Please check your internet connection and try again.
# Meftal spas
## Overview
Meftal spas is a combination product containing **mefenamic acid**, a non-steroidal anti-inflammatory drug (NSAID), and **dicyclomine hydrochloride**, an anticholinergic/antispasmodic agent. Mefenamic acid works by inhibiting cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis. Dicyclomine reduces smooth muscle tone in the gastrointestinal tract.
## Primary Indications
* Symptomatic relief of abdominal pain and cramps associated with functional gastrointestinal disorders.
* Management of primary dysmenorrhea.
## Adult Dosing
* **Abdominal Pain/Cramps:** 1 tablet (mefenamic acid 250 mg, dicyclomine 20 mg) every 8 hours as needed. Maximum duration of use is typically 7 days for abdominal pain.
* **Primary Dysmenorrhea:** 1 tablet every 8 hours starting from the onset of pain and bleeding, usually for 2-3 days.
## Pediatric Dosing
Dosing for children is **not well-established** for this combination product. Mefenamic acid and dicyclomine may be dosed individually in pediatric patients, but specific combination product dosing is not available. Consult individual drug monographs for pediatric dosing of mefenamic acid and dicyclomine if considered.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Mefenamic acid is renally excreted; severe impairment may necessitate dose reduction or avoidance.
* **Hepatic Impairment:** Use with caution. Mefenamic acid is metabolized in the liver; severe impairment may necessitate dose reduction or avoidance.
* **Elderly:** Increased risk of adverse effects, particularly gastrointestinal bleeding and renal toxicity. Use with caution and consider lower doses.
## Contraindications
* Hypersensitivity to mefenamic acid, dicyclomine, or other NSAIDs/anticholinergics.
* Active gastrointestinal ulceration or bleeding.
* Inflammatory bowel disease (e.g., Crohn's disease, ulcerative colitis).
* Severe renal or hepatic impairment.
* Glaucoma (especially narrow-angle).
* Myasthenia gravis.
* Obstructive uropathy.
* Obstructive gastrointestinal disease.
* Uncontrolled heart failure.
* Concurrent use with other NSAIDs or aspirin.
* Late pregnancy (third trimester).
## Adverse Effects
**Common:**
* Gastrointestinal: Nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia.
* Central Nervous System: Dizziness, headache, drowsiness.
* Anticholinergic: Dry mouth, blurred vision, urinary retention, constipation.
**Serious:**
* Gastrointestinal: GI bleeding, ulceration, perforation.
* Cardiovascular: Increased risk of thrombotic events (MI, stroke).
* Renal: Renal papillary necrosis, interstitial nephritis, renal failure.
* Hepatic: Hepatotoxicity, elevated liver enzymes.
* Hematologic: Anemia, leukopenia, thrombocytopenia, aplastic anemia, agranulocytosis.
* Hypersensitivity: Stevens-Johnson syndrome, toxic epidermal necrolysis.
## Key Drug Interactions
* **Other NSAIDs/Aspirin:** Increased risk of GI bleeding and renal toxicity.
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Diuretics/ACE Inhibitors/ARBs:** Increased risk of renal impairment and reduced antihypertensive effect.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
* **Anticholinergics:** Additive anticholinergic effects.
* **MAO Inhibitors/Tricyclic Antidepressants:** Potential for enhanced anticholinergic effects.
## Monitoring
* **Gastrointestinal:** Monitor for signs and symptoms of bleeding (melena, hematemesis, abdominal pain).
* **Renal Function:** Monitor BUN, creatinine, especially in patients with pre-existing renal disease or those at risk.
* **Hepatic Function:** Monitor LFTs, especially in patients with liver disease.
* **Blood Pressure:** Monitor for potential increases, especially in patients taking antihypertensives.
* **Signs of Anticholinergic Effects:** Monitor for dry mouth, blurred vision, urinary retention, constipation.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Administer with food or milk to reduce gastrointestinal upset.
* Avoid use in patients with risk factors for NSAID-associated complications (e.g., history of ulcers, concomitant anticoagulant use).
* The anticholinergic effects of dicyclomine can mask symptoms of appendicitis or other serious abdominal conditions.
* Consider alternative agents if gastrointestinal upset or anticholinergic side effects are prominent.
***
*Disclaimer: This information is intended for healthcare professionals. Always consult the official prescribing information and relevant literature for the most current and complete drug details. Dosing and safety recommendations may vary based on patient-specific factors and local institutional protocols.*
