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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 mild to moderate pain associated with smooth muscle spasms, particularly in conditions like irritable bowel syndrome, biliary colic, and renal colic.
* Relief of menstrual pain (dysmenorrhea).
## Adult Dosing
* **Pain with Spasms:** 1 tablet (mefenamic acid 250 mg, dicyclomine HCl 20 mg) every 8 hours as needed.
* **Dysmenorrhea:** 1 tablet every 8 hours as needed, usually starting at the onset of pain.
* **Maximum Daily Dose:** Mefenamic acid: 1500 mg/day. Dicyclomine HCl: 120 mg/day.
## Pediatric Dosing
Dosing for pediatric patients is not well-established for this combination product. Mefenamic acid dosing in children 6 months and older is typically 6.5 mg/kg/dose every 6-8 hours, not to exceed 4 doses in 24 hours. Dicyclomine HCl is generally not recommended in infants and young children due to the risk of serious adverse effects.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Mefenamic acid is renally excreted and can cause renal damage, especially in patients with pre-existing renal disease.
* **Hepatic Impairment:** Use with caution. Mefenamic acid is metabolized in the liver.
## 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.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Severe renal, hepatic, or cardiac impairment.
* Glaucoma, obstructive uropathy, obstructive gastrointestinal lesions, severe ulcerative colitis, myasthenia gravis, or reflux esophagitis.
* Concurrent use with other NSAIDs.
## Adverse Effects
* **Gastrointestinal:** Nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, gastrointestinal bleeding, ulceration, perforation.
* **Central Nervous System (Dicyclomine):** Dizziness, blurred vision, dry mouth, nausea, urinary retention, constipation, nervousness, drowsiness, confusion, excitation.
* **Cardiovascular (Mefenamic Acid):** Increased risk of myocardial infarction and stroke.
* **Renal (Mefenamic Acid):** Renal papillary necrosis, interstitial nephritis, glomerulitis, acute renal failure.
* **Hepatic:** Jaundice, elevated liver enzymes.
* **Hematologic:** Anemia, leukopenia, thrombocytopenia.
* **Hypersensitivity:** Rash, pruritus, bronchospasm, anaphylaxis.
## Key Drug Interactions
* **Other NSAIDs/Aspirin:** Increased risk of GI toxicity and bleeding.
* **Anticoagulants (e.g., Warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI bleeding.
* **Diuretics:** May reduce diuretic efficacy and increase nephrotoxicity.
* **Lithium:** NSAIDs can increase lithium levels.
* **ACE Inhibitors/ARBs:** Increased risk of renal impairment.
* **Anticholinergics:** Additive anticholinergic effects.
* **Antacids:** May decrease absorption of dicyclomine.
## Monitoring
* **GI Bleeding:** Monitor for signs and symptoms of GI bleeding (e.g., melena, hematemesis).
* **Renal Function:** Monitor BUN, creatinine, and urine output, especially in patients with risk factors.
* **Liver Function:** Monitor liver enzymes, especially with prolonged use.
* **Blood Pressure:** Monitor for potential increases in blood pressure.
* **Hydration/Urinary Output:** Monitor for signs of urinary retention, especially in elderly patients.
## Clinical Pearls
* Meftal spas should be used at the lowest effective dose for the shortest duration necessary.
* Avoid concurrent use with other NSAIDs.
* Administer with food or milk to minimize GI upset.
* Dicyclomine's anticholinergic effects can be more pronounced in the elderly.
* Discontinue immediately if signs of GI ulceration or bleeding, hypersensitivity reaction, or serious cardiovascular event occur.
* The risk of cardiovascular thrombotic events, myocardial infarction, and stroke is increased with NSAID use.
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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 details before making any treatment decisions.
