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# Meftal spas
## Overview
Meftal spas is a combination product containing mefenamic acid, a nonsteroidal anti-inflammatory drug (NSAID), and dicyclomine, an anticholinergic antispasmodic agent.
## Primary Indications
* Symptomatic relief of abdominal cramps and pain associated with gastrointestinal disorders.
* Management of primary dysmenorrhea.
## Adult Dosing
* **Meftal spas tablet:** 1 tablet (250 mg mefenamic acid/20 mg dicyclomine) every 8 hours as needed.
* **Maximum dose:** Not to exceed 4 tablets per day.
## Pediatric Dosing
* Dosing for pediatric patients is not well-established and should be determined by a healthcare provider based on individual patient needs and response. Mefenamic acid is generally not recommended for children under 14 years of age unless specifically prescribed.
## Dose Adjustments
* **Renal impairment:** Use with caution. Mefenamic acid is renally eliminated; dose reduction may be necessary in severe impairment.
* **Hepatic impairment:** Use with caution. Mefenamic acid is metabolized in the liver; dose reduction may be necessary in severe impairment.
* **Elderly:** Increased risk of adverse effects, particularly gastrointestinal bleeding and renal toxicity. Use with caution and consider the lowest effective dose.
## Contraindications
* Hypersensitivity to mefenamic acid, dicyclomine, or any component of the formulation.
* Patients with a history of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Inflammatory bowel disease.
* Gastrointestinal obstruction or ileus.
* Severe ulcerative colitis.
* Myasthenia gravis.
* Glaucoma.
* Infants less than 6 months of age.
* Known hypersensitivity to anticholinergic agents.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, constipation, abdominal pain, dizziness, headache, dry mouth.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; renal impairment; hepatic dysfunction; cardiovascular thrombotic events; hypersensitivity reactions; blurred vision; urinary retention.
## Key Drug Interactions
* **Other NSAIDs (including aspirin):** Increased risk of gastrointestinal bleeding and ulceration.
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding.
* **SSRIs/SNRIs:** Increased risk of gastrointestinal bleeding.
* **Anticholinergics (other):** Additive anticholinergic effects (e.g., dry mouth, blurred vision, constipation, urinary retention).
* **Antacids:** May decrease absorption of mefenamic acid.
* **Lithium:** May increase lithium levels.
* **Methotrexate:** May increase methotrexate toxicity.
## Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Assess renal function (e.g., serum creatinine, BUN).
* Monitor liver function tests if prolonged use or in patients with pre-existing liver disease.
* Monitor for anticholinergic effects (e.g., dry mouth, blurred vision, urinary retention).
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Due to anticholinergic effects, caution patients about activities requiring mental alertness (e.g., driving, operating machinery).
* Mefenamic acid is a short-term analgesic and antipyretic; generally not recommended for use beyond 7 days.
* Dicyclomine can cause drowsiness; avoid concurrent use with other CNS depressants.
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**Disclaimer:** This information is intended for healthcare professionals and should not replace consultation with current prescribing information, drug monographs, or expert clinical judgment. Always verify the latest drug information before patient administration.
