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# Meftal spas
## Overview
Meftal spas is a combination product containing mefenamic acid and hyoscine butylbromide. Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) and hyoscine butylbromide is an anticholinergic antispasmodic agent.
## Primary Indications
* Pain and spasms associated with irritable bowel syndrome (IBS).
* Dysmenorrhea (menstrual cramps).
## Adult Dosing
* **Meftal spas tablet:** 1 tablet (containing mefenamic acid 250 mg and hyoscine butylbromide 10 mg) three times daily.
* **Maximum dose:** Mefenamic acid maximum dose is generally 500 mg every 6 hours, but specific maximums for this combination product may vary by local protocol.
## Pediatric Dosing
* Safety and efficacy in pediatric patients have not been established.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Dose reduction may be necessary in severe impairment.
* **Hepatic Impairment:** Use with caution. Dose reduction may be necessary in severe impairment.
* **Elderly:** Use with caution, particularly in those with renal or hepatic impairment.
## Contraindications
* Hypersensitivity to mefenamic acid, hyoscine butylbromide, or any component of the formulation.
* Active gastrointestinal ulceration or inflammation.
* History of gastrointestinal bleeding or perforation.
* Severe renal or hepatic impairment.
* Myasthenia gravis.
* Tachyarrhythmias.
* Narrow-angle glaucoma.
* Prostatic hypertrophy with urinary retention.
* Ileus or intestinal obstruction.
* Lactation.
## Adverse Effects
* **Common:** Gastrointestinal upset (nausea, vomiting, diarrhea, constipation, abdominal pain), dizziness, drowsiness, dry mouth.
* **Serious:** Gastrointestinal bleeding, perforation, ulceration. Renal toxicity, hepatic toxicity, hypersensitivity reactions (including Stevens-Johnson syndrome and toxic epidermal necrolysis), cardiovascular thrombotic events (NSAID class effect), blurred vision, urinary retention, tachycardia.
## Key Drug Interactions
* **NSAIDs:** Increased risk of gastrointestinal bleeding and renal toxicity when used with other NSAIDs or aspirin.
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding and ulceration.
* **Diuretics, ACE inhibitors, ARBs:** Reduced antihypertensive effect and increased risk of renal impairment.
* **Lithium:** Increased serum lithium levels.
* **Anticholinergics:** Additive anticholinergic effects (e.g., dry mouth, constipation, urinary retention, blurred vision).
* **Dopamine antagonists:** May reduce efficacy of antiparkinsonian drugs.
* **Metoclopramide:** May antagonize the effects of hyoscine butylbromide.
## Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding or ulceration.
* Monitor renal and hepatic function, especially in patients with pre-existing impairment or those on long-term therapy.
* Monitor for signs of hypersensitivity reactions.
* Monitor blood pressure, particularly in elderly patients or those with cardiovascular risk factors.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Due to the anticholinergic effects of hyoscine butylbromide, caution is advised in patients with conditions that could be exacerbated by these effects (e.g., prostatic hypertrophy, narrow-angle glaucoma, constipation).
* Discontinue immediately if signs of gastrointestinal bleeding, ulceration, or severe adverse reactions occur.
* Avoid concomitant use with other NSAIDs.
This information is intended for healthcare professionals and does not substitute for professional medical advice. Always consult the most current prescribing information or your pharmacist for complete and up-to-date drug information.
