Meftal%252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252520spas

# Meftal spas ## Overview Meftal spas is a combination product containing mefenamic acid, a nonsteroidal anti-inflammatory drug (NSAID), and dicyclomine hydrochloride, an anticholinergic antispasmodic. ## Primary Indications * Symptomatic relief of mild to moderate pain and spasms associated with: * Gastrointestinal disorders (e.g., irritable bowel syndrome, diverticulitis) * Genitourinary disorders (e.g., renal colic, dysmenorrhea) ## Adult Dosing * **Usual Dose:** 1 tablet (mefenamic acid 250 mg / dicyclomine HCl 20 mg) orally 3 times daily. * **Maximum Dose:** Not explicitly defined for the combination product, but individual component maximums should be considered. Mefenamic acid maximum is typically 500 mg every 6-8 hours or 750 mg initially followed by 500 mg every 6-8 hours. Dicyclomine HCl maximum is typically 40 mg every 24 hours. ## Pediatric Dosing * **Safety and efficacy not established in pediatric patients.** Use is generally not recommended. ## Dose Adjustments * **Renal Impairment:** Mefenamic acid should be used with caution. Dose reduction may be necessary. * **Hepatic Impairment:** Mefenamic acid should be used with caution. Dose reduction may be necessary. * **Elderly:** Increased risk of adverse effects, particularly gastrointestinal bleeding and renal events. Use with caution and consider lower doses. ## Contraindications * Hypersensitivity to mefenamic acid, dicyclomine, or other NSAIDs. * History of asthma, urticaria, or allergic-type reactions after aspirin or other NSAIDs. * Intestinal obstruction, paralytic ileus, severe ulcerative colitis, toxic megacolon. * Glaucoma (narrow-angle). * Myasthenia gravis. * Infants less than 6 months of age. * Severe renal or hepatic insufficiency. * Coronary artery bypass graft (CABG) surgery. ## Adverse Effects * **Common (Mefenamic Acid):** Gastrointestinal upset (nausea, vomiting, diarrhea, constipation, abdominal pain), dyspepsia, dizziness, headache, rash. * **Common (Dicyclomine):** Dry mouth, blurred vision, urinary retention, constipation, drowsiness, dizziness, confusion. * **Serious:** * **Gastrointestinal:** GI bleeding, ulceration, perforation. * **Cardiovascular:** Increased risk of myocardial infarction and stroke. * **Renal:** Acute kidney injury, interstitial nephritis. * **Hepatic:** Liver enzyme elevations, jaundice. * **Dicyclomine related:** Heat prostration, tachycardia, pupil dilation. ## Key Drug Interactions * **NSAIDs:** Increased risk of bleeding and renal toxicity when used with other NSAIDs, aspirin, corticosteroids, anticoagulants (e.g., warfarin), antiplatelet agents (e.g., clopidogrel). * **ACE Inhibitors/ARBs/Diuretics:** Reduced antihypertensive efficacy and increased risk of renal impairment. * **Lithium:** Increased lithium levels. * **Methotrexate:** Increased methotrexate toxicity. * **Anticholinergics:** Additive anticholinergic effects. * **Antacids:** May decrease absorption of dicyclomine. ## Monitoring * **Renal function:** Baseline and periodic monitoring, especially in patients with pre-existing renal disease or those at risk. * **Hepatic function:** Baseline and periodic monitoring. * **Gastrointestinal symptoms:** Monitor for signs of bleeding or ulceration. * **Blood pressure:** Monitor for potential increases. * **Fluid and electrolyte balance:** Especially in patients with diarrhea or vomiting. ## Clinical Pearls * Use the lowest effective dose for the shortest duration necessary to minimize risks. * Administer with food or milk to reduce gastrointestinal upset. * Caution in patients with a history of asthma, bleeding disorders, or cardiovascular disease. * Avoid concurrent use of other NSAIDs. * Dicyclomine's anticholinergic effects can be particularly problematic in the elderly, leading to confusion and cognitive impairment. *** **Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the current prescribing information and relevant guidelines before administering any medication. Dosing and recommendations may vary based on individual patient factors and local protocols.