Please check your internet connection and try again.
# Meftal spas
## Overview
Meftal spas is a combination medication containing mefenamic acid, a nonsteroidal anti-inflammatory drug (NSAID), and dicyclomine hydrochloride, an anticholinergic antispasmodic.
## Primary Indications
* Pain and spasms associated with irritable bowel syndrome (IBS).
* Dysmenorrhea.
* Other gastrointestinal spasms and associated pain.
## Adult Dosing
* **Usual Adult Dose:** 1 tablet (containing mefenamic acid 250 mg and dicyclomine HCl 20 mg) three times daily.
* **Maximum Dose:** Not explicitly defined for the combination product. Mefenamic acid generally has a maximum daily dose of 1500 mg. Dicyclomine has a maximum daily dose of 160 mg.
## Pediatric Dosing
There is insufficient data to recommend pediatric dosing for Meftal spas. Dosing of individual components may be considered in pediatric patients based on age, weight, and clinical indication, under strict medical supervision.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Mefenamic acid is renally excreted.
* **Hepatic Impairment:** Use with caution. Mefenamic acid is metabolized in the liver.
* **Elderly:** Use with caution, particularly due to the NSAID component's potential for gastrointestinal and renal adverse effects.
## Contraindications
* Hypersensitivity to mefenamic acid, dicyclomine, or any component of the formulation.
* Active gastrointestinal bleeding or perforation.
* Inflammatory bowel disease (active or recent).
* Glaucoma (especially angle-closure).
* Myasthenia gravis.
* Obstructive uropathy or gastrointestinal obstruction.
* Uncontrolled heart failure.
* Aspirin-induced asthma.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Nausea, vomiting, abdominal pain, diarrhea, constipation, dizziness, dry mouth, blurred vision, urinary retention.
* **Serious:**
* **Mefenamic Acid:** Gastrointestinal bleeding, perforation, ulceration; renal toxicity (including interstitial nephritis, papillary necrosis); hepatic toxicity; cardiovascular thrombotic events; hypersensitivity reactions; Stevens-Johnson syndrome/toxic epidermal necrolysis.
* **Dicyclomine:** Anticholinergic effects (confusion, drowsiness, tachycardia, hallucinations, heat prostration, particularly in the elderly or those with impaired thermoregulation).
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding with mefenamic acid.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **Diuretics and Antihypertensives:** Mefenamic acid may reduce their efficacy and increase nephrotoxicity.
* **Lithium:** Mefenamic acid may increase lithium levels.
* **Methotrexate:** Mefenamic acid may increase methotrexate toxicity.
* **Other NSAIDs/Aspirin:** Increased risk of adverse effects.
* **Anticholinergics:** Additive anticholinergic effects with dicyclomine.
* **Amantadine, MAO Inhibitors, Tricyclic Antidepressants:** Potentiated anticholinergic effects.
## Monitoring
* **Renal function:** Monitor electrolytes and renal function tests, especially with long-term use or in patients with risk factors.
* **Hepatic function:** Monitor liver function tests.
* **Gastrointestinal symptoms:** Assess for signs of bleeding or ulceration.
* **Blood pressure:** Monitor, especially with long-term NSAID use.
* **Signs of anticholinergic toxicity:** Especially in the elderly or with high doses.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary.
* Administer with food or milk to minimize gastrointestinal upset.
* Be aware of the additive risks of combined NSAID and anticholinergic therapy.
* Caution in patients with dehydration or impaired thermoregulation due to the anticholinergic component.
* Discontinue if significant GI bleeding or adverse reactions occur.
***
*This information is intended for healthcare professionals. Always verify current prescribing information and consult with a qualified healthcare provider for any medical advice or treatment decisions.*
