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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 irritable bowel syndrome and other gastrointestinal disorders.
* Pain and inflammation associated with dysmenorrhea.
## Adult Dosing
* **Irritable Bowel Syndrome/GI Disorders:** 1 tablet (mefenamic acid 250 mg, dicyclomine 20 mg) orally every 8 hours as needed for symptoms. Maximum dose: 4 tablets per day.
* **Dysmenorrhea:** 1 tablet (mefenamic acid 250 mg, dicyclomine 20 mg) orally every 8 hours as needed for pain, usually starting with the onset of pain or bleeding. Maximum dose: 4 tablets per day.
## Pediatric Dosing
* Data for pediatric use is limited. Dosing should be determined by a pediatrician based on age, weight, and clinical response. Mefenamic acid is generally not recommended for children under 14 years of age due to potential for serious adverse effects.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Mefenamic acid is renally excreted. Dose reduction may be necessary in severe impairment.
* **Hepatic Impairment:** Use with caution. Mefenamic acid is metabolized in the liver. Dose reduction may be necessary in severe impairment.
* **Elderly:** Increased risk of adverse effects, particularly GI bleeding, renal events, and cardiovascular thrombotic events. Use the lowest effective dose for the shortest duration necessary.
## 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.
* Peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or perforation.
* Severe renal or hepatic impairment.
* Obstructive uropathy.
* Uncontrolled glaucoma.
* Myasthenia gravis.
* Severe ulcerative colitis.
* Tachycardia.
* Infants less than 6 months of age.
## Adverse Effects
* **Gastrointestinal:** Nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, gastrointestinal bleeding, perforation.
* **Central Nervous System:** Dizziness, headache, drowsiness, confusion, nervousness.
* **Anticholinergic:** Dry mouth, blurred vision, urinary retention, constipation.
* **Cardiovascular:** Increased risk of myocardial infarction and stroke (especially with chronic use of NSAIDs).
* **Renal:** Renal impairment, interstitial nephritis.
* **Hepatic:** Hepatotoxicity.
* **Hematologic:** Anemia, thrombocytopenia, leukopenia.
* **Skin:** Rash, pruritus.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Selective Serotonin Reuptake Inhibitors (SSRIs) & Serotonin Norepinephrine Reuptake Inhibitors (SNRIs):** Increased risk of GI bleeding.
* **Other NSAIDs (including aspirin):** Increased risk of adverse effects, particularly GI bleeding.
* **Diuretics & ACE Inhibitors:** May reduce antihypertensive efficacy and increase risk of renal impairment.
* **Lithium:** Mefenamic acid can decrease renal clearance of lithium, leading to increased serum levels.
* **Methotrexate:** Mefenamic acid can decrease renal clearance of methotrexate.
* **Anticholinergics:** Additive anticholinergic effects with dicyclomine.
* **CNS Depressants:** Additive sedative effects.
## Monitoring
* **GI Bleeding:** Monitor for signs and symptoms of GI bleeding (e.g., melena, hematemesis, epigastric pain).
* **Renal Function:** Monitor renal function, especially in patients with pre-existing renal disease or those on concomitant nephrotoxic agents.
* **Hepatic Function:** Monitor liver function tests, especially with prolonged use.
* **Blood Pressure:** Monitor blood pressure, particularly in patients with hypertension.
* **Signs of Anticholinergic Overdose:** Monitor for confusion, hallucinations, tachycardia, and urinary retention.
## Clinical Pearls
* Meftal spas should be used at the lowest effective dose for the shortest duration necessary to minimize the risk of serious adverse events, including cardiovascular thrombotic events, myocardial infarction, stroke, and gastrointestinal bleeding.
* Advise patients to avoid concomitant use of other NSAIDs.
* Dicyclomine can cause drowsiness; advise patients to exercise caution when driving or operating machinery.
* The anticholinergic effects of dicyclomine can be exacerbated by other medications with anticholinergic properties.
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**Disclaimer:** This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and relevant literature for definitive guidance. Local protocols and guidelines may vary.
