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## Meftal spas
### Overview
Meftal spas is a combination medication containing mefenamic acid and hyoscine butylbromide. Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID), and hyoscine butylbromide is an antispasmodic agent.
### Primary Indications
* Symptomatic relief of smooth muscle spasms associated with gastrointestinal disorders, biliary colic, and renal colic.
* Management of dysmenorrhea.
### Adult Dosing
* **Gastrointestinal spasms, renal/biliary colic:** 1-2 tablets (containing 250 mg mefenamic acid and 10 mg hyoscine butylbromide per tablet) orally three times daily.
* **Dysmenorrhea:** 2 tablets (containing 250 mg mefenamic acid and 10 mg hyoscine butylbromide per tablet) orally three times daily, starting with the onset of pain.
### Pediatric Dosing
* **Mefenamic acid:** Dosing for pediatric patients is generally based on weight. Consult specific pediatric guidelines for mefenamic acid.
* **Hyoscine butylbromide:** Not typically recommended for routine use in pediatric patients without specific indication and medical supervision. Combination products like Meftal spas are generally not recommended for children.
### Dose Adjustments
* **Renal impairment:** Use with caution. Mefenamic acid can impair renal function.
* **Hepatic impairment:** Use with caution.
### Contraindications
* Hypersensitivity to mefenamic acid, hyoscine butylbromide, or other NSAIDs.
* Active peptic ulceration or history of recurrent peptic ulceration.
* Severe renal or hepatic impairment.
* History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Myasthenia gravis.
* Gastrointestinal obstruction or paralytic ileus.
* Tachycardia.
* Angle-closure glaucoma.
* Prostatic hypertrophy with urinary retention.
* Third trimester of pregnancy.
### Adverse Effects
* **Common (Mefenamic acid):** Nausea, vomiting, diarrhea, abdominal pain, constipation, dyspepsia, dizziness, headache.
* **Common (Hyoscine butylbromide):** Dry mouth, blurred vision, tachycardia, urinary retention, constipation, drowsiness.
* **Serious (Mefenamic acid):** Gastrointestinal bleeding, ulceration, perforation, renal toxicity, hepatic toxicity, hypersensitivity reactions, cardiovascular events.
* **Serious (Hyoscine butylbromide):** Glaucoma exacerbation, urinary retention, severe allergic reactions.
### Key Drug Interactions
* **Mefenamic acid:**
* Anticoagulants (e.g., warfarin): Increased risk of bleeding.
* Corticosteroids: Increased risk of gastrointestinal ulceration and bleeding.
* Selective serotonin reuptake inhibitors (SSRIs): Increased risk of gastrointestinal bleeding.
* Diuretics, ACE inhibitors, ARBs: May reduce antihypertensive effect and increase risk of renal impairment.
* Lithium: May increase lithium levels.
* Methotrexate: May increase methotrexate toxicity.
* **Hyoscine butylbromide:**
* Other anticholinergic agents: Additive effects, increasing risk of anticholinergic side effects.
* Dopamine antagonists (e.g., metoclopramide): May reduce the efficacy of both agents.
### Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Monitor renal and hepatic function, especially with prolonged use or in patients with pre-existing impairment.
* Monitor for signs of urinary retention and glaucoma, particularly in elderly patients.
### Clinical Pearls
* Meftal spas should be taken with food or milk to minimize gastrointestinal upset.
* Maximum duration of use for mefenamic acid is typically 7 days.
* Hyoscine butylbromide can cause blurred vision; advise caution with activities requiring clear vision.
* This combination is generally not considered a first-line treatment for chronic inflammatory conditions.
***
**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and local protocols for definitive guidance. Drug dosages and recommendations can vary.
