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# Meftal Spas
## Overview
Meftal Spas is a combination medication containing mefenamic acid (a nonsteroidal anti-inflammatory drug or NSAID) and dicyclomine hydrochloride (an anticholinergic antispasmodic).
## Primary Indications
* Symptomatic relief of mild to moderate pain associated with smooth muscle spasms, such as in dysmenorrhea, gastrointestinal colic, or urinary tract spasms.
## Adult Dosing
* **Mefenamic acid:** Typically 250 mg to 500 mg every 6 to 8 hours as needed.
* **Dicyclomine hydrochloride:** Typically 10 mg to 20 mg every 6 to 8 hours as needed.
* The specific dosing of Meftal Spas (which combines these) will depend on the product formulation. Consult the product monograph for exact dosing. Maximum daily dose for mefenamic acid is generally 1500 mg.
## Pediatric Dosing
* Dosing for Meftal Spas in pediatric populations is not well-established and generally not recommended due to the potential for adverse effects, particularly with dicyclomine. Mefenamic acid dosing for children is typically based on weight.
## Dose Adjustments
* **Renal Impairment:** Mefenamic acid should be used with caution and potentially at reduced doses in patients with significant renal impairment.
* **Hepatic Impairment:** Mefenamic acid should be used with caution in patients with hepatic impairment.
* **Elderly:** Elderly patients may be at increased risk for NSAID-related adverse effects, including gastrointestinal bleeding and renal toxicity. Use with caution.
## Contraindications
* Hypersensitivity to mefenamic acid, dicyclomine, or other NSAIDs.
* Patients with a history of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Inflammatory bowel disease.
* Obstructive uropathy.
* Myasthenia gravis.
* Uncontrolled glaucoma.
* Severe renal or hepatic impairment.
* Heart failure.
* Third trimester of pregnancy.
## Adverse Effects
* **Mefenamic acid:** Gastrointestinal disturbances (nausea, vomiting, diarrhea, abdominal pain, dyspepsia, ulceration, bleeding), dizziness, headache, rash, renal toxicity, hepatic effects, increased risk of cardiovascular thrombotic events.
* **Dicyclomine:** Anticholinergic effects (dry mouth, blurred vision, urinary retention, constipation, drowsiness, confusion, tachycardia), especially at higher doses or in the elderly.
## Key Drug Interactions
* **Other NSAIDs and Aspirin:** Increased risk of gastrointestinal bleeding.
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **Diuretics and ACE Inhibitors:** May reduce antihypertensive efficacy and increase risk of renal impairment.
* **Lithium:** Mefenamic acid can increase serum lithium levels.
* **Methotrexate:** Increased risk of methotrexate toxicity.
* **Anticholinergics:** Additive anticholinergic effects with dicyclomine.
* **Antacids:** May decrease absorption of dicyclomine.
## Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Monitor renal and hepatic function, especially in patients with pre-existing impairment or elderly patients.
* Monitor for signs of cardiovascular events.
* Monitor for anticholinergic side effects.
## Clinical Pearls
* Meftal Spas should be used for the shortest duration necessary to control symptoms.
* Administer with food or milk to minimize gastrointestinal upset.
* Caution with concurrent use of alcohol due to increased risk of GI side effects.
* Dicyclomine's anticholinergic effects can be pronounced in the elderly.
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**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions.
