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# 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
* Symptomatic relief of abdominal pain and cramping associated with spasmodic conditions of the gastrointestinal tract.
* Management of dysmenorrhea.
## Adult Dosing
* **Abdominal Pain/Cramping:** Typically 1 tablet (mefenamic acid 250 mg / dicyclomine HCl 20 mg) every 8 hours as needed.
* **Dysmenorrhea:** Typically 1 tablet every 8 hours as needed, often starting at the onset of pain.
* Maximum daily dose of mefenamic acid should not exceed 1500 mg.
## Pediatric Dosing
* Information on pediatric dosing for Meftal spas is not well-established. Use in pediatric populations is generally not recommended without specific guidance from a pediatrician and careful consideration of risks.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Mefenamic acid is renally excreted; dose reduction may be necessary in severe renal impairment.
* **Hepatic Impairment:** Use with caution. Monitor liver function.
## Contraindications
* Hypersensitivity to mefenamic acid, dicyclomine, or other NSAIDs/anticholinergics.
* History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Inflammatory bowel disease (e.g., Crohn's disease, ulcerative colitis).
* Obstructive uropathy or gastrointestinal obstruction.
* Myasthenia gravis.
* Severe renal or hepatic impairment.
* Glaucoma (narrow-angle).
* Infants less than 6 months of age.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, constipation, abdominal pain, dizziness, dry mouth, blurred vision, urinary retention, drowsiness.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (MI, stroke); renal toxicity; hepatotoxicity; anaphylaxis; exacerbation of asthma; blurred vision; confusion.
## Key Drug Interactions
* **Other NSAIDs/Aspirin:** Increased risk of gastrointestinal bleeding and renal toxicity.
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding.
* **SSRIs/SNRIs:** Increased risk of gastrointestinal bleeding.
* **ACE inhibitors/ARBs:** May decrease antihypertensive effect; increased risk of renal impairment.
* **Diuretics:** May decrease diuretic effect; increased risk of renal impairment.
* **Anticholinergics:** Additive anticholinergic effects (e.g., increased dry mouth, constipation, urinary retention, blurred vision).
* **Metoclopramide:** May reduce the efficacy of metoclopramide.
## Monitoring
* **GI Bleeding:** Monitor for signs and symptoms (e.g., melena, hematemesis, abdominal pain).
* **Renal Function:** Monitor serum creatinine and BUN, especially in patients with pre-existing renal disease or those at risk.
* **Hepatic Function:** Monitor liver enzymes (ALT, AST), especially in patients with pre-existing liver disease.
* **Blood Pressure:** Monitor blood pressure, particularly with chronic NSAID use.
* **Signs of Anticholinergic Effects:** Monitor for dry mouth, blurred vision, urinary retention, constipation, cognitive impairment.
## Clinical Pearls
* This combination product aims to address both inflammatory pain and smooth muscle spasm.
* Should be used at the lowest effective dose for the shortest duration necessary.
* Administer with food or milk to minimize gastrointestinal upset.
* Avoid concomitant use with other NSAIDs.
* Caution in elderly patients due to increased risk of adverse effects.
* Dicyclomine can cause drowsiness; caution patients about operating machinery or driving.
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**Disclaimer:** This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and relevant clinical guidelines for complete and up-to-date recommendations before making any treatment decisions. Local protocols may also influence prescribing practices.
