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# Meftal spas
## Overview
Meftal spas is a combination product containing mefenamic acid and dicyclomine. Mefenamic acid is a non-steroidal anti-inflammatory drug (NSAID) used for mild to moderate pain. Dicyclomine is an anticholinergic and antispasmodic agent used to relieve smooth muscle spasms.
## Primary Indications
* Management of abdominal pain associated with smooth muscle spasms.
## Adult Dosing
* **Meftal spas:** Typically prescribed as one tablet (containing mefenamic acid 250 mg and dicyclomine hydrochloride 20 mg) three times daily.
* **Maximum:** Mefenamic acid: 500 mg every 6 hours or 1250 mg/day. Dicyclomine: Not well-established, but typical use does not exceed recommended tablet dosage.
## Pediatric Dosing
* Meftal spas is generally not recommended for use in pediatric patients due to lack of established safety and efficacy. Mefenamic acid dosing in children typically starts at 6 months of age, but dicyclomine is less commonly used in this population. Specific pediatric dosing for the combination product is not established.
## Dose Adjustments
* **Renal Impairment:** Caution is advised. NSAIDs can worsen renal function.
* **Hepatic Impairment:** Caution is advised. NSAIDs can affect liver function.
## Contraindications
* Hypersensitivity to mefenamic acid, dicyclomine, or any component of the formulation.
* Patients with active gastrointestinal ulceration or inflammation.
* History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Severe renal or hepatic impairment.
* Myasthenia gravis (due to anticholinergic effects of dicyclomine).
* Gastrointestinal obstruction or paralytic ileus.
* Glaucoma (due to anticholinergic effects of dicyclomine).
* Infants less than 6 months of age (NSAID risk).
## Adverse Effects
* **Common:** Nausea, vomiting, abdominal pain, diarrhea, constipation, dizziness, blurred vision, dry mouth, urinary retention, drowsiness.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; renal failure; hepatic failure; allergic reactions (including anaphylaxis); cardiovascular thrombotic events. Anticholinergic effects from dicyclomine can include confusion, hallucinations, and heat prostration.
## Key Drug Interactions
* **Other NSAIDs (including Aspirin):** Increased risk of gastrointestinal toxicity and bleeding.
* **Anticoagulants (e.g., Warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding and ulceration.
* **Diuretics, ACE Inhibitors, ARBs:** Mefenamic acid can reduce their antihypertensive effect and increase the risk of renal impairment.
* **Lithium:** Mefenamic acid can increase lithium levels.
* **Methotrexate:** Mefenamic acid can increase methotrexate toxicity.
* **Anticholinergics:** Additive anticholinergic effects with dicyclomine.
* **Antacids:** May decrease dicyclomine absorption.
## Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Monitor renal and hepatic function, especially with prolonged use or in susceptible patients.
* Monitor for signs of anticholinergic toxicity.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary.
* Administer with food or milk to minimize gastrointestinal upset.
* Avoid concomitant use with other NSAIDs.
* Caution in elderly patients due to increased risk of adverse effects.
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*This information is intended for clinical professionals and does not replace current prescribing information. Always verify with the most recent product monograph or local guidelines.*
