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. Mefenamic acid reduces prostaglandin synthesis, alleviating pain and inflammation. Dicyclomine reduces gastrointestinal motility and secretions.
## Primary Indications
* Symptomatic relief of mild to moderate pain associated with gastrointestinal spasms.
* Primary dysmenorrhea.
## Adult Dosing
* **Gastrointestinal Spasms/Pain:** 1 tablet (mefenamic acid 250 mg / dicyclomine 10 mg) orally every 8 hours, as needed.
* **Primary Dysmenorrhea:** 1 tablet orally every 8 hours, starting from the onset of pain or bleeding, whichever occurs first.
* **Maximum Daily Dose:** Not explicitly defined in standard labeling for the combination product, but consider maximums for individual components (mefenamic acid 1500 mg/day, dicyclomine 40 mg/day) if used for extended periods or in conjunction with other agents.
## Pediatric Dosing
Dosing for Meftal spas in pediatric patients is not established. Use with caution and consider individual component dosing if appropriate and under strict medical supervision.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Mefenamic acid is renally excreted; dose reduction may be necessary in severe impairment.
* **Hepatic Impairment:** Use with caution. Mefenamic acid is metabolized in the liver.
* **Elderly:** Use with caution. Increased risk of adverse effects, particularly gastrointestinal bleeding and renal toxicity.
## Contraindications
* Hypersensitivity to mefenamic acid, dicyclomine, or any component of the formulation.
* Patients with a history of asthma, urticaria, or allergic-type reactions after aspirin or other NSAIDs.
* Inflammatory bowel disease (e.g., ulcerative colitis, Crohn's disease).
* Gastrointestinal obstruction or paralytic ileus.
* Severe renal or hepatic impairment.
* Myasthenia gravis.
* Uncontrolled glaucoma.
* Infants less than 6 months of age (due to anticholinergic effects).
## Adverse Effects
* **Common (Mefenamic Acid):** Nausea, vomiting, diarrhea, abdominal pain, constipation, dyspepsia, dizziness, drowsiness.
* **Common (Dicyclomine):** Dry mouth, blurred vision, constipation, urinary retention, drowsiness, dizziness.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; renal papillary necrosis, interstitial nephritis, glomerulonephritis; hepatic dysfunction; hypersensitivity reactions (including anaphylaxis); cardiovascular thrombotic events (NSAID class effect); exacerbation of asthma.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **Other NSAIDs (including aspirin):** Increased risk of gastrointestinal toxicity and other adverse effects.
* **Diuretics and Antihypertensives:** NSAIDs can reduce the efficacy of these drugs and increase the risk of renal impairment.
* **Lithium:** NSAIDs can increase lithium levels.
* **Methotrexate:** NSAIDs can increase methotrexate toxicity.
* **Anticholinergics/Antimuscarinics:** Additive effects with dicyclomine, increasing anticholinergic side effects.
* **MAO Inhibitors and Tricyclic Antidepressants:** May potentiate anticholinergic effects of dicyclomine.
## Monitoring
* **Gastrointestinal:** Monitor for signs and symptoms of bleeding (e.g., melena, hematemesis, abdominal pain).
* **Renal:** Monitor renal function, especially in patients with pre-existing renal disease or those at risk.
* **Hepatic:** Monitor liver function tests.
* **Hydration:** Monitor for signs of dehydration, especially in hot weather or with vomiting/diarrhea.
* **Glaucoma:** Monitor for signs of increased intraocular pressure.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Advise patients to take with food or milk to reduce gastrointestinal upset.
* Dicyclomine can cause drowsiness; caution patients about operating machinery or driving.
* Consider risks vs. benefits, especially in elderly patients or those with comorbidities.
* Not recommended for use in infants due to potential for respiratory depression and other severe adverse effects.
***
*Disclaimer: This information is intended for healthcare professionals and does not replace the need to consult the official prescribing information and relevant guidelines. Always verify current drug information before prescribing or dispensing.*
