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# 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 reduces inflammation and pain. Dicyclomine reduces spasms of the gastrointestinal tract.
## Primary Indications
* Symptomatic relief of mild to moderate pain associated with smooth muscle spasms.
* Commonly used for dysmenorrhea and abdominal pain.
## Adult Dosing
* **Mefenamic Acid Component:** 500 mg every 8 hours as needed.
* **Dicyclomine Component:** 20 mg every 8 hours as needed.
* **Maximum Daily Dose:** Mefenamic acid: 1500 mg/day. Dicyclomine: 80 mg/day. Dosing duration should generally not exceed 7 days.
## Pediatric Dosing
Specific dosing for Meftal spas in pediatrics is not established. Mefenamic acid pediatric dosing is typically based on weight: 6.5 mg/kg/dose every 8 hours, not to exceed 500 mg/dose. Dicyclomine pediatric dosing is highly variable and dependent on age and indication, generally requiring careful titration. Combination product use in pediatrics is generally not recommended without specific product approval or robust clinical guidance.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Severe renal impairment is a contraindication to mefenamic acid.
* **Hepatic Impairment:** Use with caution. Severe hepatic impairment is a contraindication to mefenamic acid.
* **Elderly:** Increased risk of adverse effects, particularly gastrointestinal bleeding, renal dysfunction, and cardiovascular events. Use with caution and at the lowest effective dose.
## Contraindications
* Hypersensitivity to mefenamic acid, dicyclomine, or other NSAIDs/anticholinergics.
* Patients with a history of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Severe renal or hepatic impairment.
* Obstructive uropathy, obstructive gastrointestinal conditions, paralytic ileus, unstable intestinal conditions, toxic megacolon, reflux esophagitis, severe ulcerative colitis, glaucoma, myasthenia gravis, or prostatic hypertrophy with urinary retention (contraindications related to dicyclomine component).
* Pregnancy (especially third trimester) and breastfeeding.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, constipation, dizziness, drowsiness, dry mouth, blurred vision.
* **Serious:**
* **Gastrointestinal:** GI bleeding, ulceration, perforation.
* **Cardiovascular:** Increased risk of thrombotic events (MI, stroke), hypertension.
* **Renal:** Renal papillary necrosis, interstitial nephritis, glomerulonephritis, renal failure.
* **Hepatic:** Hepatotoxicity, elevated liver enzymes.
* **Hematologic:** Anemia, leukopenia, thrombocytopenia, aplastic anemia, agranulocytosis.
* **Anticholinergic:** Urinary retention, heat prostration, confusion, blurred vision, mydriasis, cycloplegia, increased intraocular pressure.
## Key Drug Interactions
* **NSAIDs:** Increased risk of bleeding and renal toxicity.
* **Anticoagulants (e.g., warfarin), Antiplatelets (e.g., aspirin, clopidogrel), SSRIs:** Increased risk of GI bleeding.
* **Corticosteroids:** Increased risk of GI toxicity.
* **ACE inhibitors, ARBs, Diuretics:** May reduce antihypertensive effect and increase risk of renal dysfunction.
* **Lithium, Methotrexate:** Increased serum levels and toxicity.
* **Anticholinergics (other):** Additive anticholinergic effects.
* **Antacids:** May decrease absorption of dicyclomine.
## Monitoring
* **Renal function:** Baseline and periodic monitoring, especially in elderly patients or those with pre-existing renal disease.
* **Liver function:** Baseline and periodic monitoring.
* **Signs and symptoms of GI bleeding:** Stool guaiac, hematocrit.
* **Blood pressure:** Monitor for hypertension.
* **Signs and symptoms of adverse anticholinergic effects.**
## Clinical Pearls
* Short-term use is recommended due to the risk of serious adverse effects associated with NSAIDs.
* Administer with food or milk to minimize GI upset.
* Advise patients to avoid concomitant use of other NSAIDs, aspirin, or alcohol.
* Dicyclomine can impair mental and physical abilities required for driving or operating machinery.
**Disclaimer:** This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and relevant clinical guidelines for complete details before making any treatment decisions.
