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 hydrochloride, an anticholinergic antispasmodic.
## Primary Indications
Symptomatic relief of abdominal pain and spasms associated with irritable bowel syndrome and other gastrointestinal disorders. Mefenamic acid also provides anti-inflammatory and analgesic effects.
## Adult Dosing
* **Meftal spas:** One tablet (mefenamic acid 250 mg, dicyclomine HCl 20 mg) three times daily.
* **Maximum dose:** Not explicitly defined for the combination product, but individual component maximums should be considered (e.g., mefenamic acid typically 750 mg every 6 hours or 1000 mg every 8 hours; dicyclomine typically 20 mg every 4-6 hours).
## Pediatric Dosing
Safety and efficacy in pediatric patients have not been established. Use is generally not recommended.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Mefenamic acid is renally excreted. Severe renal impairment is a contraindication.
* **Hepatic Impairment:** Use with caution. Mefenamic acid is metabolized by the liver.
* **Elderly:** Use with caution due to increased risk of adverse effects associated with NSAIDs.
## Contraindications
* Hypersensitivity to mefenamic acid, dicyclomine, or other NSAIDs.
* 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 ileus.
* Uncontrolled narrow-angle glaucoma.
* Myasthenia gravis.
* Severe renal or hepatic impairment.
* Children under 5 years of age (due to dicyclomine).
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, constipation, abdominal pain, dizziness, dry mouth, blurred vision, urinary retention, drowsiness.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; renal toxicity; hepatic toxicity; cardiovascular thrombotic events; hypersensitivity reactions; worsening of glaucoma.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Other NSAIDs or Aspirin:** Increased risk of gastrointestinal toxicity.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding.
* **ACE Inhibitors, ARBs, Diuretics:** May reduce antihypertensive efficacy and increase risk of renal impairment.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased risk of methotrexate toxicity.
* **Anticholinergic Agents:** Additive anticholinergic effects.
## Monitoring
* Signs and symptoms of gastrointestinal bleeding or ulceration.
* Renal function (especially in patients with pre-existing renal disease or on concomitant nephrotoxic agents).
* Liver function (especially with long-term use).
* Blood pressure.
* Signs of anticholinergic side effects.
## Clinical Pearls
* Meftal spas should be taken with food or milk to minimize gastrointestinal upset.
* Due to the anticholinergic effects of dicyclomine, patients should be advised about potential side effects such as dry mouth, blurred vision, and urinary retention, especially the elderly.
* The combination may not be suitable for patients with chronic inflammatory bowel disease due to NSAID-induced complications.
* Discontinue use if severe adverse effects occur.
***
**Disclaimer:** This information is intended for clinical use and does not replace the need for professional judgment. Always consult the most current prescribing information and relevant guidelines before making treatment decisions.
