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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 * Symptomatic treatment of abdominal cramps and pain associated with gastrointestinal disorders. ## Adult Dosing * **Meftal Spas Tablet:** 1 tablet (250 mg mefenamic acid / 20 mg dicyclomine HCl) three times daily, usually taken with food. * **Maximum Dose:** Not explicitly established for the combination product. Refer to individual agent maximums: * Mefenamic acid: Maximum 500 mg every 6 hours, or 1250 mg daily (prescription). * Dicyclomine HCl: Maximum 40 mg daily. ## Pediatric Dosing * Dosing for children is not well-established for this combination product. Mefenamic acid is generally not recommended for use in children under 14 years. Dicyclomine HCl is generally not recommended in infants under 6 months. ## Dose Adjustments * **Renal Impairment:** Mefenamic acid should be used with caution and potentially at reduced doses in patients with renal impairment due to the risk of nephrotoxicity. * **Hepatic Impairment:** Mefenamic acid should be used with caution in patients with hepatic impairment. * **Elderly:** Elderly patients may be at increased risk for adverse effects, particularly gastrointestinal bleeding and renal toxicity. Use with caution. ## 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. * Obstructive uropathy or gastrointestinal obstruction. * Uncontrolled glaucoma. * Myasthenia gravis. * Infants less than 6 months of age (due to dicyclomine). * Third trimester of pregnancy. ## Adverse Effects * **Common (Mefenamic Acid):** Diarrhea, nausea, vomiting, abdominal pain, constipation, dyspepsia, rash. * **Common (Dicyclomine):** Dry mouth, blurred vision, dizziness, drowsiness, urinary retention, constipation. * **Serious (Mefenamic Acid):** Gastrointestinal bleeding, ulceration, perforation; renal toxicity (acute kidney injury, interstitial nephritis, papillary necrosis); cardiovascular thrombotic events (myocardial infarction, stroke); hepatic reactions; hypersensitivity reactions. * **Serious (Dicyclomine):** Confusion, hallucinations, severe urinary retention, heat prostration. ## Key Drug Interactions * **NSAIDs (e.g., aspirin, ibuprofen, naproxen):** Increased risk of gastrointestinal toxicity. * **Anticoagulants (e.g., warfarin):** Increased risk of bleeding. * **Corticosteroids:** Increased risk of gastrointestinal bleeding. * **Diuretics, ACE inhibitors, ARBs:** Reduced antihypertensive effect; increased risk of renal impairment. * **Lithium:** Increased serum lithium levels. * **Methotrexate:** Increased methotrexate toxicity. * **Anticholinergic agents:** Additive anticholinergic effects. * **Antacids:** May decrease absorption of mefenamic acid. ## Monitoring * **Renal function:** Particularly in patients with pre-existing renal disease or those at risk. * **Hepatic function:** Especially with prolonged use or in patients with hepatic impairment. * **Gastrointestinal symptoms:** For signs of bleeding or ulceration. * **Blood pressure:** Especially in patients with hypertension. * **Signs of anticholinergic effects:** Dry mouth, blurred vision, urinary retention, constipation, confusion. ## Clinical Pearls * Meftal Spas should be used at the lowest effective dose for the shortest duration necessary. * Administer with food or milk to minimize gastrointestinal upset. * Advise patients to report any signs of gastrointestinal bleeding (e.g., black, tarry stools; coffee-ground emesis) or other serious adverse effects immediately. * Avoid concurrent use with other NSAIDs. * Dicyclomine can impair mental and physical abilities required for potentially hazardous activities such as driving or operating machinery. *** *Disclaimer: This information is intended for educational purposes and does not substitute for professional medical advice. Always consult the most current prescribing information and your healthcare provider before making any decisions about drug therapy.*