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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 relief of abdominal pain and cramps associated with conditions such as irritable bowel syndrome, diverticulitis, and colitis.
* Management of primary dysmenorrhea.
## Adult Dosing
* **Abdominal Pain/Cramps:** Typically 1 tablet (mefenamic acid 250 mg, dicyclomine 10 mg) every 8 hours as needed. Maximum 4 tablets per day.
* **Dysmenorrhea:** Typically 1 tablet every 8 hours starting at the onset of pain and bleeding. Maximum 4 tablets per day.
Dosing may vary based on individual response and severity of symptoms. Consult local protocols for specific guidance.
## Pediatric Dosing
Dosing for pediatric patients is not well-established and should be determined by a healthcare provider. Mefenamic acid is generally not recommended for use in children under 14 years of age for prolonged periods due to potential for serious side effects. Dicyclomine use in infants is associated with serious adverse events, including respiratory depression and coma.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Mefenamic acid is largely excreted by the kidneys. Severe impairment may require dose reduction or avoidance.
* **Hepatic Impairment:** Use with caution. Mefenamic acid is metabolized by the liver.
* **Elderly:** Increased risk of adverse effects, particularly gastrointestinal bleeding and renal toxicity. Consider lower doses.
## Contraindications
* Hypersensitivity to mefenamic acid, dicyclomine, or other NSAIDs.
* Patients with a history of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Severe renal, hepatic, or cardiac impairment.
* Intestinal obstruction, paralytic ileus, severe ulcerative colitis, toxic megacolon.
* Myasthenia gravis.
* Glaucoma (narrow-angle).
* Infants less than 6 months of age (due to dicyclomine component).
* During the peri-operative period of coronary artery bypass graft (CABG) surgery.
## Adverse Effects
**Mefenamic Acid:**
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, dyspepsia, constipation, headache, dizziness.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; renal papillary necrosis and other renal injury; cardiovascular thrombotic events (MI, stroke); hepatotoxicity; hypersensitivity reactions.
**Dicyclomine:**
* **Common:** Dry mouth, blurred vision, constipation, urinary retention, drowsiness, nausea.
* **Serious:** Tachycardia, confusion, hallucinations, heat prostration, severe allergic reactions.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding with mefenamic acid.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding with mefenamic acid.
* **Diuretics, ACE inhibitors, ARBs:** NSAIDs can reduce their antihypertensive effect and increase risk of renal impairment.
* **Lithium:** NSAIDs can increase lithium levels.
* **Methotrexate:** NSAIDs can increase methotrexate toxicity.
* **Other NSAIDs/Aspirin:** Increased risk of side effects.
* **Anticholinergics:** Additive effects with dicyclomine (e.g., increased dry mouth, constipation, urinary retention, blurred vision).
* **MAO inhibitors:** May potentiate anticholinergic effects of dicyclomine.
## Monitoring
* Signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Renal function (BUN, creatinine), especially in patients with pre-existing renal disease or those at risk.
* Liver function tests, particularly with prolonged use or in patients with liver disease.
* Blood pressure.
* Signs of cardiovascular events.
* Signs of anticholinergic side effects (dry mouth, blurred vision, urinary retention, constipation).
## 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 to avoid activities requiring mental alertness (e.g., driving) until they know how the drug affects them.
* Use the lowest effective dose for the shortest duration necessary.
* Avoid concomitant use of other NSAIDs, aspirin, or alcohol, which can increase the risk of gastrointestinal bleeding.
* Discontinue use if severe adverse effects occur.
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**Disclaimer:** This information is intended for clinical professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant guidelines before making treatment decisions.
