Please check your internet connection and try again.
# Meftal spas
## Overview
Meftal spas is a combination medication containing mefenamic acid, a nonsteroidal anti-inflammatory drug (NSAID), and dicyclomine hydrochloride, an anticholinergic antispasmodic.
## Primary Indications
* Abdominal pain associated with smooth muscle spasms, particularly in gynecological conditions (e.g., dysmenorrhea) and gastrointestinal disorders.
## Adult Dosing
* **Mefenamic acid:** 500 mg orally every 8 hours as needed for pain.
* **Dicyclomine hydrochloride:** 20 mg orally every 8 hours as needed for spasms.
* Maximum duration of use for mefenamic acid is typically 7 days.
* Maximum dose for dicyclomine is generally not specified for this combination but individual dicyclomine doses should not exceed 20 mg and frequency should not exceed every 8 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 and may accumulate.
* **Hepatic Impairment:** Use with caution. NSAIDs can affect liver function.
## 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.
* Inflammatory bowel disease.
* Obstructive uropathy.
* Gastrointestinal obstruction or paralytic ileus.
* Severe ulcerative colitis.
* Myasthenia gravis.
* Glaucoma (narrow-angle).
* Infants less than 6 months of age (due to potential for respiratory depression with dicyclomine).
* Active peptic ulceration or history of recurrent peptic ulceration.
## Adverse Effects
* **Common (Mefenamic Acid):** Gastrointestinal upset (nausea, vomiting, diarrhea, abdominal pain), dizziness, drowsiness, headache.
* **Common (Dicyclomine):** Dry mouth, blurred vision, constipation, urinary retention, drowsiness, dizziness.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; renal impairment; hepatic injury; cardiovascular thrombotic events; hypersensitivity reactions; exacerbation of glaucoma; CNS effects (hallucinations, confusion).
## Key Drug Interactions
* **Other NSAIDs/Aspirin:** Increased risk of GI toxicity.
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI bleeding and ulceration.
* **Diuretics/ACE inhibitors/ARBs:** Mefenamic acid may reduce their antihypertensive effect and increase risk of renal impairment.
* **Lithium:** Mefenamic acid may increase serum lithium levels.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **Anticholinergics/Amantadine/MAOIs:** Additive anticholinergic effects with dicyclomine.
* **Ketoconazole/Itoconazole:** Dicyclomine may reduce absorption.
## Monitoring
* **Renal function:** Baseline and periodic monitoring, especially in patients with pre-existing renal disease or those on diuretics/ACE inhibitors.
* **Liver function:** Baseline and periodic monitoring.
* **Gastrointestinal symptoms:** Monitor for signs of bleeding or ulceration.
* **Hydration status and urinary output:** Especially in elderly patients or those with risk factors for urinary retention.
* **Signs of anticholinergic toxicity:** Dry mouth, blurred vision, constipation, urinary retention.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Due to anticholinergic effects, caution patients about operating machinery or driving until they know how this medication affects them.
* Avoid concurrent use with other NSAIDs.
* Discontinue use if severe GI symptoms, signs of renal impairment, or allergic reactions occur.
* The duration of use should be as short as possible to minimize risks.
***
**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always verify current prescribing information and consult with a qualified healthcare provider before making any treatment decisions. Dosing and recommendations may vary based on individual patient factors and local institutional protocols.
