid:** Gastrointestinal disturbances (nausea, vomiting, diarrhea, dyspepsia, abdominal pain), rash, dizziness, headache, tinnitus, renal toxicity, increased risk of cardiovascular thrombotic events, myocardial infarction, and stroke.
* **Dicyclomine:** Anticholinergic effects (dry mouth, blurred vision, constipation, urinary retention, drowsiness, confusion), tachycardia.
## Key Drug Interactions
* **NSAIDs:** Increased risk of gastrointestinal bleeding when used with corticosteroids, SSRIs, or other NSAIDs.
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Lithium, Methotrexate:** NSAIDs can decrease renal clearance and increase serum levels.
* **Antihypertensives:** NSAIDs may reduce the efficacy of antihypertensive agents.
* **Anticholinergics (e.g., antihistamines, tricyclic antidepressants):** Additive anticholinergic effects with dicyclomine.
## Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding or ulceration.
* Assess for renal function (BUN, creatinine) and hepatic function (LFTs), especially with prolonged use or in at-risk patients.
* Monitor for signs of anticholinergic toxicity.
* Monitor for signs of cardiovascular events.
## Clinical Pearls
* Meftal spas is intended for short-term symptomatic relief.
* Mefenamic acid carries a risk of serious cardiovascular thrombotic events.
* Dicyclomine's anticholinergic effects can be pronounced, especially in the elderly.
* Should be taken with food or milk to minimize gastrointestinal upset.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions. Local protocols may dictate specific dosing or management strategies.
