Meftal%252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252520spas

# Meftal spas ## Overview Meftal spas is a combination product containing mefenamic acid, a non-steroidal anti-inflammatory drug (NSAID), and dicyclomine, an anticholinergic antispasmodic. ## Primary Indications * Symptomatic relief of abdominal pain and cramps associated with irritable bowel syndrome (IBS) and other gastrointestinal disorders. * Primary dysmenorrhea. ## Adult Dosing * **For gastrointestinal disorders:** 1-2 tablets (mefenamic acid 250-500 mg, dicyclomine 10-20 mg) three times daily. * **For primary dysmenorrhea:** 1 tablet (mefenamic acid 250 mg, dicyclomine 10 mg) three times daily, starting with the onset of pain and continuing for 2-3 days. Maximum daily dose is typically 4 tablets (mefenamic acid 1000 mg, dicyclomine 40 mg). ## Pediatric Dosing The use of meftal spas in children is not well-established. Mefenamic acid pediatric dosing for other indications is generally 6.5 mg/kg/dose every 6-8 hours. Dicyclomine pediatric dosing is highly variable and depends on age and indication. **Consult specific pediatric guidelines or a pediatrician for appropriate dosing.** ## Dose Adjustments * **Renal impairment:** Use with caution, especially in severe impairment. Mefenamic acid is largely renally excreted. * **Hepatic impairment:** Use with caution. * **Elderly:** Increased risk of adverse effects from both components, particularly GI bleeding and anticholinergic effects. Use lowest effective dose. ## Contraindications * Hypersensitivity to mefenamic acid, dicyclomine, or other NSAIDs. * Patients with a history of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs. * Active gastrointestinal ulceration or inflammation. * Severe renal or hepatic impairment. * Glaucoma. * Myasthenia gravis. * Severe ulcerative colitis. * Prostatic hypertrophy with urinary retention. * Cardiovascular disease or risk factors for cardiovascular disease (due to mefenamic acid). * Late pregnancy (third trimester). ## Adverse Effects * **Common (Mefenamic Acid):** Diarrhea, nausea, vomiting, abdominal pain, constipation, dyspepsia, headache, dizziness, rash. * **Common (Dicyclomine):** Dry mouth, blurred vision, urinary retention, constipation, drowsiness, dizziness, confusion. * **Serious (Mefenamic Acid):** Gastrointestinal bleeding, ulceration, perforation, renal papillary necrosis, interstitial nephritis, hepatic failure, myocardial infarction, stroke, exacerbation of asthma, Stevens-Johnson syndrome, toxic epidermal necrolysis. * **Serious (Dicyclomine):** Severe anticholinergic effects, especially in the elderly or those with underlying conditions. ## Key Drug Interactions * **Anticoagulants (e.g., warfarin):** Increased risk of bleeding with mefenamic acid. * **Corticosteroids:** Increased risk of GI ulceration and bleeding. * **Other NSAIDs, aspirin:** Increased risk of GI toxicity and adverse effects. * **Diuretics, ACE inhibitors, ARBs:** May reduce antihypertensive effect and increase risk of renal dysfunction with mefenamic acid. * **Lithium:** Increased serum lithium levels. * **Methotrexate:** Increased methotrexate toxicity. * **Anticholinergic agents (other):** Additive anticholinergic effects. * **Amantadine, quinidine:** Increased anticholinergic effects. * **Antacids:** May affect absorption of dicyclomine. ## Monitoring * Monitor for signs and symptoms of gastrointestinal bleeding, ulceration, and perforation. * Monitor for signs of renal and hepatic dysfunction. * Monitor blood pressure, especially in patients with cardiovascular risk factors. * Assess for effectiveness and adverse effects of both components. * Monitor for anticholinergic effects (dry mouth, blurred vision, urinary retention, constipation, confusion). ## Clinical Pearls * Meftal spas should be taken with food or milk to minimize gastrointestinal upset. * Due to the anticholinergic effects of dicyclomine, caution is advised when driving or operating machinery. * Avoid concurrent use of alcohol, which can increase the risk of gastrointestinal side effects. * Mefenamic acid should generally not be used for longer than 7 days. * This combination product may not be appropriate for all patients due to the potential for additive adverse effects and drug interactions. --- *This information is for educational purposes only and does not substitute for professional medical advice. Always verify current prescribing information and consult with a qualified healthcare provider before making any treatment decisions.*