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# Meftal Spas
## Overview
Meftal Spas is a combination product containing mefenamic acid, a non-steroidal anti-inflammatory drug (NSAID), and dicyclomine hydrochloride, an anticholinergic antispasmodic. Mefenamic acid reduces inflammation and pain, while dicyclomine relaxes smooth muscles in the gastrointestinal tract.
## Primary Indications
* Management of mild to moderate pain, particularly when associated with smooth muscle spasms, such as in dysmenorrhea.
## Adult Dosing
* **Mefenamic Acid:** 250 mg to 500 mg orally every 6 hours as needed. Do not exceed 1000 mg in a single dose or 2000 mg per day.
* **Dicyclomine Hydrochloride:** 10 mg to 20 mg orally every 6 hours as needed.
* The specific formulation of Meftal Spas should be consulted for exact mg per tablet.
## Pediatric Dosing
* Dosing for pediatric patients is not well-established for this combination product. Mefenamic acid pediatric dosing is typically based on weight (e.g., 5-7 mg/kg/dose every 6-8 hours), but this should not be extrapolated to the combination product without specific guidance. Dicyclomine pediatric dosing is also highly variable and should be supervised by a physician.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Mefenamic acid is renally excreted. Dose reduction may be necessary based on severity.
* **Hepatic Impairment:** Use with caution. Mefenamic acid is metabolized in the liver.
## Contraindications
* Hypersensitivity to mefenamic acid, dicyclomine, or other NSAIDs/anticholinergics.
* Patients with a history of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Inflammatory bowel disease.
* Obstructive uropathy or gastrointestinal obstruction.
* Myasthenia gravis.
* Severe renal or hepatic impairment.
* Third trimester of pregnancy.
## Adverse Effects
* **Common (Mefenamic Acid):** Gastrointestinal upset (nausea, vomiting, diarrhea, abdominal pain), dizziness, headache.
* **Common (Dicyclomine):** Dry mouth, blurred vision, constipation, urinary retention, drowsiness, dizziness.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; renal toxicity; cardiovascular thrombotic events; severe skin reactions (e.g., Stevens-Johnson syndrome); exacerbation of glaucoma; tachycardia; confusion.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Diuretics and Antihypertensives:** May reduce antihypertensive effect and increase risk of renal impairment.
* **Lithium:** Mefenamic acid can increase lithium levels.
* **Other NSAIDs and Aspirin:** Increased risk of GI adverse effects.
* **Anticholinergics:** Additive anticholinergic effects.
* **Proton Pump Inhibitors (PPIs) / H2 Blockers:** May reduce GI risk associated with NSAIDs.
## Monitoring
* **Renal Function:** Monitor serum creatinine and BUN, especially in patients with pre-existing renal disease or those on diuretics.
* **Hepatic Function:** Monitor liver function tests.
* **Gastrointestinal Symptoms:** Assess for signs of bleeding or ulceration.
* **Urinary Symptoms:** Monitor for signs of urinary retention.
* **Ophthalmic Symptoms:** Monitor for blurred vision or signs of glaucoma exacerbation.
## Clinical Pearls
* This combination is intended for short-term use.
* Administer with food or milk to minimize GI upset.
* Advise patients to avoid alcohol due to increased risk of GI bleeding.
* Dicyclomine can cause drowsiness; caution patients regarding driving or operating machinery.
* The risk of NSAID-associated adverse effects increases with duration of use and higher doses.
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This information is intended as a concise guide and does not substitute for a thorough review of the full prescribing information or current clinical guidelines. Always verify the most current drug information with the product's official prescribing information and consult with a healthcare professional.
