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# Meftal spas
## Overview
Meftal spas is a combination product containing mefenamic acid, a nonsteroidal anti-inflammatory drug (NSAID), and dicyclomine, an anticholinergic antispasmodic.
## Primary Indications
* Symptomatic relief of abdominal pain and cramping associated with irritable bowel syndrome (IBS) and other gastrointestinal disorders.
* Management of dysmenorrhea.
## Adult Dosing
* **IBS/GI Disorders:** 1 tablet (250 mg mefenamic acid / 20 mg dicyclomine) three times daily, taken 30 minutes before meals. Maximum: Not specified, but generally limit NSAID use to shortest effective duration.
* **Dysmenorrhea:** 1 tablet (250 mg mefenamic acid / 20 mg dicyclomine) three times daily, starting at the onset of pain or bleeding. Maximum: Not specified, but generally limit NSAID use to shortest effective duration.
## Pediatric Dosing
Mefenamic acid is not typically recommended for children under 14 years of age due to lack of established safety and efficacy. Dicyclomine is not recommended for infants and children due to the risk of serious adverse effects, including respiratory depression, coma, and death.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Mefenamic acid is primarily renally excreted. Dose reduction may be necessary, especially in severe impairment.
* **Hepatic Impairment:** Use with caution. Monitor liver function closely.
## 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.
* Inflammatory bowel disease (active or inactive).
* Obstructive uropathy or gastrointestinal obstruction.
* Myasthenia gravis.
* Uncontrolled glaucoma.
* Severe renal or hepatic impairment.
* Severe ulcerative colitis.
* Infants less than 6 months of age.
## Adverse Effects
* **Mefenamic Acid:** Gastrointestinal upset (nausea, vomiting, diarrhea, constipation, abdominal pain), dyspepsia, rash, dizziness, headache, renal toxicity, hepatic toxicity, increased risk of cardiovascular events.
* **Dicyclomine:** Anticholinergic effects (dry mouth, blurred vision, urinary retention, constipation, drowsiness, confusion), tachycardia.
## Key Drug Interactions
* **Other NSAIDs/Aspirin:** Increased risk of GI bleeding and renal toxicity.
* **Anticoagulants (e.g., Warfarin):** Increased risk of bleeding.
* **Diuretics, ACE Inhibitors, ARBs:** Reduced antihypertensive effect and increased risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Anticholinergics:** Additive anticholinergic effects.
* **Antacids:** May affect absorption.
## Monitoring
* Signs and symptoms of GI bleeding.
* Renal function (BUN, creatinine).
* Liver function (LFTs).
* Blood pressure.
* For anticholinergic effects, especially in elderly patients.
## Clinical Pearls
* Take with food or milk to minimize GI upset.
* Avoid concurrent use with other NSAIDs.
* Due to anticholinergic effects, caution should be exercised in patients with conditions where these effects are detrimental (e.g., heart failure, prostatic hypertrophy).
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making therapeutic decisions.*
