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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 agent. ## Primary Indications * Symptomatic relief of abdominal pain and cramping associated with irritable bowel syndrome (IBS) and other gastrointestinal disorders. * Management of primary dysmenorrhea. ## Adult Dosing * **Irritable Bowel Syndrome (IBS):** Typically 1 tablet (250 mg mefenamic acid / 20 mg dicyclomine) orally three times daily, taken with food. Maximum dose: Not clearly established for the combination product; refer to individual agent maximums. Mefenamic acid maximum dose is generally 1500 mg daily. Dicyclomine maximum dose is generally 120 mg daily. * **Primary Dysmenorrhea:** Typically 1 tablet (250 mg mefenamic acid / 20 mg dicyclomine) orally three times daily, starting at the onset of pain and bleeding. Maximum dose: See IBS. ## Pediatric Dosing * The safety and efficacy of Meftal spas in pediatric patients have not been established. Dosing recommendations are not available. ## Dose Adjustments * **Renal Impairment:** Mefenamic acid is contraindicated in severe renal impairment. Use with caution in mild to moderate renal impairment; consider dose reduction and increased monitoring. * **Hepatic Impairment:** Mefenamic acid is contraindicated in severe hepatic impairment. Use with caution in mild to moderate hepatic impairment; consider dose reduction and increased monitoring. * **Elderly:** Use with caution; elderly patients may be more susceptible to adverse effects, particularly gastrointestinal bleeding and renal toxicity. ## 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. * Use in the perioperative pain of coronary artery bypass graft (CABG) surgery. * Severe renal impairment (CrCl < 30 mL/min). * Severe hepatic impairment (Child-Pugh C). * Glaucoma. * Obstructive uropathy. * Obstructive gastrointestinal disease. * Unstable cardiovascular disease. * Myasthenia gravis. * Infants less than 6 months of age (due to dicyclomine component). ## Adverse Effects * **Common:** Gastrointestinal disturbances (nausea, vomiting, diarrhea, constipation, abdominal pain), dizziness, headache, blurred vision, dry mouth, drowsiness. * **Serious:** * **Mefenamic Acid:** Gastrointestinal bleeding, ulceration, and perforation; renal toxicity (including interstitial nephritis, papillary necrosis, and renal failure); cardiovascular thrombotic events (MI, stroke); hepatotoxicity; hypersensitivity reactions. * **Dicyclomine:** Anticholinergic effects (confusion, hallucinations, urinary retention, constipation, blurred vision, tachycardia); heat prostration. ## Key Drug Interactions * **Mefenamic Acid:** * **Anticoagulants (e.g., warfarin):** Increased risk of bleeding. * **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding. * **SSRIs/SNRIs:** Increased risk of gastrointestinal bleeding. * **Other NSAIDs/Aspirin:** Increased risk of gastrointestinal bleeding and additive effects. * **Diuretics/ACE inhibitors/ARBs:** Reduced antihypertensive effect and increased risk of renal impairment. * **Lithium:** Increased lithium levels. * **Methotrexate:** Increased methotrexate toxicity. * **Dicyclomine:** * **Anticholinergics (e.g., tricyclic antidepressants, antihistamines):** Additive anticholinergic effects. * **Amantadine:** Increased anticholinergic effects. * **MAO inhibitors:** May worsen side effects of dicyclomine. * **Opioid analgesics:** Increased risk of severe constipation and urinary retention. ## Monitoring * **Renal function:** Monitor serum creatinine and BUN, especially in patients with pre-existing renal disease or those receiving concomitant nephrotoxic agents. * **Hepatic function:** Monitor liver enzymes, especially in patients with pre-existing liver disease. * **Gastrointestinal bleeding:** Monitor for signs and symptoms of bleeding (e.g., melena, hematemesis, abdominal pain). * **Cardiovascular status:** Be aware of the potential for cardiovascular thrombotic events. * **Fluid and electrolyte balance:** Monitor for signs of dehydration or electrolyte imbalances. * **Ophthalmic examination:** Consider baseline and periodic eye exams, especially if blurred vision or other visual disturbances occur. ## Clinical Pearls * Meftal spas should be used at the lowest effective dose for the shortest duration necessary to control symptoms. * Administer with food or milk to minimize gastrointestinal upset. * Due to the anticholinergic effects of dicyclomine, caution is advised in elderly patients and those with conditions that can be exacerbated by anticholinergics (e.g., prostatic hypertrophy, constipation). * Discontinue use if severe gastrointestinal bleeding, ulceration, or signs of hypersensitivity occur. * The combination is generally not recommended for chronic use due to the risks associated with both NSAIDs and anticholinergics. **Disclaimer:** This information is for educational purposes only and does not substitute for professional medical advice. Always consult with a qualified healthcare provider to ensure the information is appropriate for your specific situation and to verify current prescribing information.