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## Meftal%25252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252520spas
### Overview
Meftal%25252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252520spas is a combination product containing mefenamic acid, an NSAID, and dicyclomine, an anticholinergic antispasmodic.
### Primary Indications
* Symptomatic relief of mild to moderate pain and spasms associated with gastrointestinal disorders, such as irritable bowel syndrome, diverticulitis, and enteritis.
### Adult Dosing
* **Meftal%25252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252520spas Tablet:** 1 tablet (containing mefenamic acid 250 mg and dicyclomine hydrochloride 20 mg) every 8 hours as needed. Maximum daily dose is typically 4 tablets.
### Pediatric Dosing
* Data for pediatric use is limited. Dosing should be determined by a healthcare provider based on weight and clinical condition. Mefenamic acid dosing in children is generally 5-7 mg/kg per dose every 6-8 hours. Dicyclomine dosing in children is typically 0.1 mg/kg per dose every 6-8 hours. **Consultation with a pediatrician is strongly recommended.**
### Dose Adjustments
* **Renal Impairment:** Use with caution. Mefenamic acid is renally excreted; dose reduction may be necessary.
* **Hepatic Impairment:** Use with caution. Mefenamic acid is metabolized by the liver.
* **Elderly:** Increased risk of adverse effects, particularly gastrointestinal bleeding and renal toxicity. Use with caution and at the lowest effective dose.
### Contraindications
* Known hypersensitivity to mefenamic acid, dicyclomine, or other NSAIDs/anticholinergics.
* Patients with active peptic ulceration or inflammatory bowel disease.
* History of asthma, urticaria, or allergic-type reactions after aspirin or other NSAIDs.
* Severe renal or hepatic impairment.
* Glaucoma.
* Myasthenia gravis.
* Obstructive uropathy or gastrointestinal obstruction.
* Tachycardia.
* Heart failure.
### Adverse Effects
* **Common (Mefenamic Acid):** Nausea, vomiting, diarrhea, abdominal pain, dyspepsia, rash.
* **Common (Dicyclomine):** Dry mouth, blurred vision, constipation, urinary retention, dizziness, drowsiness.
* **Serious:**
* **Gastrointestinal:** GI bleeding, ulceration, perforation.
* **Cardiovascular:** Increased risk of thrombotic events, hypertension, myocardial infarction, stroke.
* **Renal:** Acute kidney injury, interstitial nephritis.
* **Hepatic:** Liver dysfunction.
* **Hematologic:** Anemia, thrombocytopenia, leukopenia.
* **Anticholinergic Toxicity:** Confusion, hallucinations, delirium (especially in the elderly).
### Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Other NSAIDs:** Increased risk of GI toxicity and renal impairment.
* **ACE inhibitors, ARBs, diuretics:** May reduce antihypertensive effect and increase risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **SSRIs, SNRIs:** Increased risk of GI bleeding.
* **Anticholinergics:** Additive anticholinergic effects.
* **Antacids:** May affect absorption of mefenamic acid.
### Monitoring
* Monitor for signs and symptoms of GI bleeding (e.g., melena, hematemesis).
* Monitor renal function, especially in patients with pre-existing renal disease or those on concomitant nephrotoxic agents.
* Monitor liver function tests.
* Monitor for signs of cardiovascular events.
* Assess for anticholinergic side effects.
### Clinical Pearls
* This combination is intended for short-term use.
* Administer with food or milk to minimize GI upset.
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Avoid concurrent use with other NSAIDs.
* Dicyclomine can cause sedation; advise caution when driving or operating machinery.
***
**Disclaimer:** This information is intended for educational purposes only and does not constitute medical advice. Always verify current prescribing information with the official product monograph or reliable drug information resources before making any clinical decisions.
