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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 abdominal pain associated with spasms.
* Painful menstruation (dysmenorrhea).
## Adult Dosing
* **Meftal spas:** One tablet (Mefenamic Acid 250 mg / Dicyclomine HCl 10 mg) three times daily or as needed.
* **Maximum Mefenamic Acid dose:** 1500 mg per day.
* **Maximum Dicyclomine HCl dose:** Generally not exceeding 80 mg per day.
## Pediatric Dosing
* **Mefenamic Acid:** Generally not recommended for children under 12 years of age due to lack of established safety and efficacy.
* **Dicyclomine HCl:** Specific pediatric dosing is available but not typically combined with mefenamic acid in a single product for this age group. Consult specific pediatric guidelines for monotherapy.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Mefenamic acid is renally excreted. Severe impairment may require dose reduction or avoidance.
* **Hepatic Impairment:** Use with caution. Mefenamic acid is metabolized by the liver.
* **Elderly:** Increased risk of gastrointestinal bleeding, renal, and cardiovascular events. Use lowest effective dose.
## Contraindications
* Hypersensitivity to mefenamic acid, dicyclomine, or other NSAIDs/anticholinergics.
* Active or history of gastrointestinal bleeding or perforation.
* Active or history of peptic ulcer disease.
* Severe renal or hepatic impairment.
* Severe ulcerative colitis or toxic megacolon.
* Glaucoma (narrow-angle).
* Obstructive uropathy or gastrointestinal obstruction.
* Myasthenia gravis.
* Infants less than 6 months of age (for dicyclomine).
* Third trimester of pregnancy.
## Adverse Effects
* **Common (Mefenamic Acid):** Diarrhea, nausea, vomiting, abdominal pain, dyspepsia.
* **Common (Dicyclomine):** Dry mouth, blurred vision, constipation, urinary retention, dizziness, drowsiness.
* **Serious (Mefenamic Acid):** Gastrointestinal bleeding, perforation, renal failure, hepatotoxicity, cardiovascular thrombotic events, hypersensitivity reactions.
* **Serious (Dicyclomine):** Exacerbation of narrow-angle glaucoma, tachycardia, confusion.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding with mefenamic acid.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding with mefenamic acid.
* **SSRIs/SNRIs:** Increased risk of gastrointestinal bleeding with mefenamic acid.
* **Other NSAIDs:** Additive toxicity, increased risk of adverse effects.
* **Diuretics, ACE inhibitors, ARBs:** Reduced antihypertensive efficacy and increased risk of renal impairment with mefenamic acid.
* **Anticholinergics (e.g., tricyclic antidepressants, antihistamines):** Additive anticholinergic effects with dicyclomine.
* **CNS depressants (e.g., benzodiazepines, opioids):** Increased CNS depressant effects with dicyclomine.
## Monitoring
* **GI Bleeding:** Monitor for signs and symptoms (e.g., melena, hematemesis).
* **Renal Function:** Baseline and periodic monitoring of BUN and creatinine, especially in patients with risk factors.
* **Hepatic Function:** Baseline and periodic monitoring of LFTs, especially in patients with risk factors.
* **Blood Pressure:** Monitor for efficacy and potential NSAID-related effects.
* **Fluid and Electrolyte Balance:** Especially in patients with diarrhea or vomiting.
## Clinical Pearls
* Due to the risk of serious gastrointestinal events, use the lowest effective dose for the shortest duration necessary.
* Administer with food or milk to minimize gastrointestinal upset.
* Dicyclomine can cause anticholinergic side effects, which may be more pronounced in the elderly.
* This combination product may not be ideal for patients requiring dose titration of either component independently.
* Consider alternatives if a patient has contraindications to either NSAIDs or anticholinergics.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and local guidelines before making clinical decisions.*
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