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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). Mefenamic acid reduces inflammation and pain. Dicyclomine relaxes smooth muscles in the gastrointestinal tract.
## Primary Indications
* Painful menstruation (dysmenorrhea)
* Abdominal pain associated with smooth muscle spasms
## Adult Dosing
* **Mefenamic acid:** 500 mg every 8 hours as needed, not to exceed 7 days.
* **Dicyclomine:** Typically 20 mg every 8 hours.
* **Meftal spas (combination product):** Usually one tablet three times daily after meals. Specific dosing may vary by formulation and local protocol.
## Pediatric Dosing
Dosing in children is not well-established for this combination product. Mefenamic acid can be dosed in children ≥6 months, but dicyclomine is generally not recommended in infants and young children due to risk of respiratory depression and other anticholinergic effects.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Mefenamic acid is renally excreted. Dose reduction may be necessary.
* **Hepatic Impairment:** Use with caution. Mefenamic acid can cause liver enzyme elevations.
* **Elderly:** Use with caution due to increased risk of adverse effects from NSAIDs (e.g., GI bleeding, renal toxicity).
## Contraindications
* Hypersensitivity to mefenamic acid, dicyclomine, or other NSAIDs.
* Active GI ulceration or inflammation.
* History of asthma, urticaria, or allergic-type reactions after aspirin or other NSAIDs.
* Severe renal or hepatic impairment.
* Severe ulcerative colitis.
* Obstructive uropathy.
* Myasthenia gravis.
* Gastrointestinal obstruction or paralytic ileus.
* Glaucoma.
* Infants < 6 months of age (especially for dicyclomine component).
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, constipation, abdominal pain, dizziness, blurred vision, dry mouth, urinary retention.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events; renal failure; hepatic failure; exacerbation of asthma; severe allergic reactions. Anticholinergic effects from dicyclomine can include confusion, drowsiness, and heat prostration.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding with mefenamic acid.
* **Other NSAIDs and Aspirin:** Increased risk of GI side effects.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **ACE Inhibitors/ARBs:** Reduced antihypertensive effect and increased risk of renal dysfunction.
* **Diuretics:** Reduced diuretic and antihypertensive effect, potential for increased renal toxicity.
* **Lithium:** Mefenamic acid can increase lithium levels.
* **Anticholinergics:** Additive anticholinergic effects with dicyclomine.
* **Antacids:** May decrease absorption of mefenamic acid.
## Monitoring
* **GI symptoms:** Monitor for signs of bleeding (melena, hematemesis) or ulceration.
* **Renal function:** Monitor BUN and creatinine, especially in patients with pre-existing renal disease or those at risk.
* **Hepatic function:** Monitor liver enzymes, especially with long-term use or in patients with hepatic impairment.
* **Blood pressure:** Monitor for potential NSAID-induced hypertension.
* **Hydration and fluid balance:** Especially important in elderly or those with conditions affecting fluid balance.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Limit duration of use to the shortest effective period to minimize risks associated with NSAIDs.
* Dicyclomine can cause drowsiness and blurred vision; advise caution with activities requiring mental alertness.
* Be aware of the anticholinergic side effects of dicyclomine, particularly in the elderly.
* This combination product is not typically a first-line agent for mild dysmenorrhea or IBS.
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**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for clinical judgment. Always refer to the most current prescribing information, local guidelines, and patient-specific factors before making treatment decisions.
