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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.
## Primary Indications
* Pain and spasms associated with gastrointestinal disorders (e.g., irritable bowel syndrome, diverticulitis).
* Dysmenorrhea.
## Adult Dosing
* **Gastrointestinal Spasms/Pain:** 1 tablet (mefenamic acid 250 mg / dicyclomine HCl 20 mg) every 8 hours as needed.
* **Dysmenorrhea:** 1 tablet every 8 hours as needed, starting with the onset of pain.
* Maximum: Generally, do not exceed 4 doses in 24 hours.
## Pediatric Dosing
Dosing for pediatric patients is not well-established and should be based on clinical judgment, weight, and response. Mefenamic acid is generally not recommended for children under 14 years of age without specific indication and supervision due to potential for adverse effects.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Mefenamic acid is primarily renally excreted.
* **Hepatic Impairment:** Use with caution.
## 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.
* Inflammatory bowel disease.
* Obstructive uropathy or gastrointestinal obstruction.
* Myasthenia gravis.
* Severe renal or hepatic impairment.
* Glaucoma (narrow-angle).
* Infants less than 6 months of age (due to risk of respiratory depression with dicyclomine).
## Adverse Effects
* **Mefenamic Acid:** GI upset, nausea, vomiting, diarrhea, abdominal pain, rash, headache, dizziness, drowsiness, renal impairment, elevated liver enzymes. Increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke. Gastrointestinal bleeding, ulceration, and perforation.
* **Dicyclomine:** Dry mouth, blurred vision, urinary retention, constipation, drowsiness, confusion, dizziness, nausea, nervousness, palpitations.
## Key Drug Interactions
* **NSAIDs:** Increased risk of bleeding with anticoagulants (e.g., warfarin) and antiplatelet agents (e.g., aspirin, clopidogrel). Increased risk of nephrotoxicity with ACE inhibitors, ARBs, diuretics, and cyclosporine.
* **Dicyclomine:** Increased anticholinergic effects with other anticholinergic agents (e.g., tricyclic antidepressants, antihistamines). May reduce the absorption of other orally administered drugs.
## Monitoring
* Monitor for signs and symptoms of GI bleeding or perforation.
* Monitor renal and hepatic function, especially with prolonged use or in patients with pre-existing impairment.
* Monitor for signs of anticholinergic effects.
## Clinical Pearls
* Meftal Spas should be taken with food or milk to minimize GI upset.
* Due to the anticholinergic effects of dicyclomine, patients should be advised to avoid activities requiring mental alertness (e.g., driving) until they know how the drug affects them.
* Avoid concurrent use with other NSAIDs.
**Please verify current prescribing information for the most up-to-date and complete drug details.**
