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# Meftal spas
## Overview
Meftal spas is a combination product containing mefenamic acid, a nonsteroidal anti-inflammatory drug (NSAID), and dicyclomine hydrochloride, an anticholinergic antispasmodic. Mefenamic acid reduces inflammation and pain by inhibiting prostaglandin synthesis. Dicyclomine reduces smooth muscle activity in the gastrointestinal tract, relieving spasms.
## Primary Indications
* Treatment of abdominal pain and cramps associated with irritable bowel syndrome (IBS).
* Relief of dysmenorrhea.
## Adult Dosing
* **Usual dose:** 1 tablet (containing mefenamic acid 250 mg and dicyclomine HCl 20 mg) three times daily.
* **Maximum dose:** Not to exceed 4 tablets per day. Dosing should not exceed 7 days for dysmenorrhea.
## Pediatric Dosing
There is insufficient data to recommend Meftal spas for pediatric use.
## Dose Adjustments
* **Renal impairment:** Use with caution. Mefenamic acid is renally excreted.
* **Hepatic impairment:** 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.
* Gastrointestinal obstruction or atony.
* Severe colitis.
* Uncontrolled glaucoma.
* Prostatic hypertrophy or bladder neck obstruction.
* Age > 65 years with certain comorbidities.
* Third trimester of pregnancy.
## Adverse Effects
* **Common (Mefenamic Acid):** Nausea, vomiting, diarrhea, abdominal pain, constipation, dizziness, headache, rash.
* **Common (Dicyclomine):** Dry mouth, blurred vision, urinary retention, constipation, drowsiness, dizziness.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; renal toxicity; hepatic toxicity; cardiovascular thrombotic events; hypersensitivity reactions; exacerbation of asthma.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **Other NSAIDs:** Increased risk of adverse effects.
* **Diuretics, ACE inhibitors, ARBs:** Reduced antihypertensive effect and increased risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Anticholinergic agents:** Additive anticholinergic effects.
* **Antacids:** May decrease absorption of mefenamic acid.
## Monitoring
* Monitor for signs of gastrointestinal bleeding (melena, hematemesis).
* Monitor renal and hepatic function, especially with prolonged use or in patients with pre-existing impairment.
* Assess for signs of anticholinergic effects (dry mouth, blurred vision, urinary retention).
* Monitor blood pressure.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Avoid concurrent use with other NSAIDs or aspirin.
* Discontinue if significant gastrointestinal bleeding or other serious adverse effects occur.
* Dicyclomine can cause drowsiness; caution patients about operating machinery or driving.
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This information is intended for clinical decision-making and should not replace a thorough review of the current prescribing information. Always verify with the most up-to-date product monograph and local guidelines.
