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# Mefenamic Acid / Dicyclomine (Meftal Spas)
## Overview
Meftal Spas is a combination product containing mefenamic acid, a nonsteroidal anti-inflammatory drug (NSAID), and dicyclomine, an anticholinergic antispasmodic.
## Primary Indications
Treatment of abdominal pain associated with spasms, particularly in conditions like irritable bowel syndrome, and for pain and inflammation.
## Adult Dosing
* **Mefenamic Acid component:** Typically 500 mg every 8 hours as needed for pain. Maximum daily dose is 1500 mg.
* **Dicyclomine component:** Typically 10-20 mg every 6-8 hours as needed for spasms. Maximum daily dose is 80 mg.
* *Note:* Specific dosing may vary based on local protocols and individual patient response.
## Pediatric Dosing
Dosing for pediatric patients is not well-established for this combination product. Mefenamic acid can be dosed in children aged 6 months and older, but dicyclomine use in children is often cautious due to potential side effects. Consult specific pediatric guidelines or specialized resources.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Mefenamic acid is renally excreted, and dose reduction may be necessary.
* **Hepatic Impairment:** Use with caution. Mefenamic acid can affect liver function.
* **Elderly:** Increased risk of adverse effects from both components, particularly gastrointestinal bleeding and anticholinergic effects. Use with caution.
## Contraindications
* Hypersensitivity to mefenamic acid, dicyclomine, or other NSAIDs/anticholinergics.
* Active gastrointestinal ulceration or inflammation.
* Severe renal or hepatic impairment.
* Patients with a history of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Obstructive uropathy.
* Uncontrolled narrow-angle glaucoma.
* Myasthenia gravis.
* Severe ulcerative colitis.
* Toxic megacolon.
* Infants less than 6 months of age.
## Adverse Effects
* **Mefenamic Acid:** Gastrointestinal upset (dyspepsia, nausea, vomiting, diarrhea, constipation, abdominal pain), peptic ulceration, bleeding, renal toxicity, hypersensitivity reactions (rash, asthma exacerbation), headache, dizziness.
* **Dicyclomine:** Anticholinergic effects (dry mouth, blurred vision, constipation, urinary retention, drowsiness, confusion), tachycardia.
* **Combination:** Increased risk of gastrointestinal bleeding due to NSAID component and potential exacerbation of anticholinergic effects.
## Key Drug Interactions
* **NSAIDs (including mefenamic acid):** Increased risk of bleeding with anticoagulants (e.g., warfarin) and antiplatelet agents (e.g., aspirin, clopidogrel). May reduce the efficacy of antihypertensives and diuretics. Increased nephrotoxicity with ACE inhibitors and ARBs.
* **Anticholinergics (including dicyclomine):** Additive effects with other drugs having anticholinergic properties (e.g., tricyclic antidepressants, antihistamines), increasing risk of confusion, urinary retention, constipation, and blurred vision. May reduce the absorption of drugs taken concomitantly due to decreased gastrointestinal motility.
## Monitoring
* **GI Bleeding:** Monitor for signs and symptoms of GI bleeding (melena, hematemesis, abdominal pain).
* **Renal Function:** Periodic monitoring of renal function, especially in patients with pre-existing renal disease or those on long-term therapy.
* **Liver Function:** Periodic monitoring of liver function, especially in patients with pre-existing hepatic disease.
* **Anticholinergic Effects:** Monitor for signs of systemic anticholinergic toxicity, especially in the elderly or those with impaired cognition.
## Clinical Pearls
* This combination aims to treat both inflammation/pain (mefenamic acid) and smooth muscle spasm (dicyclomine).
* Administer with food or milk to minimize gastrointestinal upset from mefenamic acid.
* Use the lowest effective dose for the shortest duration necessary.
* Caution is advised in patients with cardiac, renal, or hepatic impairment.
* Elderly patients are at higher risk for severe adverse effects.
* Avoid concurrent use of other NSAIDs or salicylates.
* Monitor for signs of urinary retention, especially in elderly males.
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**Disclaimer:** This information is intended for clinical professionals. Always consult the most current prescribing information, local protocols, and conduct a thorough patient assessment before making any prescribing decisions. Information may not be exhaustive and specific patient factors must be considered.
