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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. Mefenamic acid reduces inflammation and pain. Dicyclomine reduces smooth muscle spasms.
## Primary Indications
* Treatment of abdominal pain associated with smooth muscle spasms, particularly in conditions like irritable bowel syndrome or menstrual cramps.
## Adult Dosing
* **Mefenamic Acid/Dicyclomine:** Typically one tablet (250 mg mefenamic acid / 20 mg dicyclomine) three times daily.
* **Maximum Doses:**
* Mefenamic Acid: 1500 mg daily.
* Dicyclomine: Specific maximum daily dose for this combination is not well-established, but for dicyclomine alone, it is generally 80 mg daily.
## Pediatric Dosing
* Safety and efficacy in pediatric patients are not established. Use is generally not recommended.
## Dose Adjustments
* **Renal Impairment:** Mefenamic acid should be used with caution in patients with pre-existing renal disease. Dose reduction may be necessary based on severity.
* **Hepatic Impairment:** Mefenamic acid should be used with caution. Dose reduction may be necessary.
* **Elderly:** Increased risk of adverse effects, particularly gastrointestinal bleeding and renal dysfunction. Use with caution.
## 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.
* Severe renal or hepatic impairment.
* Inflammatory bowel disease.
* Glaucoma.
* Myasthenia gravis.
* Obstructive uropathy.
* Obstructive gastrointestinal lesions.
* Unstable heart failure.
* Use in the elderly is often cautioned due to increased risk.
## Adverse Effects
* **Common (Mefenamic Acid):** Diarrhea, nausea, vomiting, abdominal pain, constipation, dyspepsia.
* **Common (Dicyclomine):** Dry mouth, blurred vision, drowsiness, dizziness, constipation, urinary retention.
* **Serious (Mefenamic Acid):** Gastrointestinal bleeding, perforation, ulceration; renal failure; hepatic failure; cardiovascular thrombotic events; severe skin reactions (e.g., Stevens-Johnson syndrome, toxic epidermal necrolysis); bronchospasm.
* **Serious (Dicyclomine):** Tachycardia, confusion, severe constipation, exacerbation of glaucoma, urinary retention.
## Key Drug Interactions
* **NSAIDs:** Increased risk of gastrointestinal bleeding with concurrent use of other NSAIDs, corticosteroids, SSRIs, or anticoagulants.
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Diuretics and Antihypertensives:** NSAIDs can reduce the efficacy of these drugs and increase the risk of renal impairment.
* **Lithium:** Mefenamic acid can increase lithium levels.
* **Digoxin:** Mefenamic acid can increase digoxin levels.
* **Anticholinergics:** Additive anticholinergic effects with other drugs possessing these properties (e.g., tricyclic antidepressants, antihistamines).
## Monitoring
* **Renal function:** Monitor serum creatinine and BUN, especially in elderly patients or those with pre-existing renal disease.
* **Hepatic function:** Monitor LFTs if there is any suspicion of liver dysfunction.
* **Gastrointestinal symptoms:** Monitor for signs of bleeding or ulceration.
* **Blood pressure:** Particularly important in patients taking antihypertensives.
* **Urinary symptoms:** Monitor for signs of retention.
## Clinical Pearls
* Meftal spas should be taken with food or milk to minimize gastrointestinal upset.
* Due to the anticholinergic effects, patients should be advised about potential blurred vision, drowsiness, and dizziness, and cautioned about operating machinery or driving.
* Use for the shortest duration necessary to control symptoms.
* Consider alternative treatments if diarrhea is a prominent symptom, as mefenamic acid can also cause diarrhea.
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*Please verify current prescribing information for the most up-to-date details.*
