Please check your internet connection and try again.
# Meftal spas
## Overview
Meftal spas is a combination product containing mefenamic acid, a nonsteroidal anti-inflammatory drug (NSAID), and dicyclomine, an anticholinergic antispasmodic.
## Primary Indications
* Symptomatic relief of abdominal pain and cramps associated with irritable bowel syndrome (IBS) and other gastrointestinal disorders.
* Management of primary dysmenorrhea.
## Adult Dosing
* **Irritable Bowel Syndrome/Gastrointestinal Disorders:** 1 tablet (250 mg mefenamic acid / 20 mg dicyclomine) three times daily, typically before meals. Maximum dose: 4 tablets daily.
* **Primary Dysmenorrhea:** 1 tablet (250 mg mefenamic acid / 20 mg dicyclomine) three times daily, starting with the onset of pain and continuing for up to 3 days. Maximum dose: 4 tablets daily.
## Pediatric Dosing
* **Mefenamic Acid:** Dosing for mefenamic acid in children over 6 months is typically based on weight (e.g., 5-7 mg/kg/dose every 6-8 hours, not to exceed 4 doses in 24 hours, or a maximum of 500 mg per dose).
* **Dicyclomine:** Dosing for dicyclomine in children is often weight-based (e.g., 0.1 mg/kg/dose every 6-8 hours).
* **Meftal spas (combination):** Specific pediatric dosing for the combination product is not well-established. Use in children requires careful consideration and is often guided by individual component dosing and clinical judgment. Dosing will depend on the child's weight and age, and should not exceed adult maximums.
## Dose Adjustments
* **Renal Impairment:** Mefenamic acid is renally excreted. Use with caution in patients with severe renal impairment; dose reduction may be considered, though specific guidelines are limited.
* **Hepatic Impairment:** Use with caution in patients with hepatic impairment; monitor liver function closely.
* **Elderly:** Elderly patients may be more susceptible to adverse effects, particularly gastrointestinal bleeding and renal toxicity from NSAIDs.
## Contraindications
* Hypersensitivity to mefenamic acid, dicyclomine, or other NSAIDs.
* Active gastrointestinal bleeding or ulceration.
* Inflammatory bowel disease (ulcerative colitis, Crohn's disease).
* Severe renal or hepatic impairment.
* Myasthenia gravis.
* Gastrointestinal or urinary obstruction.
* Glaucoma (especially narrow-angle).
* Infants < 6 months of age.
## Adverse Effects
* **Common (Mefenamic Acid):** Gastrointestinal upset (nausea, vomiting, diarrhea, constipation, abdominal pain), dyspepsia, dizziness, headache, drowsiness.
* **Common (Dicyclomine):** Dry mouth, blurred vision, urinary retention, constipation, drowsiness, confusion.
* **Serious:** Gastrointestinal bleeding, perforation, ulceration; renal toxicity (including interstitial nephritis, papillary necrosis); hepatotoxicity; cardiovascular thrombotic events; hypersensitivity reactions; Stevens-Johnson syndrome; toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Other NSAIDs/Aspirin:** Increased risk of gastrointestinal toxicity.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding.
* **SSRIs/SNRIs:** Increased risk of gastrointestinal bleeding.
* **Diuretics, ACE inhibitors, ARBs:** Reduced antihypertensive effect; increased risk of renal toxicity.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
* **Anticholinergics:** Additive anticholinergic effects.
* **Antacids:** May decrease absorption of mefenamic acid.
## Monitoring
* **Gastrointestinal:** Monitor for signs and symptoms of GI bleeding (melena, hematemesis, abdominal pain).
* **Renal Function:** Monitor serum creatinine and BUN, especially in patients with pre-existing renal disease or those on concomitant nephrotoxic agents.
* **Hepatic Function:** Monitor liver enzymes (ALT, AST) periodically, especially with long-term use or in patients with liver disease.
* **Blood Pressure:** NSAIDs can cause or exacerbate hypertension.
## Clinical Pearls
* Meftal spas should be used at the lowest effective dose for the shortest duration necessary.
* Administer with food or milk to minimize gastrointestinal upset.
* Caution is advised in patients with dehydration, particularly in children, due to the risk of dicyclomine-induced urinary retention and potential for exacerbation of dehydration.
* The anticholinergic effects of dicyclomine can mask symptoms of appendicitis or other acute abdominal conditions.
* Avoid concomitant use with other NSAIDs.
***
**Disclaimer:** This information is intended for healthcare professionals. Always verify current prescribing information and consult relevant guidelines before making clinical decisions.
