Please check your internet connection and try again.
# Mefenamic Acid / Dicyclomine Hydrochloride (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 and cramps associated with irritable bowel syndrome (IBS).
* Management of dysmenorrhea (menstrual cramps).
## Adult Dosing
* **Irritable Bowel Syndrome:** One tablet (mefenamic acid 250 mg / dicyclomine HCl 20 mg) three times daily, taken 30 minutes before meals. Maximum duration of use is typically 2 weeks.
* **Dysmenorrhea:** One tablet three times daily, starting from the onset of pain or bleeding, for up to 3 days.
## Pediatric Dosing
* The safety and efficacy of mefenamic acid and dicyclomine in pediatric patients are not well-established. Use is generally not recommended in children under 12 years of age.
## Dose Adjustments
* **Renal Impairment:** Mefenamic acid should be used with caution in patients with renal impairment. Dosage reduction may be necessary.
* **Hepatic Impairment:** Mefenamic acid should be used with caution in patients with hepatic impairment.
* **Elderly:** Use with caution, particularly due to increased risk of gastrointestinal bleeding and renal adverse effects associated with NSAIDs.
## Contraindications
* Hypersensitivity to mefenamic acid, dicyclomine, or other NSAIDs.
* History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Inflammatory bowel disease (active or history of).
* Gastrointestinal obstruction or paralytic ileus.
* Uncontrolled narrow-angle glaucoma.
* Myasthenia gravis.
* Severe renal or hepatic impairment.
* Severe heart failure.
* Pregnancy (especially in the third trimester).
## Adverse Effects
* **Common (Mefenamic Acid):** Nausea, vomiting, diarrhea, abdominal pain, dyspepsia, constipation, rash, dizziness.
* **Common (Dicyclomine):** Dry mouth, blurred vision, dilated pupils, urinary retention, constipation, confusion, drowsiness, rash.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; myocardial infarction, stroke; renal failure; Stevens-Johnson syndrome, toxic epidermal necrolysis; anaphylaxis.
## Key Drug Interactions
* **NSAIDs (e.g., aspirin, ibuprofen):** Increased risk of gastrointestinal adverse effects.
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding.
* **ACE Inhibitors, ARBs, Diuretics:** Reduced antihypertensive effect, increased risk of renal impairment.
* **Anticholinergics:** Additive anticholinergic effects with dicyclomine.
* **Digoxin:** May increase serum digoxin levels.
## Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Assess for signs of renal or hepatic dysfunction.
* Monitor blood pressure, especially in patients with hypertension.
* Monitor for adverse effects of anticholinergic therapy (dry mouth, blurred vision, urinary retention, constipation).
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Avoid concomitant use with other NSAIDs.
* Due to anticholinergic effects, use with caution in elderly patients and those with conditions exacerbated by anticholinergics (e.g., prostatic hypertrophy, constipation).
* Discontinue if significant gastrointestinal bleeding or adverse effects occur.
***
*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions.*
