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# Meftal Spas ## Overview Meftal Spas is a combination medication containing Mefenamic Acid, an NSAID, and Dicyclomine Hydrochloride, an anticholinergic antispasmodic. ## Primary Indications * Symptomatic relief of spasmodic abdominal pain, particularly associated with: * Irritable Bowel Syndrome (IBS) * Gastroenteritis * Biliary colic * Renal colic * Dysmenorrhea ## Adult Dosing * **Usual dose:** 1 tablet orally every 8 hours. * **Maximum dose:** Not to exceed 4 tablets in 24 hours. * Dosing should be adjusted based on patient response and tolerance. ## Pediatric Dosing * Specific pediatric dosing for Meftal Spas is not well-established. Mefenamic acid and dicyclomine should be used in children only when clearly needed and under the guidance of a pediatrician. Dosing of individual components in children is typically weight-based. ## Dose Adjustments * **Renal Impairment:** Use with caution. Mefenamic acid is primarily renally excreted and can cause renal damage. Dose reduction may be necessary. * **Hepatic Impairment:** Use with caution. Mefenamic acid can cause liver dysfunction. Dose reduction may be necessary. * **Elderly:** Increased risk of adverse effects from NSAIDs, particularly gastrointestinal bleeding and renal toxicity. Use with caution and at the lowest effective dose. ## 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 impairment. * Severe hepatic impairment. * Severe heart failure. * Obstructive uropathy. * Obstructive gastrointestinal disease. * Myasthenia gravis. * Uncontrolled glaucoma. * Infants less than 6 months of age (due to anticholinergic effects). ## Adverse Effects * **Common:** Nausea, vomiting, diarrhea, abdominal pain, dizziness, drowsiness, blurred vision, dry mouth, constipation. * **Serious:** * **Gastrointestinal:** GI bleeding, ulceration, perforation. * **Cardiovascular:** Increased risk of thrombotic events (MI, stroke). * **Renal:** Renal papillary necrosis, interstitial nephritis, renal failure. * **Hepatic:** Hepatitis, jaundice. * **Hematologic:** Anemia, leukopenia, thrombocytopenia. * **Ophthalmic:** Angle-closure glaucoma. * **CNS:** Confusion, hallucinations. ## Key Drug Interactions * **Anticoagulants (e.g., Warfarin):** Increased risk of bleeding. * **Corticosteroids:** Increased risk of GI ulceration and bleeding. * **Other NSAIDs:** Additive risk of adverse effects. * **Diuretics, ACE inhibitors, ARBs:** Reduced antihypertensive effect and increased risk of renal impairment. * **Lithium:** Increased lithium levels. * **SSRIs:** Increased risk of GI bleeding. * **Anticholinergics:** Potentiated effects of dicyclomine (e.g., increased dry mouth, constipation, urinary retention, blurred vision). ## Monitoring * **Renal function:** Monitor serum creatinine and BUN, especially in patients with pre-existing renal disease or those at risk. * **Hepatic function:** Monitor liver enzymes, especially with prolonged use or in patients with liver disease. * **Gastrointestinal symptoms:** Assess for signs of bleeding or ulceration. * **Blood pressure:** Monitor in patients with hypertension. * **Signs of anticholinergic effects:** Monitor for dry mouth, blurred vision, urinary retention, constipation. ## Clinical Pearls * Meftal Spas should be used for the shortest duration necessary to control symptoms. * Administer with food or milk to minimize gastrointestinal upset. * Avoid concurrent use with other NSAIDs or aspirin unless specifically indicated and monitored. * Caution patients about operating machinery or driving due to potential for drowsiness and blurred vision. * Ensure adequate hydration to help prevent constipation, a common anticholinergic side effect. *** **Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant guidelines before making clinical decisions. Local protocols may vary.