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# Mefenamic Acid / Dicyclomine (Meftal Spas) ## Overview Meftal Spas is a combination product containing mefenamic acid, a non-steroidal anti-inflammatory drug (NSAID), and dicyclomine, an anticholinergic antispasmodic. ## Primary Indications * Symptomatic relief of abdominal pain and cramps associated with irritable bowel syndrome (IBS) and other gastrointestinal spasms. * Treatment of dysmenorrhea. ## Adult Dosing * **Meftal Spas Tablet:** Typically, 1 tablet (containing mefenamic acid 250 mg and dicyclomine hydrochloride 10 mg) orally every 8 hours. * **Maximum Daily Dose:** The maximum daily dose for mefenamic acid is generally 1500 mg, and for dicyclomine, it is 40 mg. Therefore, exceeding 6 tablets of Meftal Spas per day would exceed these limits. ## Pediatric Dosing * **Mefenamic Acid:** Pediatric dosing for mefenamic acid is established, but specific dosing for the combination product Meftal Spas in pediatrics is **not well-established**. Dosing would need to be calculated based on the individual components and age/weight of the child, under strict medical supervision. * **Mefenamic Acid (when used alone):** * Children 6 months to 12 years: 5 to 7 mg/kg orally every 8 hours. * Maximum dose: Not to exceed 500 mg per dose or 1500 mg per day. * **Dicyclomine:** Use in infants and children is generally **not recommended** due to the risk of serious anticholinergic side effects. If used, doses are highly individualized and require careful monitoring. ## Dose Adjustments * **Renal Impairment:** Caution advised. Mefenamic acid is renally excreted. Dose reduction may be necessary. * **Hepatic Impairment:** Caution advised. Mefenamic acid can affect liver function. * **Elderly:** Increased risk of adverse effects, especially gastrointestinal bleeding and renal impairment. Use with caution. ## Contraindications * Hypersensitivity to mefenamic acid, dicyclomine, or any component of the formulation. * Active gastrointestinal ulceration or bleeding. * Severe renal or hepatic impairment. * Severe ulcerative colitis or toxic megacolon. * Glaucoma. * Myasthenia gravis. * Obstructive uropathy or gastrointestinal obstruction. * Infants less than 6 months of age (for dicyclomine component). * Pregnancy (especially third trimester). ## Adverse Effects * **Mefenamic Acid:** Gastrointestinal upset, nausea, vomiting, diarrhea, abdominal pain, dyspepsia, gastritis, gastrointestinal bleeding, perforation, renal impairment, hepatic dysfunction, headache, dizziness, rash, bronchospasm. * **Dicyclomine:** Anticholinergic effects: dry mouth, blurred vision, urinary retention, constipation, drowsiness, confusion, tachycardia. ## Key Drug Interactions * **Mefenamic Acid:** * **Anticoagulants (e.g., warfarin):** Increased risk of bleeding. * **Corticosteroids:** Increased risk of gastrointestinal bleeding. * **Other NSAIDs/Aspirin:** Increased risk of gastrointestinal side effects. * **ACE inhibitors/ARBs/Diuretics:** Reduced antihypertensive effect, increased risk of renal impairment. * **Lithium/Methotrexate:** Increased serum levels and toxicity. * **Dicyclomine:** * **Anticholinergics/Other Drugs with Anticholinergic Properties (e.g., tricyclic antidepressants, antihistamines, antipsychotics):** Additive anticholinergic effects. * **MAO Inhibitors:** May potentiate anticholinergic effects. ## Monitoring * **Gastrointestinal Bleeding:** Monitor for signs and symptoms (e.g., melena, hematemesis, abdominal pain). * **Renal Function:** Monitor BUN and serum creatinine, especially in patients with pre-existing renal disease or those on concurrent nephrotoxic agents. * **Hepatic Function:** Monitor liver enzymes, especially with long-term use. * **Blood Pressure:** Monitor for potential effects on blood pressure. * **Signs of Anticholinergic Overdose:** Especially in elderly patients or those with renal impairment. ## Clinical Pearls * Due to the risk of gastrointestinal bleeding and renal effects associated with NSAIDs, this combination product should be used for the shortest duration necessary and at the lowest effective dose. * Anticholinergic effects of dicyclomine can be exacerbated by hot weather and fever, leading to heat stroke. * The efficacy and safety of this combination in pediatric populations are not well-established, and its use requires careful consideration and medical supervision. *** **Disclaimer:** This information is for educational purposes only and does not constitute medical advice. It is essential to consult with a qualified healthcare professional for diagnosis, treatment, and medication management. Always verify current prescribing information with the manufacturer's official documentation or a reliable drug database before administering any medication.