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# Meftal Spas ## Overview Meftal Spas is a combination product containing **Mefenamic Acid** (an NSAID) and **Dicyclomine Hydrochloride** (an anticholinergic/antispasmodic). ## Primary Indications * Symptomatic relief of abdominal pain and cramping associated with smooth muscle spasms, particularly in gastrointestinal and genitourinary conditions. * Primary dysmenorrhea. ## Adult Dosing * **Mefenamic Acid:** 250 mg to 500 mg orally every 6 to 8 hours as needed. Do not exceed 1500 mg in a 24-hour period for short-term use. For longer-term use, do not exceed 1000 mg every 6 to 8 hours. * **Dicyclomine Hydrochloride:** 10 mg to 20 mg orally every 6 to 8 hours as needed. *Note: Dosing for Meftal Spas specific formulations will depend on the concentration of each component per unit.* ## Pediatric Dosing Dosing for Meftal Spas in pediatric patients is not well-established and should be determined by a healthcare provider based on the child's weight and clinical condition. Mefenamic acid dosing in children typically ranges from 5 to 7 mg/kg/dose orally every 6 to 8 hours. Dicyclomine pediatric dosing is also variable and generally lower than adult doses. ## Dose Adjustments * **Renal Impairment:** Use with caution. Mefenamic acid is renally excreted. Dose reduction may be necessary in severe renal impairment. * **Hepatic Impairment:** Use with caution. Mefenamic acid is metabolized by the liver. Dose reduction may be necessary. * **Elderly:** Elderly patients may be more susceptible to adverse effects of NSAIDs (e.g., GI bleeding, renal dysfunction). Use the lowest effective dose. ## 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 (active or history). * Obstructive uropathy or gastrointestinal obstruction. * Myasthenia gravis. * Severe renal or hepatic impairment. * Glaucoma (narrow-angle). * Gastrointestinal bleeding or perforation. * Late pregnancy (third trimester). ## Adverse Effects * **Mefenamic Acid:** * Gastrointestinal: Nausea, vomiting, diarrhea, abdominal pain, dyspepsia, GI bleeding, perforation, ulceration. * Renal: Acute kidney injury, interstitial nephritis. * Hepatic: Hepatotoxicity. * Hematologic: Anemia, leukopenia. * Other: Headache, dizziness, rash, Stevens-Johnson syndrome, toxic epidermal necrolysis. * **Dicyclomine Hydrochloride:** * Anticholinergic effects: Dry mouth, blurred vision, constipation, urinary retention, drowsiness, confusion (especially in elderly). * Other: Nausea, vomiting, headache, rash. ## Key Drug Interactions * **NSAIDs (other):** Increased risk of GI toxicity. * **Anticoagulants (e.g., warfarin):** Increased risk of bleeding. * **Corticosteroids:** Increased risk of GI ulceration and bleeding. * **Diuretics, ACE inhibitors, ARBs:** Mefenamic acid can reduce their antihypertensive and diuretic effects and increase the risk of renal impairment. * **Lithium:** Mefenamic acid can increase lithium levels. * **SSRIs/SNRIs:** Increased risk of GI bleeding. * **Anticholinergics (other):** Additive anticholinergic effects. * **Proton Pump Inhibitors (PPIs):** May reduce the risk of NSAID-induced GI ulcers. ## Monitoring * **Renal function:** Baseline and periodically, especially in patients with pre-existing renal disease or those at risk. * **Liver function:** Baseline and periodically, especially in patients with liver disease. * **Complete blood count (CBC):** Baseline and periodically, especially with long-term use or in patients with bleeding risks. * **Signs of GI bleeding:** Monitor for stool guaiac, melena, hematemesis. * **Signs of anticholinergic toxicity:** Monitor for confusion, urinary retention, blurred vision, dry mouth, especially in the elderly. ## Clinical Pearls * Meftal Spas should be used at the lowest effective dose for the shortest duration necessary to control symptoms. * Administer with food or milk to minimize GI upset. * Inform patients about the potential for serious GI bleeding, even without prior symptoms. * Advise patients to avoid alcohol due to increased risk of GI irritation. * Caution in patients with cardiovascular risk factors; NSAIDs carry a risk of cardiovascular thrombotic events. *** **Disclaimer:** This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and relevant clinical guidelines for complete details and to verify dosages and safety information before administering any medication.