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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). Mefenamic acid provides analgesic and anti-inflammatory effects, while dicyclomine reduces gastrointestinal smooth muscle spasms.
## Primary Indications
* Symptomatic relief of mild to moderate pain associated with abdominal cramps and spasms.
## Adult Dosing
* **Meftal spas tablet:** One tablet (250 mg mefenamic acid / 20 mg dicyclomine HCl) orally 3 times daily as needed for pain and spasm.
* **Maximum dose:** Not explicitly defined for the combination product. However, standard mefenamic acid dosing is typically limited to 7 days for over-the-counter use and 14 days for prescription use, with a maximum daily dose of 1500 mg. Dicyclomine HCl dosing should not exceed 160 mg per day.
## Pediatric Dosing
* Dosing for Meftal spas in pediatric patients is not established and is not recommended.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Mefenamic acid is renally excreted; consider dose reduction and increased monitoring.
* **Hepatic Impairment:** Use with caution. Mefenamic acid is metabolized in the liver; consider dose reduction and increased monitoring.
* **Elderly:** Increased risk of adverse effects, particularly gastrointestinal bleeding and renal dysfunction. Use with caution and at 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 (due to dicyclomine component).
* Severe renal or hepatic impairment.
## Adverse Effects
* **Common (Mefenamic Acid):** Diarrhea, nausea, vomiting, abdominal pain, dyspepsia, constipation, flatulence.
* **Common (Dicyclomine):** Dry mouth, blurred vision, urinary hesitancy, constipation, dizziness, drowsiness, nausea.
* **Serious:**
* **Mefenamic Acid:** Serious gastrointestinal bleeding, ulceration, and perforation; cardiovascular thrombotic events (myocardial infarction, stroke); renal failure; hepatic failure; severe skin reactions (e.g., Stevens-Johnson syndrome, toxic epidermal necrolysis).
* **Dicyclomine:** Anticholinergic toxicity (confusion, hallucinations, severe constipation, urinary retention).
## Key Drug Interactions
* **NSAIDs (e.g., aspirin, ibuprofen, naproxen):** Increased risk of gastrointestinal bleeding and renal impairment.
* **Anticoagulants (e.g., warfarin) and Antiplatelets (e.g., clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding.
* **Diuretics and Antihypertensives (e.g., ACE inhibitors, ARBs, beta-blockers):** NSAIDs can reduce their efficacy and increase the risk of renal impairment.
* **Lithium:** NSAIDs can increase lithium levels.
* **Methotrexate:** NSAIDs can increase methotrexate levels and toxicity.
* **Other Anticholinergics (e.g., atropine, some antihistamines, tricyclic antidepressants):** Additive anticholinergic effects with dicyclomine.
* **Potassium-sparing diuretics:** Increased risk of hyperkalemia.
## Monitoring
* **GI Bleeding:** Monitor for signs and symptoms of bleeding (e.g., melena, hematemesis, abdominal pain).
* **Renal Function:** Monitor serum creatinine and BUN, especially in patients with pre-existing renal disease or those on concomitant nephrotoxic agents.
* **Hepatic Function:** Monitor liver enzymes, especially in patients with pre-existing liver disease.
* **Blood Pressure:** Monitor in patients with hypertension.
* **Signs of Anticholinergic Toxicity:** Monitor for confusion, blurred vision, urinary retention, and severe constipation, particularly in the elderly or those with other anticholinergic medications.
## Clinical Pearls
* Meftal spas should be used for the shortest duration necessary to control symptoms.
* Administer with food or milk to minimize gastrointestinal upset.
* Due to the anticholinergic effects of dicyclomine, patients should be advised to avoid activities requiring mental alertness (e.g., driving, operating machinery) until they know how the drug affects them.
* Dehydration can exacerbate anticholinergic side effects. Ensure adequate fluid intake.
* The risk of serious cardiovascular events, myocardial infarction, and stroke associated with NSAIDs may increase with duration of use and in patients with risk factors.
Please verify the information against the most current prescribing information or consult with a healthcare professional. This information is not a substitute for professional medical advice.
