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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.
## Primary Indications
* Management of abdominal pain associated with smooth muscle spasms, particularly in conditions like irritable bowel syndrome or diverticular disease.
* Symptomatic relief of mild to moderate pain, especially when associated with spasms.
## Adult Dosing
* **Mefenamic acid:** 250 mg to 500 mg orally every 6 to 8 hours as needed for pain. Maximum daily dose is 1500 mg.
* **Dicyclomine hydrochloride:** 20 mg orally every 6 to 8 hours as needed for spasms. Maximum daily dose is 120 mg.
* **Meftal spas (Combination):** Dosing varies by product formulation. Consult specific product labeling. Typically, one tablet (containing both active ingredients) is taken orally every 6 to 8 hours as needed.
## Pediatric Dosing
* Mefenamic acid: Generally not recommended in children under 14 years for anti-inflammatory use. For pain, dosing may vary.
* Dicyclomine hydrochloride: Generally not recommended in infants and children under 6 months due to risk of respiratory depression and other serious adverse effects. Safety and efficacy in older children are not well established with this combination product.
* **Meftal spas (Combination):** Use in pediatric patients is generally not recommended.
## Dose Adjustments
* **Renal Impairment:** Mefenamic acid should be used with caution in patients with renal impairment. Dicyclomine is renally excreted and may accumulate. Dose reduction or avoidance may be necessary.
* **Hepatic Impairment:** Mefenamic acid should be used with caution.
* **Elderly:** Increased risk of adverse effects, particularly GI bleeding and renal toxicity with mefenamic acid. Use with caution.
## Contraindications
* Hypersensitivity to mefenamic acid, dicyclomine, or other NSAIDs/anticholinergics.
* Active or history of gastrointestinal bleeding or perforation.
* Severe renal or hepatic impairment.
* Severe ulcerative colitis or toxic megacolon.
* Obstructive uropathy or gastrointestinal obstruction.
* Myasthenia gravis.
* Glaucoma (uncontrolled).
* Infants less than 6 months of age (for dicyclomine component).
* Third trimester of pregnancy.
## Adverse Effects
* **Mefenamic acid:** Gastrointestinal (dyspepsia, nausea, vomiting, diarrhea, constipation, abdominal pain, GI bleeding, perforation), renal (renal papillary necrosis, interstitial nephritis), cardiovascular (increased risk of MI, stroke), hypersensitivity reactions.
* **Dicyclomine:** Anticholinergic effects (dry mouth, blurred vision, urinary retention, constipation, drowsiness, dizziness), tachycardia.
* **Combination:** May exhibit additive or synergistic adverse effects.
## Key Drug Interactions
* **Mefenamic acid:**
* Anticoagulants (e.g., warfarin): Increased risk of bleeding.
* Corticosteroids: Increased risk of GI ulceration and bleeding.
* SSRIs: Increased risk of GI bleeding.
* ACE inhibitors, ARBs, diuretics: May reduce antihypertensive effect and increase risk of renal impairment.
* Lithium: May increase lithium levels.
* Methotrexate: May increase methotrexate toxicity.
* **Dicyclomine:**
* Other anticholinergics: Additive anticholinergic effects.
* MAOIs: May potentiate anticholinergic effects.
* Amantadine, quinidine: Increased risk of anticholinergic adverse effects.
* CNS depressants: May increase sedation.
## Monitoring
* **For Mefenamic Acid:** Monitor for signs and symptoms of GI bleeding or perforation, renal function, and blood pressure.
* **For Dicyclomine:** Monitor for signs of anticholinergic toxicity, especially in the elderly or those with underlying conditions.
## Clinical Pearls
* This combination product should be used for the shortest duration necessary.
* Consider the risks associated with both NSAIDs (GI bleeding, cardiovascular events) and anticholinergics (anticholinergic side effects, urinary retention) when prescribing.
* Not typically a first-line agent for pain or spasm management.
* Use cautiously in patients with pre-existing GI, renal, or cardiovascular conditions.
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**Disclaimer:** This information is intended for clinical use and does not substitute for professional medical judgment. Always consult the most current prescribing information and relevant clinical guidelines for complete details, including specific indications, contraindications, warnings, precautions, adverse reactions, and drug interactions before initiating any medication. Dosing and recommendations may vary based on local protocols and individual patient factors.
