Meftal%2525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252520spas

# 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 * Management of dysmenorrhea. * Relief of abdominal pain and cramps associated with irritable bowel syndrome or gastrointestinal spasms. ## Adult Dosing * **Dysmenorrhea:** 1 tablet (250 mg mefenamic acid, 10 mg dicyclomine HCl) orally every 8 hours as needed, starting with the onset of pain. * **Irritable Bowel Syndrome/Gastrointestinal Spasms:** 1 tablet (250 mg mefenamic acid, 10 mg dicyclomine HCl) orally every 8 hours as needed. The maximum daily dose of mefenamic acid should not exceed 1000 mg in the first 24 hours and 500 mg every 6 hours thereafter. ## Pediatric Dosing Safety and efficacy in pediatric patients have not been established. Consult specialized pediatric drug references or national guidelines for specific recommendations. ## Dose Adjustments * **Renal Impairment:** Use with caution. Mefenamic acid is renally excreted. Dose reduction may be necessary, though specific guidelines are limited. Monitor renal function closely. * **Hepatic Impairment:** Use with caution. Mefenamic acid is metabolized in the liver. Dose reduction may be necessary. Monitor liver function. * **Elderly:** Elderly patients may be more susceptible to NSAID-related adverse effects, including gastrointestinal bleeding and renal dysfunction. Use the lowest effective dose for the shortest duration. ## Contraindications * Hypersensitivity to mefenamic acid, dicyclomine, or other NSAIDs/anticholinergics. * History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs. * Active gastrointestinal ulceration or inflammation. * Severe renal or hepatic impairment. * Myasthenia gravis. * Glaucoma (narrow-angle). * Obstructive uropathy or gastrointestinal obstruction. * Unstable heart failure. * Use in the third trimester of pregnancy. ## Adverse Effects **Common (mefenamic acid):** Nausea, vomiting, diarrhea, abdominal pain, dyspepsia, constipation. **Common (dicyclomine):** Dry mouth, blurred vision, urinary retention, constipation, drowsiness, dizziness. **Serious:** * **Gastrointestinal:** Severe GI bleeding, ulceration, perforation. * **Cardiovascular:** Increased risk of thrombotic events (MI, stroke). * **Renal:** Renal papillary necrosis, interstitial nephritis, renal failure. * **Hepatic:** Hepatotoxicity, elevated liver enzymes. * **Dermatologic:** Severe skin reactions (e.g., Stevens-Johnson syndrome, toxic epidermal necrolysis). * **Anticholinergic toxicity:** Confusion, hallucinations, tachycardia, urinary retention. ## Key Drug Interactions * **Anticoagulants (e.g., warfarin):** Increased risk of bleeding. * **Corticosteroids:** Increased risk of GI ulceration and bleeding. * **SSRIs/SNRIs:** Increased risk of GI bleeding. * **Diuretics and antihypertensives:** Mefenamic acid can decrease their efficacy and increase the risk of renal impairment. * **Lithium:** Mefenamic acid can increase lithium levels. * **Methotrexate:** Mefenamic acid can increase methotrexate levels. * **Other NSAIDs:** Increased risk of adverse effects. * **Anticholinergics:** Additive anticholinergic effects. ## Monitoring * **GI Bleeding:** Monitor for signs and symptoms (melena, hematemesis, abdominal pain). * **Renal Function:** Monitor serum creatinine and BUN, especially in patients with pre-existing renal disease or those at risk. * **Hepatic Function:** Monitor liver function tests, especially in patients with liver disease or those on long-term therapy. * **Blood Pressure:** Monitor blood pressure, especially in patients with hypertension. * **Signs of Anticholinergic Toxicity:** Assess for dry mouth, blurred vision, urinary retention, constipation, and cognitive impairment. ## Clinical Pearls * Meftal spas should be used at the lowest effective dose for the shortest duration necessary to control symptoms. * Concurrent use with other NSAIDs or aspirin should be avoided unless specifically indicated and with caution. * Patients should be advised to report any signs of GI bleeding, renal dysfunction, or severe allergic reactions immediately. * Dicyclomine's anticholinergic effects can be exacerbated by other medications with anticholinergic properties. * Consider potential for gastrointestinal upset with mefenamic acid; administration with food may be beneficial for some patients, though absorption may be slightly reduced. *** **Disclaimer:** This information is intended for clinical use by healthcare professionals and does not replace a thorough review of the product's prescribing information. Always consult the most current official drug monograph and local guidelines for definitive and comprehensive information, especially regarding pediatric dosing and specific patient populations.