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# Meftal spas
## Overview
Meftal spas is a combination product containing mefenamic acid (a nonsteroidal anti-inflammatory drug, NSAID) and hyoscine butylbromide (an anticholinergic antispasmodic).
## Primary Indications
* Short-term symptomatic relief of pain and spasms associated with gastrointestinal conditions, biliary colic, and renal colic.
* Primary dysmenorrhea.
## Adult Dosing
* **Gastrointestinal/Biliary/Renal Colic:** 1-2 tablets (250 mg mefenamic acid / 10 mg hyoscine butylbromide to 500 mg mefenamic acid / 20 mg hyoscine butylbromide) orally 3-4 times daily as needed for pain and spasms.
* **Dysmenorrhea:** 1-2 tablets (250 mg mefenamic acid / 10 mg hyoscine butylbromide to 500 mg mefenamic acid / 20 mg hyoscine butylbromide) orally every 4-6 hours, starting at the onset of pain.
* **Maximum Dose:** Mefenamic acid: 1500 mg per day. Hyoscine butylbromide: 100 mg per day.
## Pediatric Dosing
* Safety and efficacy in pediatric patients have not been established.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Mefenamic acid is primarily renally excreted.
* **Hepatic Impairment:** Use with caution.
## Contraindications
* Known hypersensitivity to mefenamic acid, hyoscine butylbromide, or other NSAIDs.
* History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Active peptic ulceration or history of recurrent peptic ulceration.
* Severe inflammatory bowel disease (e.g., Crohn's disease, ulcerative colitis).
* Severe heart failure.
* Angle-closure glaucoma.
* Myasthenia gravis.
* Ileus or suspected ileus.
* Tachycardia.
* Megaloblastic anemia.
* Children under 12 years of age.
## Adverse Effects
* **Mefenamic Acid:** Gastrointestinal (dyspepsia, nausea, vomiting, diarrhea, abdominal pain, ulceration, bleeding), renal (renal impairment, interstitial nephritis), hepatic (elevated liver enzymes), hypersensitivity (rash, asthma, Stevens-Johnson syndrome), central nervous system (dizziness, headache).
* **Hyoscine Butylbromide:** Anticholinergic effects (dry mouth, blurred vision, urinary retention, constipation, tachycardia), dizziness.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **Other NSAIDs (including aspirin):** Increased risk of adverse effects, particularly gastrointestinal.
* **Diuretics and antihypertensives:** May reduce efficacy and increase risk of renal toxicity.
* **Lithium:** Mefenamic acid can increase serum lithium levels.
* **Methotrexate:** Mefenamic acid can increase methotrexate toxicity.
* **Probenecid:** May increase serum concentrations of mefenamic acid.
* **Anticholinergics:** Additive anticholinergic effects.
* **Dopamine antagonists:** May reduce the effects of levodopa.
## Monitoring
* Signs and symptoms of gastrointestinal bleeding.
* Renal function (serum creatinine, BUN), especially in patients with pre-existing renal disease or those taking diuretics/ACE inhibitors.
* Liver function tests, particularly with prolonged use.
* Blood pressure.
## Clinical Pearls
* Due to the risk of gastrointestinal bleeding, mefenamic acid should be used at the lowest effective dose for the shortest duration necessary.
* Avoid concurrent use with other NSAIDs.
* Caution is advised in patients with dehydration, severe infection, or compromised autonomic nervous system function, as hyoscine butylbromide can worsen symptoms.
* Long-term use of mefenamic acid is not recommended.
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**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions. Dosing and recommendations may vary based on individual patient factors and local protocols.
